Momwithastethoscope's Weblog

July 24, 2008

Goliaths and David

Filed under: Uncategorized — momwithastethoscope @ 8:03 pm

Five years ago, I gave birth to a different kind of baby, my own medical practice.  The difference between the labor and delivery of this child compared to my human children is that the pushing and contractions are ongoing.  While a formal MBA would teach me a great deal, this process has been a business boot camp for someone with little business education but lots of gut instincts.  With a shoestring budget and staff, I opened the door to see pediatric patients and their parents in 2003.  The learning curve has been a roller-coaster ride of information and emotions, and I feel responsible now for not only my patients but my staff’s wellbeing, too.

Why would the mother of two young children want to take on the growth and development of something so large?  There were all of the typical reasons: autonomy, desire to have my own patient base, and control of my income and future.   But mostly I wanted movement.  I joined my previous practice five years prior to this decision, and it was a practice that had been through better times.  There was little interest in upgrading the dilapidated exam rooms and any new ideas were beaten to death by committee.  At the time I left it felt stagnant.  The divorce between myself and these other partners wasn’t pretty (I was escorted to my car with a box on the last day).   The rift has healed, but the scar between our two practices will always be there. 

My own practice feels very different.  We’ve done well.  I say we, because I cannot take sole credit for the double digit success of the practice. My husband is my administrator, billing person, in-house IT fixer, and handy man.  I’m sure he wears even more hats than that.  I’ve had a loyal front office scheduler who has been with me from the first day.  I have a terrific partner who joined me two years ago when I was working in less than 1400 square feet.  My nursing staff has grown from one RN to four full-time clinical staff.  And in four years time, I closed my patient panel to new patients because I was busy. 

Through two pediatric collaboratives, I have been able to implement new ideas in pediatric healthcare.  Continuing the momentum that started the practice is a constant challenge, but I feel that I owe my patients the best of what’s out there.  That momentum has caught the eye of two large and competing healthcare systems in our area, and we are being wooed to join forces with one of them. 

I have very mixed feelings about giving up this baby. I have nurtured this collection of patients and parents and staff with heart and soul.  When we moved into a larger office a year ago the practice grew into its kindergarten body quickly.  Yet our youth means that we don’t have the financial foundation to do everything I would like to.  For instance, our sign on the front of the building is still a banner because we haven’t anteed up the $5K for the sign.  The $20K CBC machine will have to wait until winter and we are out of our lean summer season. 

Part of the wooing means that we would have the bells and whistles of a well-backed, financially sound healthcare partner.  EMR would no longer be just a bunch of letters.  The phone system would get its much needed upgrade.  We might even get the services of a decorator to go beyond wall color.  All we have to do is sign on the dotted line to begin the process.

But I have a lot of questions.  How will my patients receive this merger and acquisition?  Will I be required to only use the physicians in my network?  Will I be instructed to only use a certain lab and radiology departments? What if they aren’t as good as what I use now?  Is this healthcare system really financially healthy?   Will they be able to provide me with prn help when someone calls in sick?  Will my staff be taken care of in terms of benefits and salary by their new boss?  Will I have to give up giving out samples?   Can they help us with call   coverage?  How will other physicians react?  How long do I have to make the decision? 

My biggest question is about how proactive these big guys are willing to be.  Will they support the wellness, as well as, the sickness of my patients?  Do they see the value of patient education? Will they be as eager to embrace new concepts as I am?  Can they help me merge the old-fashioned physician-patient relationship with the best of technology (as technical as you can be in a pediatric practice)?

I feel like the parent watching her child go off to the brave new world of school for the first time and wondering if I should home school.  Do I let this baby go?











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