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Small practice evolution: The medical micropractice


Going without staff, using technology, and spending more time with fewer patients characterize the micropractice model.

Every so often, a new patient of internist Jean Antonucci in Farmington, ME, looks puzzled when the doctor herself-and not a medical assistant-walks into the waiting room and escorts him to a 125-square-foot room.

In that room, which looks out on pine trees and a stream, Antonucci takes vital signs, asks the patient what's bothering him, diagnoses and treats that problem, and collects the copay. By the time the patient leaves, he realizes that Antonucci is truly a one-woman show.

"I really don't need staff," says Antonucci, who rents the space from another physician. "I'm amazed at how well this method works."

This minimalist approach also maximizes job satisfaction, says Antonucci, who used to get worn out hurrying through 25 patients a day. "Now I'm able to balance my life and my work while my patients receive good healthcare," she says. And she enjoys being a jack-of-all-trades. "People might say we're control freaks, but doctors are unhappy when they lose control of their practices."

There's a price to pay for this contentment, however. Micropractice doctors typically earn 25 percent less than their peers, which may be why there are so few of them. FP Gordon Moore in Rochester, NY, the reputed father of the micro movement, estimates that only several hundred doctors, predominantly on the younger side, have adopted this model.

Those who have are quick to note that the goal of slashing overhead is to improve patient care, and not just to boost the bottom line. The traditional practice model, with its emphasis on seeing enough patients to hit income benchmarks, has it all wrong, Moore asserts. "I'm not willing to subvert patient outcomes for financial reasons."

Hands-on and idealistic, micropractitioners view themselves as the future of medicine. Would this model work in your future? We've interviewed these pioneers to find out what it takes to succeed without the life support of a traditional practice.

Benefits by the numbers

Micropractice doctors are fanatical cost-cutters. Here's the math that explains why.

Overhead generally represents between 50 and 60 percent of collections for primary care physicians, according to the Medical Group Management Association. So if your overhead stands at 60 percent and you see 25 patients a day at a clip of four per hour, 15 of those visits cover staff salaries, rent, equipment, supplies, malpractice insurance, and other costs. The remaining 10 visits account for your compensation.

Let's say you reduce overhead to 30 percent of collections-a goal that many micropractice doctors have achieved-by jettisoning staff and operating out of a 200-square-foot office. Now you need to see only 7.5 patients a day (in addition to the 10 appointments paying your salary and benefits), bringing the daily total to 17.5. With a 30 percent reduction in the number of daily visits, you're able to lengthen the time for each one from 15 to 20 minutes.

In reality, micropractice doctors typically see only 10 to 12 patients a day, with the average visit lasting 30 minutes. Handling chores that traditionally fall to employees puts some constraints on their productivity. At the same time, they prefer this slower pace-even though it may cost them revenue-because they have more time to listen to and educate patients.

"In my old practice, I could expect at least one patient a day to leave the exam room without understanding what I told him," says John Brady in Newport News, VA, a micropractice FP since 2003. "Now, that might happen once every six months."

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Jennifer N. Lee, MD, FAAFP
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