Monday, May 14, 2007

Physician Mindsets - Two Solo Practice Mindsets

Do You Single or Mingle?

In Mind Set! (Collins, 2007), John Naisbitt, who wrote Megatrends, observes how you think about an issue depends upon your mindset.

Naisbitt puts it this way, ”Judgments in every area are driven by mindsets, from world affairs to personal relations.” If you think of the world as a clash of civilizations, all politicians as crooks, outsourcing to India as stealing American jobs, cats as the planet’s cleanest pets, global warning as a threat to civilization, husbands as faithful rather than as philanders, you receive the same information differently.

How one perceives the future of solo practice also depends on mindsets.

If you cherish your independence, want to be your own boss, seek a deep personal relationship with your patients, strive to reduce your overhead, and have information technology savvy, you may think a solo practice as the way to go.

Dr. Gordon Moore, a solo family physician in Rochester, New York, is such a person. In “Going Solo: One Doc, One Room, One Year Later” (American Academy of Family Practice, March 2002), Moore described how gratifying and rewarding solo practice can be.

Using a “lean” IT system with Internet access, Moore saw every patient on the day they called, delivered comprehensive care, took his own call, developed deep and personal relationships with patients by spending 30 minutes with each one, reduced his patient load from 25 to 30 to 12 patients a day, operated without support staff in a room of 150 square foot, averaged $65 a visit, and took home $155,000.

On the other side of the solo mindset divide is David Lawrence, MD, chairman emeritus of Kaiser Permanente. In his widely acclaimed book, From Chaos to Care: The Promise for Team-Based Medicine, Perseus Publishing 2002, Lawrence maintains solo practice is dying because one doctor, acting alone, can’t handle American Medicine’s demands..

Lawrence conveys his message in the form of a fictitious solo practitioner, Adam Landers, MD. He says Dr. Landers lacks the time, money, and organization to be a high quality physician and to deliver on the promise of modern medicine. Landers, Lawrence maintains, will fall further and further behind. These are Lawrence’s words, “For the simple and routine illnesses, he provides a valuable service. But for more complex and chronic conditions, neither he nor his colleagues in other solo or small group practices are prepared for what medicine now requires and patients demand. The forces are too strong and the changes too profound.”

According to a 2003 CDC survey of National Ambulatory Care, 38.5 percent of patients still go to solo practitioners for their care. This visitation rate may change over time. New physicians are much less likely to enter practice and more likely to work as salaried employees of group medical practices, clinics, hospitals, or health networks.

To those who say solo practice is dead as a dodo, I say, “Some Death, Some Dodo.” Solo practice may be dying, but patients haven’t recognized it yet.

1 comment:

DrBob said...

I just stumbled upon your blog and have got lost for a couple of hours reading your fascinating posts. You are definitely going on my blogroll!!
Can I say that your summary of Dr Moore's practice was EXCITING. Whereas for me the Dr Lawrence view just isn't!
I worked as a Family Physician in Scotland in a 4 man practice, a small duo (that was the BEST) and a 6 person practice before getting out and going to work in a hospital in Glasgow (the fact its Glasgow Homeopathic Hospital will not, I hope, make you write me off!).
Our NHS is way different from what you guys have in the US but I think your focus on an entrepreneurial approach is SO refreshing! And I think your focus on IT is just as refreshing.
But the KEY to all this is definitely shifting power to the patient away from the paternalistic doctor. I am SO with you on that.
Here's what I'm wondering - are you aware of any exploration of solo practice with Web 2.0 technologies? Is that maybe a way to get the best of both worlds?
Come and have a look at my blog. I have probably a bit of a different perspective from you but I think we have core values in common.