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Wednesday May 23, 2012

The Joys -- and Advantages -- of Solo Practice

One weekday afternoon when I was sitting on a bleacher watching my daughter play softball, another parent asked me why I wasn't at my office seeing patients. My answer? She's only going to grow up once. I attended every one of my daughter's high school softball games, but I also made plenty of time for patients.

Many physicians struggle with work/life balance, so being your own boss has distinct advantages. I own my own small practice in suburban Boston, and I love being a solo doc -- again.

I started my career as a family physician back in 1990, and I owned my own practice by 1992. Over time, it grew to include two other physicians and a nurse practitioner. But after Harvard Pilgrim Health Care -- one of our region's biggest health plans -- lost more than $200 million and fell into receivership in 1999, things got tough for me as well.

By 2001, I thought I had no choice but to become an employed physician, and I went to work at a hospital-owned practice. It's a decision I regret. After four years, I'd had enough of being an employee and went back to being my own boss.

This time around, there are no partners. The practice includes me, a nurse practitioner, a medical assistant and a front office worker. I also recently hired an office manager to help us achieve meaningful use and to transform the practice into a patient-centered medical home. I'm a better business person this time, understand contracts better and know what it takes financially to run a practice.

So why do I prefer things this way? For one thing, I'm in control. Not only do I set my own schedule, I can fix problems without interference or going through channels.

More importantly, I have a stronger bond with my patients than I did as an employee in a large practice. When a patient seeks care in a group practice, he or she may not see the same physician every time. As a solo family doc, my patients know I am involved in all aspects of their care, even if they see the nurse practitioner.

I know my patients, their families and their stories. It helps that my practice is in Walpole, Mass., a town of about 22,000 people where I grew up.

It sounds pretty good, right? And yet the number of small and solo family practices is in decline. A recent AAFP survey shows that 63 percent of our active members are employed physicians. The figure is even higher among new physicians.

This trend is troubling to me. We can't forget about the small and solo family practices out there because there still are many areas of the country that cannot support large practices.

Part of the problem is that students and residents often are not exposed to the small and solo practice model, though there are exceptions. How can our students and residents develop an interest in something they've never experienced?

We need to find more ways for students and residents to see this kind of practice, but it isn't always easy for small practices and solo docs because having a student or resident for a rotation can slow you down, which hurts productivity and finances.

Small practices often are located far from medical schools and residency programs. Personally, my practice is an hour from my old med school in Boston. It might not be feasible for some small practices and solo docs to have med students or residents in their practices on a regular basis or for those physicians to be regular visitors in educational settings. But there are things we can do in a less formal matter. I have had medical students shadow me in my practice. I have done grand rounds at my alma mater. And I am working with my state chapter to come up with other connections for small, solo practices and medical students and residents.

So for my fellow small practice and solo docs out there, what are you willing to do to expose our future family physicians to our model of care? Our small towns and rural areas cannot afford to lose it.

Laura KnobelM.D., of Walpole, Mass., is a third-year member of the AAFP Board of Directors.

Posted at 01:53PM May 23, 2012 by Laura Knobel, M.D.

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