DOCtalk by Dr. Gregg 1/6/14

Why Does Simon Practice?

Simon – Dr. Simon Princewalleter – is a small practice, primary care provider who works diligently every day, often seven days a week. He keeps his own books, but has an accountant advisor and an outside billing company. He has three staff members who he loves and who seem to appreciate him. (He loses sleep on numerous payday eves worrying that he won’t have enough to meet their payroll.) He efforts to keep current on standards of care and evidence-based guidelines. He takes his own after-hours calls, tries to offer quality online tools for his patients including a nice website and an attractive patient portal, and uses a good electronic medical tool for all his patient records. He tries to keep up with governmental and insurance company rules and regs, maintains HIPAA watchfulness, and protects his digital patient data. He spends many hours doing things for which he was never trained.

He is going into debt to stay afloat.

Why does Simon continue this struggle? Why not sell out to an ACO or join a group? Why does Simon practice?

Simon, it appears, is part of a dwindling breed. He loves his practice, his staff, and his patients. He thinks he provides a value and services that are unique. He likes being entrepreneurial despite the challenges and mounting pressures. He likes being a small practice doctor, with all that entails. He isn’t convinced that a regular paycheck and institutional guidelines would ever provide the warm sense of satisfaction he gleans on his own.

But, he knows that he cannot continue to watch debt mount. He struggles to find new resource avenues. He provides some consulting services which, while detracting from his family time, help keep the lights on and the family fed. He looks for ways to see more patients that don’t entail cutting value and patient care quality. He considers innovative options for increasing practice revenues through digital services offerings. He trims staff benefits though he despises the necessity.

Why does Simon continue to struggle when the “security” of a group might be so much cozier?

Simon loves being innovative. He loves seeing what needs to be done and then defining creative ways to accomplish the job. He loves making decisions and seeing where they lead. He doesn’t mind when his decisions are wrong; he just decides on what needs to be done next to make it better. He likes his mom-and-pop shop ways.

As witnessed all over the country, though, he knows moms and pops are fading from the landscape. Corporate conglomerates have the clout and the monies to push moms and pops aside or, all too often, just steamroll them into oblivion.

He sees the conglomerate writing on the healthcare wall. Simon knows he may not be able to avoid the centralization of healthcare. It may be inevitable that he will one day become subsumed by the healthcare Borg.

Why does Simon continue to buck the trend and keep his individualist ways?

Simon isn’t arrogant or excessively proud. He’s just trying to do a good job and provide the best he can for those for whom he cares, whether patients or staff or family. He also knows that something deep down inside him would probably get lost if he sold out to a corporate structure. He believes strongly in the American ethos of the pioneer spirit upon which his country stands so proud. He thinks innovation, even micro-innovation on a micro-scale such as his little practice, has a value and an intrinsic worth that can never be replicated in an institutional setting. He believes he can make a difference – perhaps a small difference, but nonetheless an important difference – by being true to the values he holds dear. He believes his best is brought forth in his entrepreneurial realm.

Why does Simon practice?

Simon loves what he does, he loves those for whom he cares, and he thinks he has found the best way to repay all that he has been given by being the best “him” that he can be: a small practice doc trying to do what’s right, delivering personal care the best way he can – for as long as he can.

From the trenches…

“We must free ourselves of the hope that the sea will ever rest. We must learn to sail in high winds.” – Aristotle Onassis

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).