I have a friend who used to enjoy practicing medicine. He owned his practice, made the difficult transition to an electronic health record (EHR, successfully attested to Meaningful Use, then quit in disgust to run a cash-pay botox clinic. He had not taken a vacation in 12 years. I hate to see this happen to a fellow physician because it robs patients of an experienced doctor and erases the doctor’s dreams of making a difference in the lives of his patients. I have a solution that has allowed me to avoid the same mistake and maintain my sanity. What I do is to practice medicine almost the same way I learned in residency 31 years ago. Of course, I practice 2017 medicine, but deliver it in the same manner in which I was first trained. I am a solo, independent physician and I see about 25 patients a day. I take one morning and one afternoon off per week, don’t work evenings or weekends and I no longer do hospital rounds. I am able to make a decent living and have been in my location for over 15 years. My husband serves as my office manager and we now own the building which we built 16 years ago. We do our own payroll, billing and office management. We have never purchased an EHR, although we e-prescribe and submit all of our claims electronically. I hand write my notes while I talk to (and face!) my patients. I don’t copy and paste, use software or a scribe or templates, and I don’t click a mouse 3,000 (or is it 4,000?) times a day. I don’t have an online portal or phone menu, and an actual human answers every phone call at the office. I don’t do a patient-centered medical home because that idea is completely impractical for my situation. I have smart nurses who can anticipate my needs without relying on annoying morning huddles. I do not employ medical assistants, because they cannot make the office function as well as my nurses. I won’t participate in the Medical Access and CHIP Reauthorization Act (MACRA) because the cost to try to implement those measures is prohibitive and I will fare better financially by just taking the penalty. I already take the hit for not having an EHR, yet I still come out ahead by not absorbing the reduced productivity and the ongoing IT costs. I take six weeks of vacation per year spaced one week every other month. I learned years ago that if I skimped on vacations, I became irritable. I think adequate time away from the office is a necessary self-preservation tactic. Does this sound like the way you used to practice medicine back when you were happy? My method is radical only because it maintains the patient, rather than the computer, as the center of care. I actually listen to my patients without any electronic interference (except when their cell phone rings during an office visit). Many doctors are employed by large corporations. They are pestered by non-physicians in suits who glide around their offices and set policy as if they actually know what it is like to be a doctor. I have heard of employed colleagues being told to boost their productivity by seeing patients more frequently than they prefer, or to remain open on holidays that they would rather spend with family. I even know of an experienced physician who was told to stop complaining about an incompetent office manager and just put up with her. I believe that the secret to happiness is autonomy. Everything that happens in my office is the way I like it, because I set the policy. I can live with the results because no one is forcing me to do anything. I am also able to hire my own staff. If it is clear that an employee is not able to do the job, I have found it to be a real drag on office morale. I remove that person quickly to maintain the staff at a high level of experience and efficiency. Another lifestyle benefit is that I don’t have to attend any long, after-hours committee meetings. My meetings consist of a drive home with my husband in which we discuss patient and employee issues, insurance reimbursement, malpractice premiums, cash flow, etc. I get coding tips and billing feedback from these evening drives. I am lucky to be married to the office manager, but for any office, a sharp, dedicated office manager is a must. My husband can boast a collection rate far beyond any billing service that I am aware of around here. All of our family’s income is generated by the practice. Another perk of owning our office is that we avoid the landlord issues that I hear friends bemoaning. Because we do our own maintenance, we don’t have to depend on someone else to fix the potholes in the parking lot. A final benefit is that I have built up a practice of generally decent patients. I will tolerate patient noncompliance but not threatening behavior, and I will put up with rudeness but not abuse of my staff. Patients who create such chaos in my office can completely derail a whole workday so I will ask that patient to seek their medical care elsewhere. Most of my patients are a pleasure to treat. I intend to practice this way until I retire. If for some reason our balance sheet tips because of the insanity of value-based care, I will convert to a direct primary care model. But I hope to do what I have been enjoying for 28 years of practice now. I am fortunate that I have control over my practice life and I do not dread going to work each day. When I am not in the office, I spend time on our 25-acre farm where we maintain a small flock of chickens, put up 1,000 bales of hay every summer and plant native Ohio trees. I work closely with pre-med students at the University of Dayton in an effort to interest them in family medicine. They are invited to the farm to help clear invasive plants while earning money for our annual medical brigade to Central America. When I am in the office, I also host third and fourth-year medical students for rotations. I hear of friends spending their weekends chained to their laptops finishing patient notes or preparing charts for the coming week. I am not about to relinquish my spare time in such a manner. Instead, I can be found knitting, biking, reading, sewing, weeding my garden or digging holes in the ground for trees. For those of you who have the option, think of disconnecting yourself from the tyranny of large groups that are not responsive to your individual needs. I hope that you, too, may rediscover the key to enjoying medicine and life. Source
