Doctors find going solo painless

By Erik Lacitis
Seattle Times staff reporter
http://seattletimes.nwsource.com

If patients getting a checkup at Dr. Donald Stewart’s clinic in Sammamish feel at ease — like they’re visiting the family doc at his home — it’s because they are.

On July 28, Stewart began his new life as a downsized solo physician, chucking his previous career running a group clinic.

With high-tech help and by cutting his overhead — such as buying furniture on Craigslist.org — he now can work out of what used to be the mother-in-law apartment in the basement of his home.

“It’s the most fun I’ve had since I started in medicine 25 years ago,” said Stewart, who is 57. “Now, I’m having enough time with patients so I can enjoy working with them.”

Stewart is part of a small, but growing, trend among family-practice physicians.

They’re going it alone.

A Yahoo chat group, practiceimprovement1, in which many of the members are solo practitioners, has 472 members nationwide. Stewart said he was tired of dealing with piles of paperwork and rushed 15-minute appointments.

Stewart, a 1980 University of Washington School of Medicine graduate, said his was a fairly typical career.

“You start a practice, you work hard, you see a lot of patients, you grow the practice, you hire more doctors, you keep growing the practice,” he said.

“The problem is that in primary care, the economy of scale doesn’t work. Pretty soon you hire an office manager, and someone to deal with all the government regulations, and so on.”

At his group practice, he said, five doctors needed a support staff of 22, “which means you have to see patients more quickly because of the overhead.”

For the doctors starting up a “micropractice,” it means that it’s just them, a small office, an exam table and basic laboratory equipment.

For a patient such as Todd Lovell, 48, of Issaquah, a wealth adviser for Smith Barney, it’s not such a bad deal, either.

On a recent afternoon, Lovell drove to Stewart’s home on East Lake Sammamish Parkway Northeast, across the highway from the lake.

He was greeted by Stewart’s wife, Eva, a nurse who also worked with Stewart at the group practice.

Eva Stewart said that at first she wondered how patients would react to “coming to the basement of somebody’s house.”

But the couple fixed up the apartment, such as putting in recessed lighting and new carpeting.

Lovell sat on a comfy leather sofa, which, along with a leather chair, the Stewarts had gotten for $150. The room has a fireplace, piano and a TV that displayed a tape of an aquarium.

“This is great,” he said. “How do you beat this? Fresh air, sunshine, a view of the lake, and it’s not sterile and clinical.”

“Time to talk”

The individual credited with starting the micropractice movement is Dr. Gordon Moore, 46, of Rochester, N.Y.

In 2001, tired of working at a hospital practice in which he saw patients for 10 to 15 minutes, he went solo. Now, he said, his patients can schedule 30- or 60-minute appointments.

“We give people time to talk,” said Moore. “That’s when we find out the really scary things or real symptoms of what’s worrying them. People first want to test the waters of how the doctor is going to respond.”

Recently, a patient said he wanted to see Moore just to chat about some routine lab results. Moore knew he could have explained the results over the phone.

But right at the end of the appointment, Moore said, the patient opened up.

“We had been talking about nickel-and-dime stuff. Then he says, ‘I felt my heart skip and jump the other day. What was that about? I felt so frightened I thought I was gonna die.’ ”

It turned out to be simple palpitations, said Moore.

These days, Moore also runs idealmicropractice.org, a Web site for doctors who have or are contemplating such a career change.

Moore said what makes it all possible is available software that allows doctors to schedule appointments online. Theirs are largely paperless offices. Patients can access their own health charts online.

Doctors also can do their insurance billing, or subscribe to services that do it for them.

And federally approved laboratory equipment for the basics — such as blood and liver tests — is small and relatively inexpensive. A brand-new basic electrocardiogram machine, for example, retails for around $2,600; used ones sell for much less on eBay.

Patient appreciation

In Sammamish, Donald Stewart still is learning some of the basics for running a home office.

But with 700 patients signing releases to have their records transferred to his new practice, he no longer is accepting new ones.

At her Bellevue clinic, Dr. Gwen Hanson also is not accepting new patients. She went solo in December 2004.

Her goal is to let patients make same-day appointments, Hanson said. If patients have to wait more than 15 minutes after arriving, she gives them a $5 Starbucks gift card. If they bicycle or walk to her office, they also get a gift card.

It’s not the $5 that matters, Hanson said, it’s that patients know she appreciates them.

She has 400 to 600 patients, Hanson said. She works two full days and three half-days. She takes seven weeks of vacation a year. She can spend time with her husband and three teenage daughters.

Hanson said her overhead is around $1,800 a month, which includes office rental and malpractice insurance. After those expenses, her before-taxes annual income is $110,000.

Like Don Stewart and Gordon Moore, Hanson gives her office, home and cellphone numbers to patients. Patients have not called them unnecessarily late at night, the doctors said.

“I want to be reachable,” Hanson said. “When people do call, I’m always glad they did.”

Hanson has never regretted making the jump to a solo practice.

“I’ve been a doctor for more than 20 years. Generally, when you get together with a group of doctors, there is a lot of griping and complaining about the frustrations they have with the system,” she said.

“But when you get together with doctors in micropractices, it’s completely different. They’re laughing and talking about how they enjoy their work.”
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