As promised, I will turn my laser like focus to the task of “fixing” primary care. I will examine both micro and macro ways of doing this, coming up with to do lists that physicians can implement in their practices as well as global suggestions that will take shifts in health care policy. (Which only we as a group of physicians can enact!)
1. The pay stinks.Yes it does. Physicians do not get pay raises because they are more experienced or incredibly good. The only way to increase the pay is to do one of three things: see more patients, add more services and globally lobby for getting paid for thinking (which is what primary care physicians do best). At the practice level, you need to examine patient flow, appropriate billing for services rendered (example: are you billing/coding appropriately for immunizations?) and decide on an appropriate number of patients to see. Calm down, I am NOT telling you to become a patient care mill, rather to be realistic and set a REASONABLE number of patients you could see. Also realize that the pay is limited, and it will take a major change in reimbursement to get paid appropriately for what you do. (Sorry, it is what it is. Get out there and lobby for change!)
2. You got an MD instead of an MBA. I am addressing this early in the game because it is probably the most important. In my neck of the woods, massage therapists, as part of their curriculum, learn marketing and accounting. They are better equipped to set up a practice then a physician who has spent 4 years in medical school then 3 more in residency! (Academic medicine, are you listening?) Here is the big message of this post:
You must learn the business of medicine.
But how? There are books on practice management, seminars on practice management, journals on practice management, and a good accountant and bookkeeper are essential. But YOU must understand the financial underpinnings of your practice, even if you have God’s gift to office managers. (For more on seminars, visit my website: www.extramd.com.) Later this week, after I do my nights shifts, I will put up a page with a list of resources I found helpful. C’mon, as a physician, you are used to soaking up knowledge like a sponge, you can do it!
3. Coding is really fun. Sorry, but this is another one you MUST learn. I don’t care that it is boring, picky and strong medicine even for the most confirmed of insomniacs. Once again, avail yourself of every resource you can to learn it. Think seminars, books, consultants. No whining, just do it. (And remember, ICD-10 is coming. Sheesh.)
4. You are a hamster on a wheel. You will have to weigh revenues vs. practice style here. Of course, you will need to maximize revenues, billing and collections no matter what you do. However, if you choose to see fewer patients per day, then you need to reconcile yourself to less revenues, and ultimately less income. Your practice partners may have some input on this (!), but if you are solo, consider the micro practice model that is getting a fair amount of hype. Whatever you do, be very clear in your mind what your expectations are.
All right, enough for today. We will continue PookieMD’s crash course on primary care resuscitation in my next post. Until then, keep the doors open, and get out and learn a little about the business of medicine!