Since starting this website and blog a short time ago I have received emails from doctors in many countries, which is of course wonderful. As an American doctor who started this website out of frustrations I experienced opening my own practice, I realize I was a bit myopic to assume that private practice issues we face are unique to America. In fact, the issues and the processes are often identical, no matter how a country’s healthcare system is structured. I think it’s safe to say that many things will not change even under healthcare reform because, after all, being an excellent doctor supercedes politics and finances.

Several of the international physicians have kindly submitted articles for inclusion on this website. I hope they represent a trend that will continue as we can all learn from each other. The original tagline for PrivatePractice.MD was “Doctors Helping Doctors” and that’s a sentiment I hope to always encourage. Dr. Lawrence Kindo in India has written several articles. The first is entitled “A Perspective On The Indian Healthcare System” and shares his opinion and overview of the medical system in India. I found it interesting that he believes medical tourism will become a big industry for India, and I had the thought that we American doctors never think about our healthcare system in that way (at least I haven’t). Yet we know that people travel to the US from all over the world for the excellent and advanced medical care available in the US. Dr. Kindo’s other article gives a overview of the training Indian doctors receive. It is entitled “Medical Education In India and the US: A Comparison.” I think you’ll find it an interesting article also.

Dr. Rodrigo Rubio , a Mexican anesthesiologist and MBA student, kindly offered to share his knowledge and insights about private medical practice from a Mexican perspective. He has proposed a series of articles, with the first article talking about the value proposition we physicians bring to our patients. I think you’ll agree that the principles are universal and location- independent.

I encourage everyone to write and share their experiences and perspective.  Please leave comments as well!

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!

Maybe the truth hurts, if Dr. Gawande is right. But maybe his conclusion is too much of a gross generalization. Some physicians enriching themselves at the expense of their patients (which I agree is unethical and plain wrong) does not mean that all physicians are guilty as charged. But what about all the other factors that determine the final cost of healthcare to patients, and our country and society in general? Dr. Gawande discounts the effect of unnecessary testing done to “CYA” in case of lawsuits. Tort reform isn’t needed based on his findings. No mention of prescription costs is included in the article. Now doctors are the main, biggest, perhaps sole reason for our current healthcare crisis!

And the article’s conclusion is that “entrepreneurial doctors”, which includes not only doctors performing their own procedures (like getting a little ultrasound machine and doing their own studies) to get the payment instead of the local hospital, but also any doctor that has any other diversified stream of income! If you own your own medical office building and get rent from other tenants, you are guilty! Don’t consider doing chart review for insurance companies or your friendly malpractice lawyer! You’ll be tainted and contributing to the problem. (I’m not sure if authoring best selling books counts against you.)Suppress any instinct to do anything but cerebral medicine, or else you won’t be one of the better doctors!

Isn’t there a middle ground? Aren’t all extremes bad? I’ve written on my blog elsewhere that my personal experience is that having a well-run practice, fiscally sound, leads to better medicine. I’m sure of it. Maybe I need to apply for a double-blind study grant as the principle investigator to prove that point, but I’d like to hear how any other state of practice is better for the patient or the doctor.

I agree that our healthcare system is broken and needs a major overhaul. I know there are bad, inept, greedy, selfish doctors. Bet that true of any industry from banking to journalism and everywhere in between. But doctors have the public trust, maybe moreso than our politicians, and doctors certainly have answered a high calling that demands extremely ethical behavior. Doctors, even entrepreneurial doctors, are no doubt part of the problem and hopefully will be a big part of the solution to our current healthcare dilemma.

So be that better doctor. Behave well. Make ethical unbiased selfless decisions for your patients. Your practice will thrive. Patients will know you’re a top doctor and it will all work out for you.

But stand up for yourself in this debate too! I think doctors need to contribute to the solution, even if it takes painful self-examination and even a change in behavior to no longer be part of the problem. We deserve to be paid a fair wage for our work. We don’t need to apologize if we’re “entrepreneurial”, as long as we are ethical and remain true to our patients and our life’s calling. Let’s hear you!

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.