Today one of my patients kindly gave me a basket of tomatoes and other vegetables harvested from her garden just this morning. I was touched by her friendly gesture, and surprised because I practice in that urban mecca called Hartford, CT. I’m not sure how many productive gardens there are near me (not to mention that few tomatoes have survived the blight wiping out the tomato harvest in Connecticut this summer).

Reflecting on my day during my drive home, I recalled a wonderful and eye-opening family practice rotation during my fourth year in medical school (1987) to fulfill the AHEC requirement. I lived with a family practice physician’s family in a small central Ohio farming community for one month. Everywhere she went, I went. I scrubbed in and watched her deliver babies. I observed her examining endless patients in her office until early evening many days, helping or assisting when I could, and then went to her home for dinner before crashing into the spare bed in her guest room each night to sleep. Her family welcomed me, as did her many patients.

Maybe Doctors Feel Like Celebrities in Rural Communities (but are too humble to admit it.)

By the end of the month I was recognized and greeted as “doc” by people I passed on the street as I walked to the post office or corner store (pretty cool experience for a new doctor), and I couldn’t help but smile and feel lucky to be there. These patients often brought my hard-working preceptor vegetables from their garden, or a freshly baked pie, or a scarf knitted just for her. Clearly they welcome their doctors into their lives as another family member.

The family practice rotation accomplished its goal of exposing a city boy to rural primary care medicine. I didn’t even think about the logistics and practice management aspects of my preceptor’s practice, so different from others I had seen up to then, or talk to her about her salary. She mentioned she loved the “life of a country doctor” and “don’t consider it if you want to make a lot of money”. Practicing medicine for the sake of practicing medicine, and being such an important part of these patients’ lives and families, was definitely appealing to me.

What Do You Mean You “Want To Be A Country Doctor”?

When that rotation ended, and I returned home to my reality, I was convinced I would follow in that inspiring family physician’s footsteps and hang up my shingle in a small rural town someday. Alas, it was not to be. For reasons you can guess, trite reasons to some degree I’ll admit in retrospect, I was tempted by the fruit of other specialties and ended up denying my dream of a rural primary care practice. It was the right decision for me then, and I enjoy my medical practice now, but I still remember that very special experience in small town America and sometimes even let myself wonder how my life may have been different had I chosen that career path.

A basket of garden vegetables brought it all back for me today.

Recently I discovered the blog Ideal Medical Practices which is a group or collaborative blog (like I’m working to build here at PrivatePractice.MD). In their own words, the authors state their blog’s purpose is “to pursue, support, evaluate, and educate others with regard to delivering superb health care in a vital and sustainable environment. ” I share that goal!

Currently they are sponsoring a blogging contest for participants at their IMP Camp in Seattle, WA August 14-15, 2009. Participants will blog at the camp about their concept of an ideal medical practice.

Go check it out. I think you’ll find it as useful and interesting as I have!

In the past, perhaps, starting and managing a medical practice was pretty standard stuff. Get your medical degree, hang out your shingle, and you stayed in business as long as you took good care of your patients. But there’s no doubt the classic private practice paradigm of the last 50 years will disappear and new practice models will evolve. It’s fair to say, I think, that no two practices will be completely alike and instead there will be many versions. Some of the “reformers” might argue that all medical and healthcare practices should operate like McDonald’s and in some practice settings maybe that wouldn’t be such a bad approach.

To counter that opinion and state the obvious, patients are individuals, and require tailored specific care, unlike a hamburger that gets cooked exactly 90 seconds on each size. The tailored-care approach makes much more sense to me. Personalized care will be the new paradigm, in biotechnology, pharmaceuticals, stem cell solutions to diseases and in every direction healthcare is improving and evolving today. Private practices can deliver personalized tailored care better than any other practice model. Practices should partner with the government or big institutions, perhaps, to benefit from their resources of scale, but the private practice will be the best vehicle to deliver the personalized care of the (near) future to our large and diverse population. Physicians as entrepreneurs will make that care happen.

Dr. David Marcinko, over at the HealthcareFinancials.com website wrote an interesting article recently entitled “The Power of ‘Me, Inc’ for Physicians” that reflects my thoughts exactly. Give it a read. His website and service has much to offer physicians running their own business, their own private medical practices.

Please add a piece of advice or useful tip that you use in starting or managing your own private practice. Use the comment section to this post. Once enough tips are suggested, they will be organized on the resources page.  If you have a dilemma or question, you can ask it here too. The plan for this website is to have a private doctor’s forum eventually, but I will wait until this community grows over time.

In the description directly from the X Prize website it states “This first-of-its kind competition will focus on reinventing the health care system in a bold, measurable and scientific fashion to catalyze dramatic improvements in health and health care value in the United States. The Grand Challenge for the Healthcare X PRIZE is to create an optimal health paradigm that empowers and engages individuals and communities in a way that dramatically improves health value. The proposed prize is designed to improve health value by more than 50 percent in a 10,000 person community during a three year trial.”

The rest of the details can be found on the X Prize website if you want to start imagining how your ideal system would function.

Several private medical practices located relatively close in one region could easily create and treat a community of at least 10,000 patients. These practices could pool resources and create a microcosm, a medical utopia of sorts, along a new paradigm to show that patients received comprehensive care (including preventive care and education), while the small business community of private medical practices also thrived. We have to think big ideas in this uncertain time, and come out stronger and better. The X Prize might provide the impetus for positive change. What do you think? Can we private practice docs pull this one off?

Show me why I need some type of insurance protection, and I’ll listen carefully at least. Of course I have life insurance, mostly term life insurance. But I have some whole life insurance too because I hope to outlive my term insurance and still leave my family enough money to bury me and pay off my debts. My father did NOT believe in life insurance, preferring instead to put his money in the stock market. He passed away last year, before the market tanked (thank goodness) and all I can tell you is his stocks didn’t do so well. I’m still working… but I digress as usual.

I also have disability insurance, good car and homeowners insurance, and an umbrella policy to cover what the other policies won’t cover. I’m considering a policy for Errors and Omissions since starting PrivatePractice.MD, but that policy is more for corporate board members I think. There are all sorts of specialized insurance products so be sure to ask your agent to review your business risks and determine if those risks can be mitigated with insurance.

You work hard to start and build your business and you don’t want it taken from you due to some preventable or unfortunate event. Business Liability insurance should protect you from those sorts of risks. If you have partners you might also consider having the medical practice buy life policies for each partner which pays the surviving spouse for that partner’s equity ownership in the practice in the event the partner dies. Otherwise your new partner may be the spouse! I can see how that might cause some problems for the daily office routine (but again I digress).