New year, new challenges

January 28, 2019

The only thing certain in life is change. Learn how one physician is coping with the transition back to solo practice following her associate’s departure.

Editor’s Note: Physicians Practice’s blog features contributions from members of the medical community. The opinions are that of the writers and do not necessarily reflect the opinions of Physicians Practice or UBM. 

It’s a new year. And as with every new year, our practice is faced with new challenges. This year, however, our challenges are greater than usual.

In December, my one and only associate left the practice. She worked for me for eight years. I was somewhat worried that others might think she left because I had not offered her a partnership. I did after she had been employed for three years, but she declined. At the time, she wanted to focus on practicing medicine rather than on the business of running a practice. I understood. After all, I know all too well how burdensome being responsible for the practice 24/7/365 can be.

Had she taken my previous offer, however, she wouldn’t have been able to just up and leave. That last statement is a bit of a hyperbole. She didn’t just up and leave. She recently found another opportunity and gave me plenty of notice.

For the past few months, I have been preparing myself psychologically and making some changes in the practice to help ease the transition back to solo practice.

Some are moving to her new practice. Some are switching to other practices. Some of her patients are going to stay, enough to more than fill the schedule. As such, I am no longer accepting new patients.

I have adjusted my office hours to give myself some more time to deal with the phone calls, paperwork, and other responsibilities of a solo practice. I have made arrangements with another area endocrinologist to cover for me when I am away, which isn’t often, anyway.

I have also declined to have residents shadow me in the office. I truly regret that I must do this. I love teaching and believe that the residents benefit from shadowing. After all, diabetes and thyroid disease are so prevalent-and so misunderstood. However, the time constraints of mentoring are too much.

Since I am the only revenue generator now, I cannot afford to maintain staffing levels. When I first opened the office, I hired a receptionist. She was responsible for phone calls, scheduling, depositing checks, and filing. I handled all the clinical tasks such as rooming patients, seeing them, and giving injections. I even did my biopsies unassisted. Of course, back then, I saw only 8-12 patients a day.

As the practice got busier, I hired one medical assistant (MA). In preparation for hiring a second physician, I hired another MA. The MAs room patients, give injections, assist in procedures, download data from glucose meters and insulin pumps, and return some clinical phone calls in addition to cross-covering for the receptionist. Now that I’m solo again, I can’t support three employees. But since I see 24-28 patients a day, I can’t afford a day without my MAs.

I had to let my receptionist of nine years go. I can’t reasonably say it was harder on me than it was for her, obviously, but I wrestled with that decision for a long time. Now, my MAs have absorbed her job as well as their own. Eliminating new patients has alleviated some of the work, although there are some people who, despite an outgoing message that says we regret that we are no longer accepting new patients, call and demand an explanation.

We have survived our first full week and even a few days of just one MA and me, as the other had scheduled some time off.

People keep asking me if I will hire another physician. I haven’t decided. I’m going to see whether being solo will work. Saying no when I have to say no. Accepting that I can't do all things for all who ask. Calling in favors from time to time.

A recent survey found that 9 percent of endocrinologists are solo practitioners, and I know several myself. I know it can be done. It’s just a matter of figuring out the best way to do it. And if I can’t, well, then I’ll be in for more change in 2019.

Melissa Young, MD, FACE, FACP, is sole owner and solo practitioner at Mid Atlantic Diabetes and Endocrinology Associates, LLC. As such, she is both actively involved in patient care and practice management while also raising two kids and a dog in suburban New Jersey.