Editor’s Note: D-I-Y Career Repair

Robert Posner and Herbert Parris have never met, but they have a lot in common. Internal medicine physicians who realized years ago that dealing with third-party payers is a sucker’s game, they both took matters into their own hands.

As a result, they are both now happier and wealthier than they would have been otherwise. And when I asked them to offer a bit of advice to their stuck-in-a-rut colleagues in primary care, each told me in his own way: Lose your fear, quitchyerbellyachin’, understand your market power, and make a plan.

“People get locked into this idea of ‘Well, this is it. Let me just ride this out for the next 15 years,’” Parris says. “But you don’t have to be afraid to explore the options. … Otherwise, [your dissatisfaction] will just transition to your patients, and then to your family, and then you’ll just be all-around miserable.”

Posner says he dropped insurance 11 years ago, after a large carrier refused to pay him for services until his patients filled out a customer-satisfaction survey that the plan had mailed to its members. “We had to have our staff on the phone for hours and hours, begging people to send in that survey,” he recalls. “So at that point I looked at myself in the mirror and said, ‘What are you doing, man? This is crazy.’”

He operates a cash-only primary care practice in Burke, Va., and recently added a separate weight-loss business that he says is highly profitable. He charges patients $305 for a short initial visit (they also receive a supply of a supplement Posner developed), and they return for 12 weekly follow-up and counseling sessions at $68 a pop.

Marketing was easy, he says: “I just a put a sign up in my office that said, ‘New weight-loss program. Ask Dr. Posner. Within two weeks I had 60 people saying ‘I want in.’ At that point I thought, ‘Hmm, I’m onto something here.’”

But even before he added the weight-loss business, the cash-only transition alone simplified his practice, reduced expenses and his blood pressure, and cost him fewer patients than he expected it to. (He continues to file insurance claims on patients’ behalf, provided they pay him up-front.)

Parris was an internist specializing in sports medicine when he decided in 2001 that nine years of regular practice were enough. After an ill-fated but illuminating stint as an insurance company medical director, he decided to open his own business. But what kind?

“I wanted a business model that wasn’t insurance-dependent,” he explains, but “I didn’t want to open a muffler shop.”

So with the help of a business broker, he opened an Ageless Remedies medical spa franchise in Denver in December 2005. Parris says he nets more than he would have in regular practice; the no-insurance business model means he only needs a small staff, most of whom perform procedures and generate revenue.

Posner suggests primary-care physicians have been taking it on the chin so long that they're starting to think they deserve it. “You should not accept what insurance companies are telling you you’re worth,” he argues. “We already have the infrastructure to be more powerful than we are. There are numerous opportunities.”

Weight loss may be one: Americans spend $33 billion annually on weight-loss products and programs, according to MSNBC, some of it well-spent on people who do lose weight and keep it off. Many are your patients. But how much of that money goes in your pocket?

“I really think physicians are missing the boat,” says Posner. “Who’s Jenny Craig? Nobody knows Jenny Craig. But people do know their own physicians.”

Posner is lining up physicians interested in franchising his program; learn more at www.spdiet.com. Ageless Remedies has developed a pitch to physicians, too: www.agelessremedies.com.

I don’t know enough about either program to endorse them. I do know that slapping cash ancillaries onto a conventional practice - be it a weight-loss product or Botox injections - is not a panacea for struggling groups. Think before you leap. But if you want to be happy and successful in a healthcare system that is trying hard to make physicians less relevant, you will need to think creatively. And you will have to take a leap, eventually.

Bob Keaveney is the executive editor of Physicians Practice. Tell him what you think at bkeaveney@physicianspractice.com.

This article originally appeared in the April 2008 issue of Physicians Practice.