A revolution in the making


Fam Pract Manag. 2007 Sep;14(8):11.

Thank you for Dr. Brian R. Forrest's article “Breaking Even on Four Visits Per Day” [June 2007]. I am a solo 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!

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.


Send your comments to fpmedit@aafp.org. Submission of a letter will be construed as granting AAFP permission to publish the letter in any of its publications in any form. We cannot respond to all letters we receive. Those chosen for publication will be edited for length and style.


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