By Catherine Munson, MD
There is nothing permanent except change. ~ Heraclitis
Since I graduated from residency (when dinosaurs roamed the Earth and Prozac was the new medical wonderchild), psychiatrists have been subject to myriad changes in the practice of psychiatry. This has come both from within (such as continually evolving Maintenance of Certification requirements) and without (electronic medical records, mandatory use of ICD-10 codes, etc.). Uncertainty about the structure of healthcare in the United States, as well as the usual anxiety expected with running a small business add their toll.
Whether you are just starting a practice or have had your shingle out for a few decades, it is vital to adapt to changes in a way that is sustainable. Particularly in a solo-practice, you and your skills are the product. Ideally your work-space must be supportive for your patients and yourself.
Clinical practice keeps physicians busy enough that it is easy to forget that time and energy is needed to manage the practice, even if a practice manager has been hired. The practice manager is paid by the owner of the practice and needs to know what systems the owner/physician wants to have in place, so the manager can implement and maintain them.
The first step in building a sustainable practice is to review all systems: for intake, for scheduling, for documentation, as well as for emergencies. Review them alone, and if applicable, with all of your staff to detect problems. Review online comments on your practice — do take them with a grain of salt, but if you see a pattern in any complaints, address these as soon as you can. In psychiatry it is a tricky issue whether or not to reply to complaints online, however change conditions so that they cannot be a source of complaint in the future. If you are starting a practice, try to imagine the process for treatment from a prospective patient calling to book an intake appointment all the way through potential discharge and how you would like your practice handle each phase. You may not be able to implement every detail as you would like to start with, but you can aim for that over time, or adjust your model as you gain experience.
This is the introduction to a series of posts designed to consider some of the choices involved in creating your ideal practice. Whether those choices involve fee for service versus accepting insurance, or issues involving scheduling, pricing strategies, employees, hiring adjudicative medical staff (therapists, nurses, PAs), and outsourcing defined tasks (think of answering services and EMR’s, among others). The next article in this series will discuss payment. A vital ingredient for a sustainable practice.
