letters

Enjoying the commute

I enjoyed Dr. Mitchell L. Cohen's piece "Making the Most of the Daily Commute" [The Last Word, July/August 2007]. I ran into similar boredom in a 1993 green Saturn sedan. Now I like to commute by bike. My commute is 10 minutes each way by car or about 22 minutes by bike. It takes a bit longer, but I find myself invigorated when I get to the office. On the return, I shed stress, work up a good sweat and am more relaxed when I get home to connect with my family. I'm sneaking a bit of painless physical activity into my day! I also get to greet neighbors audibly rather than fuming at other drivers under my breath. Commitments sometimes get in the way, but I end up feeling as though each trip by bike is a treat!

Tim Roberts, MD
Grants Pass, Ore.

OB care in family medicine

Dr. Sarina Schrager's "Balancing a Personal Life With OB Care" [June 2007] crystallized the message I have been trying, mostly unsuccessfully, to get across to medical students and residents. I am hopeful that her practical eloquence will help others understand that incorporating this very rewarding and interesting area into one's practice does not mean a loss of personal life. There is nothing like the voice of experience from someone like Dr. Schrager to enlighten others. After reading this, maybe more of our students, residents and colleagues will choose to include obstetrics in their scope of practice. Our presence in OB care is much needed!

Kristin K. Elliott, MD, FAAFP
Crosby, Minn.

A revolution in the making

Thank you for Dr. Brian R. Forrest's article "Breaking Even on Four Visits Per Day" [June 2007]. I am a solo family physician and have been using a model similar to Dr. Forrest's since August 2005. My practice includes just me and my wife, a registered nurse, in one room that we rent in a local fitness center. Our cash-only practice charges $45 per visit and an additional $5 to $10 for most lab tests. Our overhead is lower than Dr. Forrest's because we have no employees, and I'm paying myself only $1,000 a month while we pay down business debt. (I supplement my income by working 10 shifts per month at a local urgent care center.) We see patients three days a week and break even on 12 visits. I am building my patient base and hope to be working full time at my office by the end of the year. Our biggest boon has been the small businesses in our area. With health care and insurance costs skyrocketing, business owners are looking for places to send employees for fast, friendly and effective care at reasonable prices.

Thank you for the many articles that have addressed this issue and others that lone family physicians face. Right on, Dr. Forrest, and let the revolution continue!

J. Shane Purcell, MD
Anderson, S.C.

I enjoyed Dr. Forrest's article and would add my voice to the growing number of doctors who have discovered the meaning of overhead. I opened my practice in April 2005 in my home in the Blue Ridge Mountains. Our area is extremely poor and medically underserved. Nearly 50 percent of the population is uninsured.

My practice is limited to Medicare, Medicaid and a discounted fee-for-service charge of $30 per visit. I have no rent to pay, and for the first two years I had one employee. In 2006, with such a small staff, we collected 93 percent of charges. We brought in $184,000 and spent $44,000 on overhead (24 percent). This is with only word-of-mouth advertising in a remote area. We have already closed the practice to new patients except for immediate family members and are now seeing between 350 and 400 patients per month. I recently hired a second assistant. I expect revenue to improve to about $250,000 this year. Because of the increase, the costs associated with our additional employee will probably not change the overhead percentage. I do many house calls and receive more praise for this than anyone has a right to. The fun is back in practice.

John W. Tracy, MD, FAAFP
Fancy Gap, Va.

Clarification

Kent J. Moore's article "Billing for Medicare Part D Vaccines" [July/August 2007] suggests that physicians should "complete a CMS-1500 form for the vaccine and give it to the patient." Many plans require Part D enrollees to file for reimbursement on plan-specific paper claim forms and may not permit the patient to simply send in the CMS-1500 form alone.