Home Forums Discussions General Discussion my 1 doc 0 staff practice

Well, I'm not too self-absorbed :-D,

but since you asked, Bert....

When I started out solo in 2003 I started out on a shoestring in a tiny office with one nurse. Not long after, the nurse moved on to better, more lucrative things and I continued running my office alone.

Not long after that, I saw an article in Medical Economics called "1 doctor, 0 staff" which profiled the practice of Jim Ochi, MD, an ENT in San-something California. I spoke with doctor Ochi at length and we shared our ideas (mostly his ideas) about running a practice with NO STAFF whatsoever.

He introduced me to Paperport which he uses for keeping his charts. DNS was used for transcription. He uses Microsoft online tools for patient self-scheduling, and answers his phone messages. In addition, he has a website.

Some of these ideas I incorporated into my practice, but mainly the use of paperport, along with the greater self-confidence of knowing that there are other physicians out there--a few besides Dr. Ochi in fact--who practice in this (absurd by conventional standards) practice model. I also use a wireless camera to keep an eye on the waiting area while I'm in the exam room--that's my own thing. ("No comments about how I should give myself 100% to the patient" hahahha--am I quoting anyone?)

I handle all the charting and communications/phone by myself. The only thing I outsource is the billing. Practicing in this way creates a miniscule overhead, allowing me to schedule few patients per day, with longer visits per patient and still keep a nice lifestyle going.

I am happy for others who find the traditional practice format meets their needs, but for me, this is the only way that makes me happy.

So that would be like the IMP or Concierge practice? Do your patients pay per visit or a one-time yearly charge?

It's traditional fee-for service: third party, medicare, and a tiny sprinkling of medicaid and cash. Really there's nothing concierge about it. It's just that I have to do everything by myself.

Sounds really awesome.
I'm solo, like Bert. But we have staff, it would be nice to cut some overhead.

Solomio,

Are you an FP? I have one MA and one receptionist and I am strongly considering downsizing. I would love to talk to you some time and see how you do it?

I am internal medicine.

One thing about FP that is a consideration is that you essentially cannot do any gyne exams without a female associate. At least I think it's risky to do so. I basically make sure my patients have a gynecologist.

I am most happy to help out in any way I can. Feel free to PM or email me for contact info.

This is very similar to my practice with a few exceptions. First I am an FNP But I do not accept any insurance I am a fee for service practice. I have a receptionist that handles the front and I do everything else. By not billing my overhead is very low and I can afford the one staff person. For me it really works! My husband who is my supervising MD would love to be able to do what I am doing!

www.hifamilymedicine.com

For those who are interested in low overhead/no staff or low staff practices, the Ideal Medical Practice listserve is a great resource. Some folks here are also there. Very supportive group and lots of info on frugal technological options for practice management.

I have been in my current practice since 2004 and have had a receptionist intermittently. Most recently, I had my daughter acting as receptionist as she needed part-time work. She is now off to med school and I am finding, once again, there are great advantages to working totally alone. I am more organized, there are no interruptions, and the money I save means I can see 1-2 fewer patients per day. My patients love the longer visits and I find the practice very satisfying. And if you didn't offer longer visits, gosh- you would just be out of there that much earlier!

Carla Gibson FNP
Missoula, MT

all sounds truly intriguing.
What if you want a day off? Do you just turn the phones off or do you have coverage?

Actually, we've been doing this since before I'd even heard of IMP. If you notify your patients that you will be out, and have a good message system, you will be okay. Have someone that can cover just in case. But we've rarely had to ask another doctor to see a patient. It has happened, but not very often if only out for a couple days. Now a week, yeah that's more problematic.

Best thing is to get together with other small practices. I cover Dr. B when she needs a week off, so she is only too happy to do the same for me.

Could someone define the terms "vacation" and "coverage" for me. I want to be part of this discussion.

Pardon the half dozen questions, but how do you manage the phone while you are seeing patients? About how many patients do you like to see in a day? Do you do hospital work or are you office based only? Since you take insurance plans, how do you deal with prior authorizations? Thanks.

Happy to answer any number of questions.

With my smaller overall volume there are fewer calls. I see ten pts per day (between 6 and 12) three and half days a week. I have privileges at two hospitals but only have an admission occasionally. Most of the work is in office.

Phone: I'm using Iphone which has "visual voice mail". this allows me between appts to quickly scan the list of calls and return calls on a priority basis and finish returning remaining calls later.

Prior authorizations are not a big problem. This is where the insurance environment in your area is a variable. My patients are medicare and PPO mostly. Occasionally I have a prior auth. The typical form I use for the most common insurance company is on my paperport desktop; when needed I type in the info and drag it to the FAX icon and away it goes. Another time saver: a patient has an ins. co. that requires a prior auth for every referral. I keep a copy of the form in the chart in paperport with the patient's data pre-filled out: I.D., SS#, name, DOB..so each time I "grab" it and only have to put the referral info, ICD code in, drag it to the FAX icon....