Micropractice, Part One

Talking a year ago with a physician friend about how I run my practice, I was surprised when he told me there was a name for what I’m doing. “You’re running a micropractice,” he said. “What’s more, more and more physicians are doing the same.” So I decided to learn more about it and improve my game.

A “micropractice” isn’t really new at all. It’s an updating of a successful the old model of a doctor working out of a limited space, giving people the time they need, answering phone calls personally and offering quick appointments to those who call.

The way a contemporary micropractice differs is that it uses 21st century technology to eliminate all or most staff, and to cut through the paperwork that caused most doctors to leave solo practice. As a result the overhead is low. This allows you to spend more time with people and less time on administration.

It’s an encouraging sign that a group of physicians had enough of the dark side of contemporary medicine and took matters into their own hands. Those who want to learn more about how physicians are making this work should take a look at the Ideal Micropractice Project at www.idealmicropractice.org.

And true enough. It’s what I do. I had my fill of the “business” side of things a long time ago.

I had a nine-year career as a professional chef. I was reasonably good and worked my way up to second-in-command of a professional kitchen. The money was good, but I was no longer cooking. Instead, I spent my day supervising those who cooked. I found that I hated going to work because I was spending my time doing work I didn’t enjoy (supervision) instead of the work I loved (cooking).

Then, I felt my call to ministry. I went to school and had a thirteen-year career as a parish minister. Ten of those years was as pastor to a prominent church which grew to the point where I was no longer doing ministry. I was facilitating people and groups who did the ministry. As before, I felt the joy leave. I was spending my time on work I didn’t like, while the work I loved was being done by others.

When I entered community ministry (the ecclesiastical name for what I do) I made myself a promise that it wasn’t going to happen again. I was not going to let my practice grow to the point where I would have to move it to a professional building, hire staff, etc. I did not want to spend my day supervising others, dealing with Workmen’s Compensation claims and the chapters in a Policy Book.

Been there. Done that. Got the T-Shirt and the Tote-Bag. Don’t need to do that again.

As my work has been accepted by the mainstream medical community, I’ve had to resist the temptation to let my practice grow out of control. More than a dozen times I have had to take steps to limit my load so that I remain the person who works with my clients. I use technology to do things that in other practices are done with staff. Computers do my accounting, billing, record-keeping, scheduling and keep me current on research. I use waiting lists when I must, and I’m always looking for ways to streamline (called “continuous flow processing”). I keep my practice lean and personal.

It’s worked for me. Because I have tight control of overhead, I’ve not had to raise my rates in years. I can usually get new people in within a reasonable time, and I’ve always got room to accommodate emergencies or special circumstances for established clients. Despite the fact that I give away a lot of what I do in free programs, my paying client schedule remains comfortable and I do fine.

Yet, there is always room for improvement. In 2007 I’ll be working with the material from the Ideal Micropractice Project and will change some things. I’d like to make it easier for clients to get me on the phone. I can probably use my web site better than I do now. Some office processes take too much time, and there probably is a better way to do them. You may notice some changes, but they’ll be improvements and upgrades.