The Solo Practitioner – Getting Rare, But Not Extinct
Dying Breed or Model for Future Generations?
Sanford J. “Sandy” Brown, M.D. is a solo practitioner and one of more than 30 physicians who provide critical support to the hospital as a member of the medical staff.
As a solo practitioner, however, he is not affiliated with any medical group or managed care plan, as most doctors are these days. Much like the doctors of the old frontier, he has a wooden shingle hanging out front of a modest, no-frills building and he goes it alone, depending on a single staff member to help him manage a busy practice.
A popular, friendly physician who has practiced medicine on the Coast since 1976, Dr. Brown is a family practice specialist with a national reputation as a leader in the practice of wellness medicine and managing a solo practice. For seven years, his monthly article on the life of an independent physician, “Practice Diary”, was one of the most popular columns in Family Practice Management, an official publication of the American Academy of Family Physicians.
Chinese Connections
When the printed column and the on-line version ceased being published in 2005 supporters complained, missing his insights into caring for patients, wellness promotion, and managing a small medical practice. Among his devotees – much to his surprise — was a nurse practitioner in China, who had collected his magazine columns over the years, translating them into Chinese. After his column ended, the nurse contacted him about helping her translate the remainder of his 66 monthly columns into a Chinese-language medical journal. He agreed, if one day she and her publisher would collate all his diaries into a book. Last year, that happened.
The280-page book, simply called the Sanford J. Brown Diary, is a bible for the budding specialty of family medicine in China. And the copy sitting in Dr. Brown’s Fort Bragg office waiting room, which includes the Chinese translation next to the original English, makes for good reading. It’s full of colorful anecdotes, behind-the-scenes stories, and sage advice.
Online Counseling
Today, he writes for MedScape, which is a part of the WebMD Health Professional Network. WebMD physician information websites include theHeart.org and eMedicine.com. Dr. Brown also moderates MedScape’s Family Medicine discussion board.
Besides acting as a mentor to other physicians, he prides himself in his ability to manage all aspects of his business without help.
“Most physicians I know love practicing medicine, but they don’t enjoy the business side of dealing with personnel issues, overhead costs and battles with insurers for payment,” explained Dr. Brown. “I have learned everything I need to know to run my practice.
“If my office manager is on vacation or sick, I can sign in patients on the computer, schedule appointments, handle billing, file charts, respond to patient voicemail calls, and update their files. I also know who to call to resolve a payment issue.” It’s a skill he teaches to other physicians who come and spend a week in his office learning the business side of a solo practice.
“You learn to be the captain of your own ship, make decisions about your practice and hours; there are a lot of perks connected with being your own boss,” he said.
Keeping Current
Although Dr. Brown teaches medicine and business to other doctors and keeps his medical education credentials current, he says solo practitioners – like any good doctor – need to be careful not to exceed their capabilities. “You don’t have to know everything,” he said. “We have specialists, and I don’t hesitate to use one when I need advice or help.”
Another benefit of a solo practice, Dr. Brown notes, is the time he gets to spend with each patient evaluating their health status and counseling them.
His HealthTrends database, which contains detailed health status information on nearly1,500 patients, allows him to look at patients’ risks for diseases like diabetes, and correlate years of weight, diet, exercise and blood glucose readings in the database with changes in a patient’s health related to those risk factors.
Decades of Data
The database information is taken from tests conducted during annual physicals and from a multi-page patient questionnaire that asks for information on life-stress events (births, deaths, job losses), diet, exercise, and other health issues.
Armed with this information, Dr. Brown gives each patient an hour-long appointment that includes a thorough physical exam and a review of their health risks His patients take away copies of their lab results, educational materials from pre-screened physician-only websites, a comprehensive assessment of their current health status, and a prescription for health improvement.
Like the hospital’s other medical staff, Dr. Brown is dedicated to providing hands-on, cutting-edge patient care. At the same time, he and his patients relish the homey trappings of old-fashioned country medicine Dr. Brown dispenses from his small office with the wooden shingle out front.
News Reports Chronicle the Woes of Solo Practice Physicians
Reports of my demise have been greatly exaggerated – Mark Twain
Relatively low earnings, rising overhead and overwhelming patient loads are sending veteran primary-care physicians into early retirement and driving medical students into better-paying specialties, creating what the New England Journal of Medicine recently called a crisis. Much of the problem lies in an endangered business model: the one- or two-physician general practice. Such practices are particularly difficult for primary-care physicians to maintain because of their relatively slim and declining margins.
Small general practices afford doctors autonomy to practice medicine as they see fit and can produce strong doctor-patient bonds. But these physicians have little or no clout to leverage better payments with insurers; they have no economy of scale, which makes overhead more burdensome.
The economic slowdown is making matters worse. Physician revenues nationwide are falling as patients who have lost jobs or homes stop paying their bills and skip appointments.
The solo practitioner — long the pillar of family medicine — is slowly but surely becoming extinct.
MCDH’s Independent Physician Team
Keevan Abramson, M.D.
Specialty: OB/GYN
Medical School: Hahnemann University
Residency: Mount Zion Medical Center
Board Certifications: American Board of Obstetrics and Gynecology
(707) 964-0259
Jeffrey Berenson, M.D.
Specialty: Internal Medicine
Medical School: University of California, San Francisco; Cornell University
Residency: Mount Zion Medical Center
Board Certification(s): American Board of Internal Medicine
(707) 937-1055
Sanford Brown, M.D.
Specialty: Family Practice
Medical School: Medical College of Wisconsin
Fellow, American Academy of Family Physicians
(707) 964-9168
Joseph Fleming, M.D.
Specialty: Ophthalmology
Medical School: University of California, San Francisco
Residency: University of California, San Diego
Board Certifications: American Board of Ophthalmology
(707) 961-0544
Peter Glusker, M.D., Ph.D., FACP
Specialty: Neurology, Sleep Disorders Medicine
Medical School: University of Oklahoma
Residency: University of California, San Diego
Board Certifications: American Board of Psychiatry & Neurology and the American Board of Sleep Medicine
(707) 964-6624
Eric Gutnick, M.D.
Specialty: OB/GYN
Medical School: Cornell University
Residency: University of California, San Francisco
Board Certifications: American Board of Obstetrics & Gynecology
(707) 964-0259
Jeffrey Kraut, M.D.
Specialty: Pediatrics
Medical School: Marquette School of Medicine
Residency: Albert Einstein Medical School at Lincoln Hospital, Bronx, NY
Board Certifications: American Board of Pediatrics and the American Board of Emergency Medicine
(707) 964-5696
Paul Lagomarsino, M.D.
Specialty: Orthopedic Surgery
Medical School: St. Louis University
Residency: University of California, San Francisco
Board Certifications: American Board of Orthopedic Surgery
(707) 961-4550
William Mahon, M.D.
Specialty: Pediatrics
Medical School: University of California, Davis
Residency: Sacramento Medical Center
Board Certifications: American Board of Pediatrics
(707) 964-5696
William Rohr, M.D.
Specialty: Orthopedic Surgery
Medical School: Washington University
Residency: Naval Hospital San Diego
Board Certifications: American Board of Orthopedic Surgery
(707) 961-4333
Kenneth Susman, M.D.
Specialty: General Surgery
Medical School: University of California, Davis
Residency: Kaiser Medical Center, Oakland; UC Davis
Board Certifications: American Board of Surgery
(707) 961-1972