'The Toughest Decision I Made as a Physician'

March 11, 2012

Going into solo practice has had its rewards and challenges

The toughest decision I made as a physician was to open a solo pediatric practice four years ago. Before that, I had been working as a salaried physician ever since I finished my residency in 1995.

During the last year of my residency, I had the opportunity to rotate through solo and group pediatric practices. However, I was impressed with the lifestyles of the physicians who worked at the hospital-based clinics and community health centers, even though they earned a lower income than those in private practice.

My first professional position was that of a school-based clinic physician at a middle school. After only one year the hospital decided to close the clinic and eliminate my position. Later, I was hired by a multi-specialty community health center where my duties included working in the pediatric clinic and sharing hospital call. I felt compelled to leave when the company stopped compensating me for seeing the hospital patients.

Repeatedly, I found myself unhappy and frustrated with every employer I worked for. The administrators always failed to abide by the terms of the contracts; like failing to pay the physicians a percentage of the paid claims for each hospital admission, or the bonuses that were based on productivity. When I voiced my discontent to my husband, his reply was that I was never going to be happy unless I start my own business.

In 2004, my family and I relocated to southwest Florida. At first, I contemplated starting my own business. Nevertheless, after considering several options, I decided to seek yet another employed position - the lucrative package that this new employer offered convinced me to accept the position.

The first 12 months of work were very pleasant and exciting. Then, in the middle of my second year, the bonuses stopped coming. My discontent with the company grew more and more. I realized that as long as I remained a salaried physician my income would always remain stagnant, and if I desired financial freedom, I needed to start my own business.

Finally, in the spring of 2007, with the help of some local friends, I registered my business with the state of Florida, searched for a practice location and applied for a business loan. Because I had signed a contract with a non-compete clause that encompassed a 20-mile radius, I knew that I had to have a good marketing plan before we officially opened.

The days leading to the official opening of the practice were very challenging and stressful. My staff and I spent several days meeting and negotiating with various medical equipment and office furniture vendors and software companies. Applications were filed with diverse health insurance companies. I decided to purchase an EHR and reached a deal with a company even before my business loan was finally approved.

In December 2007, the practice officially opened its doors with me as the sole pediatrician, a part-time medical assistant, one part-time front desk receptionist, and an office manager who was a nurse and also my friend. We decided to outsource our billing because I had little knowledge of claims submissions and I was a poor coder. However, in the first six months, not a single claim had been processed because, according to the biller, we did not have all the credentials for billing.

A colleague recommended another billing company which was a small improvement over the former one. Although many claims were processed, our Medicaid EPSDT claims could not be processed. We had projected more than 50 percent of our income to come from Medicaid patients. Ten months into the practice, the business checking account (which consisted mostly of the loan we had obtained from the bank) was almost depleted. Every month I feared that I would not be able to afford the office overhead expenses. Then, our front desk receptionist informed me that she had some billing experience and could help with the claims submissions; with her help, we started transmitting claims onsite.

In the second half of 2008, the real estate market started experiencing a downfall, taking a big toll on our patient flow. Many of our patients transferred out of the practice because their parents had lost their jobs and had to seek work out of town or in another state. We saw patients leaving the practice as fast as they were coming in. As much as I continue to seek opportunities for earning extra income, having to manage my practice and see patients does not allow me much time to travel. I usually complete my patient's charts by midnight almost daily. And, I have to reserve half a day per week to complete administrative work.

Presently, my practice generates only enough money to cover overhead expenses, including payroll. Although I pay myself a salary, it is not even half of what I earned for more than 10 years as a salaried physician; and sometimes I find it difficult to do even that. In the past three and a half years, my husband and I have had to deplete our 403 B pension and whole life insurance plans, as well as other small savings in order to support our family. In January 2010 we decided to short sale our home; six months later our house sold for less than half of what it was valued at two years earlier. With a family income less than $50,000 per year and three demanding teenagers, we still find it hard to pay our bills.

It has been emotionally, mentally, and physically challenging and exhausting to run a solo private practice. The two aspects that I find most frustrating to manage are the never-ending paperwork, and dealing with the health insurers. The EHR that we have owned for four years has not only been deficient but also is not certified. Thus, for the last six months we have been leasing a certified web-based EHR. While this new EHR allows me to see patients at a much faster rate, it still seems impossible for me to complete the patients' record at the end of each encounter. Power outages, EHR malfunctions, and the constant interruption by staff members conspire to slow me down. Being both the physician and the office manager, I have to oversee almost everything that goes on in the practice on a daily basis. It is tiresome to stare at a computer for more than eight hours daily. By 5 p.m. or 6 p.m., my vision becomes blurred forcing me to step away from my work for two hours.

Having the freedom to dictate my own schedule and practice pediatrics in a manner that I deem ethical and professionally rewarding has been the most pleasant aspect of owning my own business. About 70 percent of my patients and their families are struggling financially and being able to serve them has been a blessing. Nevertheless, if I could have predicted the future of our country's economy, I do not believe that I would have started a new business.

Lucienne Deltor Valcourt, MD, completed her medical education at the HSCAB, New York, in June 1992. She completed a pediatric residency at Long Island Jewish Medical center, Schneider's Division, in June 1995. She is a board certified pediatrician and has been practicing general pediatrics in Naples, Fla., since 2004. Dr. Valcourt is currently in private practice at Amazon Pediatrics, and is married with three teenage children.

This article originally appeared online in the March 2012 issue of Physicians Practice.