Although hard to believe, tomorrow marks the six year anniversary of my practice. During that time, I have had over 15,000 visits from over 2000 patients. I watched babies from their first week of life grow to the point they are now ready for first grade. I diagnosed and treated diseases, reassured those who were healthy, and watched helplessly as some die. I became engaged in my neighborhood (where my practice is located) and have spoken at numerous schools at all levels. Articles were written about my practice in local and national journals and I even tried my own hand at writing some op-ed pieces. I had the pleasure of watching as the IMP movement grew from a few crazy iconoclasts into a real force on the cutting edge of medicine. I have spoken at state and national conventions and, through the support of my fellow IMPs, I have even won an award. Through the guidance of John Wasson and Gordon Moore, I understand more now about the doctor-patient relationship and what constitutes good medicine than I ever thought possible, and strive as hard as I can to improve the care I give to my patients. Along the way, I never missed one of my childrens' school meetings and made almost every field hockey or soccer game. I even completed two marathons (which were very painful). Though in constant motion, my personal and professional lives are in sync with each augmenting the other. I am happy.
I write this not because I am a narcissist gloating over what has transpired, but because I feel strongly if I can do it others can. Happiness and success is possible in primary care, but the practice has to be specifically set up to allow it to happen. Automony (the ability to make and implement decisions you deem best for patient care without outside interference) and Breathing Room (the time set aside each week to focus on improving you and your office) are essential. I have made many mistakes over the past six years, but having the time to assess my processes and the flexibility to change them allows me to learn from my mistakes and encourages my practice improve and evolve.
With all that said, my fear is that the future of my practice is still in doubt. I can see practicing like this for years or even decades longer, but the environment surrounding primary care is toxic and depressing and worsening every day. My practice is still running on a razor thin margin and my take home salary remains less than it was in my previous practice. Although the quality I am delivering is much better than average (and I have the data to prove it), insurance companies are rejecting more claims and are putting ever increasing administrative hurdles (prior auths, referrals, etc) in the way. These financial uncertainties and administrative insanities combine to make my practice's future look murky. I love what I do. My patients love what I do. The larger community seems to love what I do. But, I'm not certain I will still be around in another six years because an insane payment system makes it impossible to stay financially viable. That realization is a rather bitter birthday pill to swallow.
John Brady
Happy birthday!
Re: the future...call me. ;-)
Posted by: Kent | April 27, 2009 at 07:13 PM