Paul Lance Walker, DO

If you find yourself working longer hours for less money, we have a suggestion: Start an occupational medicine practice. 

After graduating from family medicine residency, we opened a primary care practice in Roxboro, North Carolina. We were the   typical family medicine physicians and not only owned our own practice, but also served on hospital committees, had admission   privileges, and even served as medical examiners for the county. We soon expanded and added the first-ever urgent care center   in Roxboro and incorporated an electronic health record system into our office in 2002. 

Business   was booming, and we were busy. By all of the standard measures, we had   developed the ideal family practice. The practice   thrived, but we were suffering. Between the family practice, urgent   care center, and on-call and hospital work, we routinely   worked 60- to 70-hour weeks. Our income was on par with other family   practitioners, until we looked at it from an hourly rate   perspective. That's when we realized that we were stressed, overworked,   underpaid, and had no idea how to make it better.  Then occupational medicine discovered us. A nurse at a local power plant stopped by and asked for help with some fire department   physicals. With no training in this type of physical and little experience in areas such as audiometry and spirometry, we   told her we were sorry we could not help her and sent her away. Fortunately for us, she was persistent and returned a couple   of weeks later and asked again. This time we agreed to help, and it turned out to be the defining moment in our careers. 

Fire   department physicals are reimbursed at about four times the rate of a   routine family practice patient visit, and no follow-up   care or insurance billing is required. We simply sent an invoice to the   company at the end of the month and received payment   in less than 30 days. The best part was that each physical took no more   time than a routine family practice visit would. Realizing   the potential to increase our cash-based income, we began to look at   how to maximize our return on time by adding more occupational   medicine to our practice. 

To accomplish this, it helped to get creative with scheduling. Because appointments for occupational medicine exams were made   ahead of time, we would perform these physicals on certain days of the week or during a particular time of day. 

Primary care physicians (PCPs) already are trained to perform the medical exam component but usually lack the business and   marketing expertise to be successful. Those areas were where we encountered the biggest learning curve that we had to overcome. 

We decided on a two-pronged strategy to first capitalize on our existing occupational medicine offerings and then to expand   our reach. As is the case with many PCPs, we already offered some basic occupational medical services, such as truck driver,   work, and workers' compensation physicals. We had always looked at these services as little more than an additional convenience   for our family medicine patients. Seeing the potential, we changed our thinking and began to focus on refining and marketing   these services. 

To   develop a successful occupational medicine business, our first   challenge was to educate ourselves and our staff. We accomplished   this task by attending courses from the Centers for Disease Control and   Prevention's National Institute for Occupational Safety   and Health and the Council for Accreditation in Occupational Hearing   Conservation to learn about spirometry and audiometry,   which are integral to most companies' occupational medical programs.   The American Osteopathic College of Occupational and   Preventive Medicine also offers a three-part basic course on   occupational medicine, which can lead to a certificate of added   qualifications in occupational medicine for osteopathic physicians.   Finally, the American College of Occupational and Environmental   Medicine offers a Foundations of Occupational Medicine course.  We found that it was also important to learn about the needs and wants local companies had, and how other providers they had   used did or did not meet them. We met with local plant managers and industrial safety coordinators and made it a point to   take a plant tour of every company they worked with. Only then were we able to develop a medically sound program around the   needs of each individual company. 

Once we had a firm grasp on what we needed to do and how, we put our occupational medicine program together. The first step   was to brand the program separately from our family practice. 

One   of the chief complaints we heard was that companies felt that most   providers did not prioritize occupational medicine.   We wanted to change this perception, so we developed a stand-alone   occupational medical program with its own Web page, brochures,   business cards, and phone number. We designated one person in our   office as the occupational medicine coordinator. We also   standardized communication between our practice and our clients, and   prioritized our occupational medicine clients to ensure   that we were staffed to accommodate their needs without long waits   behind our family medicine patients. 

The   program was good, and our clients were happy. Many of them had been   using multiple providers for occupational medical   services but consolidated their business with us. The next step was to   expand our business by marketing our occupational medical   services. 

Every city   has companies that must meet government mandates that ensure the health   and safety of their employees. We just   had to identify them. We gathered our brochures and contacted local   industries. Our strategy was to arrange plant tours, which   would give us an "in" to learn about the plant and ask about the   company's current occupational medical provider. Few were   satisfied with their current providers, and most were willing to give   us a chance. Most companies were surprised that a physician   would take the time to show an interest in their practices and   procedures. 

Our practice not only became busier; it also became more efficient. Occupational medicine visits paid about two times what   we were being paid for a family medicine patient encounter. We billed for occupational medical services outside of workers'   compensation using a simple computer spreadsheet, which eliminated billing costs. 

Our income from   occupational medical services steadily grew as we expanded and refined   our services. With the extra income,   we were able to hire one, then two midlevel providers to see work-in   patients. Doing so helped us cut our overall hours, allowed   us to spend more time with our primary care patients, and made our days   much less stressful. The additional help also gave   us time to discuss marketing ideas and build our business. Our work   week was cut back to 35 hours, with an increase in income. 

Together, we now own   SiteMed and perform on-site physicals for companies throughout the   southeastern United States. Recently,   we started a small group seminar series to teach other PCPs how to   implement creative strategies to add occupational medicine   to their practices. Our goal is to be the mentors we wished we would   have had when we started our occupational medical practice.   We often talk about the money and time we would have saved if someone   had helped us along the way. 

Fernandez and Walker founded SiteMed, an occupational medical company that delivers on-site wellness and medical services   to businesses throughout the southeastern United States, after years of blending occupational medicine with their practice.   Send your feedback to 

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