1 doctor, 0 staff

When patients arrive at James Ochi's office in San Diego, they flip a light switch in the waiting room to announce their arrival. When he's ready to see them, the solo pediatric otolaryngologist greets them himself and leads them into the exam room. While this provides a nice personal touch to Ochi's practice, it's also a necessity-because he really is solo.

Ochi has no receptionist, no nurse, and no front or back office staff. Instead, he does nearly everything himself. Between patients, he sterilizes his instruments, changes the exam table paper, and checks his messages. At the end of each day he straightens up the waiting room, empties the wastebaskets, and puts out the trash. "My colleagues think I'm nuts," he admits. "But for me, this is the only way to run a practice."

Ochi didn't start out practicing like this. After medical school, residency, and a fellowship in England, he joined a pediatric ENT group in San Diego. But in 1992, after less than two years with the group, he decided to go out on his own. "The trouble with many groups," Ochi explains, "is that there's often more pressure to serve the needs of the group than the needs of the patients."

It was on a medical mission trip to Mexico that Ochi got the inspiration to simplify his practice. "I was sitting there working in a hut that's smaller than my garage, with no office, no receptionist, and few resources," he recalls. "I was treating people who had the same problems my patients have back here, and getting the same results. There were dogs and cats running around, and dozens of patients waiting for hours in the hot sun. But despite those conditions, they were happy because someone actually spent time with them. So I began wondering, 'Why can't I do that back home?' "

When he returned, Ochi began cutting his overhead so that he wouldn't feel pressured to see so many patients. The transition took nearly two years, and included dropping one full-time staffer. "As my overhead dropped," says Ochi, "I found I could afford to drop the managed care contracts that weren't worth the hassle."

The secret: lots of technology Ochi's first big step in automating his practice was converting to electronic records in 1997. That enabled him to let his other full-time employee go, saving $48,000 in salary, benefits, and payroll taxes. And, instead of having a transcriptionist type his dictated chart notes, he uses voice-recognition software that converts them directly into computerized records.

To manage the records, Ochi uses a software program called PaperPort that allows him to pull up charts on his laptop whenever he needs them at the office or at home. He updates and stores the records twice a week on backup DVDs. "Having instant access to medical records is a great advantage," he says, "particularly for this kind of practice."

The next step in Ochi's automation process was online scheduling, for which he uses Microsoft Appointment Manager. Parents now book their children's appointments on his Web site-which he designed himself, and maintains for only $300 a year. The Web site ( http://www.ochi.com) includes online registration and medical history forms for new patients, which parents fill out and bring with them, along with a referral if necessary.