Small but mighty

Micropractices: Small footprint, big changes for patient care, DOs say

Three DOs talk about why they love running a micropractice.

A micropractice is a type of solo practice that aims to run more efficiently by reducing overhead costs in order to increase time with patients. Physicians running micropractices limit the size of their patient population and employ time-saving technologies to increase efficiency; these actions serve the goal of fostering a strong patient-doctor relationship.

Physicians in micropractices reported higher satisfaction with family time and lower satisfaction with income compared to physicians practicing in more traditional academic or community medicine settings, according to a 2013 survey from the Journal of the American Board of Family Medicine. When asked to rate the quality of the care they provided, micropractice physicians scored themselves higher than employed physicians did.

Increased accessibility

In a micropractice, physicians typically get to know their patients better. Doctors are often more accessible and patients aren’t usually going through a receptionist or an answering service to reach them. Instead, micropractice physicians answer their own phones and use HIPAA-compliant apps to communicate with patients via text and email.

“Patients should be able to call the doctor any time if they have a problem or issue,” says Mark Leeds, DO, who runs a micropractice in Fort Lauderdale, Florida. “They shouldn’t have to wait in long lines in a crowded office or deal with an answering service.”

Lone-wolf approach

In a micropractice model, the team of medical assistants and nurses disappears or is greatly reduced.

“Managing people is a challenging aspect to running a business, so a micropractice eliminates that challenge, or really cuts down on it,” says Greg Esmer, DO, who runs a micropractice in Portland, Oregon.

Micropractice doctors also don’t have to extend their license and liability to a team of people.

“I’ve had the good fortune to work with some very well-trained people, but taking responsibility for every word out of a team’s mouth every day is unnerving,” says April Goggans, DO, who runs a micropractice in Grand Junction, Colorado. “I vastly prefer to be the only one around. Therefore, if I mess up, it’s actually my fault.”

How 3 micropractices operate

Below are the finer details on how Dr. Leeds, Dr. Esmer and Dr. Goggans run their micropractices.

Mark Leeds, DO

Mark Leeds, DO | Fee-for-service and direct primary care hybrid

Dr. Leeds practices family medicine with a focus on treating patients with opioid dependence. He has been running his current micropractice in Fort Lauderdale, Florida, for about two years. His practice is predominantly fee-for-service, but he’s also borrowed some tactics from the direct primary care model. For instance, he doesn’t charge patients for follow-up appointments occurring within a month of the original appointment.

April Goggans, DO
April Goggans, DO | Membership and cash pay-per-visit hybrid

Dr. Goggans practices family medicine in a direct primary care model. Instead of dealing with insurance companies, patients can pay membership fees for continuous care or opt to pay cash for each visit. Dr. Goggans says the thought of opening her own practice was intimidating at first, but after reading some books and taking a class in marketing, she felt more prepared. She has been practicing in her “favorite way of practice” for about a year in Grand Junction, Colorado.

Greg Esmer, DO
Greg Esmer, DO | Fee-for service model

Dr. Esmer is a neuromusculoskeletal medicine specialist. After taking out a small business loan, he has been running his micropractice, Osteopathic PDX, in Portland, Oregon, for five years. He uses an insurance-based, fee-for-service model. Dr. Esmer says he paid off his loan within a year after opening his practice. A self-described introvert, Dr. Esmer says he values the down time he has between patients.

5 comments

  1. I agree with the doctors in this article. I opened my own micropractice called Serenity Osteopathic in Madison, Wisconsin, and I love spending an hour with each patient. The doctors in this article and I share a few of the same mentors. If you want to know how to open your own micropractice and start loving Medicine again, contact Dr April, Dr Mark, or myself.

  2. Khayriyyah Chandler DO here of Chandler Wellness Care in Haddonfield NJ (NJAOPS) I started off as a hybrid and now fully DPC. It is definitely an alternative. We need more support from our peers and larger organization to decrease costs. My malpractice and association fees are the same as a million dollar practice. It’s all a wor in progress. Some locations better than the other… Hopefully we will embrace the diversity in medicine, personalized care, and uniqueness more often.

  3. I love this idea, but I would lose all my patients who need a pediatrician if I did this. I see a primarily Medicaid population that can’t even afford shoes for their kids sometimes, let alone pay cash for the doctor. We have a private practice with 6 physicians. We are being told by the large Children’s hospital in town that we might as well sell to them now because the direction of healthcare is the end of small private practices. We need to have the system work for all of us. I don’t want to have to abandon the kids who need my care in order to make a living and pay off my student loans. I also don’t think I should be forced into a loss of autonomy by a healthcare system. There has to be a better way. I love private practice, but I don’t live the healthcare system.

  4. I am an OMS-3 hoping to practice OMT or FM/OMT independently or with 1-2 other physicians in a very small practice, hopefully near or in Portland, OR. This practice model is exactly what I want, but I worry about the ability to generate the income needed to pay off half a million dollars in school loans.

    I suppose the main challenges are knowing what to charge and building up a patient base.

  5. I remain confused by all the new unnecessary terminologies in medicine. I began a solo full family practice in 1979 and I have the same practice today. Everything I do is the same but now I am considered a “micropractice”. This is a poorly chosen characterization of solo practice which could be misinterpreted. On the financial side, Medicare and commercial insurance carriers are finally recognizing the value of what we do in family practice by offering a multitude of reimbursed preventive services. Solo practices can still do well. Speaking of labels, I would encourage our younger family practitioners to challenge the label primary care. Nationally, there is no such medical school or residency that offers a degree or certification in primary care. It’s an attempt of others to categorize us with non-physicians.

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