It’s almost a joke in the world of medicine that doctors, particularly primary care doctors, are terrible business people. We tend to prioritize helping people and caring for them to such an extent that we sometimes neglect the financial side of the equation. Or maybe we just don’t want to acknowledge that there is a financial transaction as part of caring for a person.
(We’ve seen doctors avoid the business of medicine and excuse themselves from running the healthcare industry as a whole, and the industry reflects that change — but that’s another discussion for another day.)
When I went into medicine, I knew I wanted to provide primary care and to be a generalist — I wanted to be able to do it all. I knew I wanted to give back in a way that mattered, and I thought I’d likely make that happen in an urban setting. As I meandered through my training, I became more and more disillusioned with the business of healthcare and the outcomes we, as a society, get from our healthcare system. Being a part of that broken system became unthinkable. I struggled to go to work, feeling like each 7-10 minute interaction I had with each patient was more of a disservice than helpful.
(In all seriousness, in my former job, I’d open a window in my computer with a timer preset to 10 minutes, start each patient interaction with a cold, “We only have 10 minutes together, how would you like to prioritize your time?” and hit “start” on the timer, watching it tick off the seconds we had together until it finally blared in an intentionally intrusive manner, imploring me to end the visit.)
So I set out on my own. I felt the current system was broken, so I left it, and found myself drawn to direct primary care in a way that was magnetic. I knew, once I had heard of it, that it was how I wanted to practice medicine. It was how I wanted to interact with people. What I didn’t realize was that by following this path, I’d end up squarely in the realm of becoming a small business owner.
I joke with anyone who asks that I didn’t mean to end up here. I never meant to be a solo provider, and I certainly didn’t mean to open a business. But one thing let to another, and I now find myself at the helm of a small but strong primary care clinic that provides a much-needed service in the heart of urban Kansas City.
Since taking this step, I’ve started to wonder if the capitalistic world is made up of two types of people: those who own a business and those who do not. Setting out on your own, regardless of the industry, changes the way you think about work, the world, politics, and becomes an all-consuming project, interrupting your thoughts at dinner, your cadence in social gatherings, and your dreams when you’re finally able to nod off to sleep.
I’m now at the point that, nine months into this adventure, I can take a moment to reflect on how things have gone in my new endeavor as a business owner. I’ve prevented at least 5 emergency room visits. I’ve also demanded that several patients go to the ER. I’ve visited a patient in the clinic, then at their home, then visited them in the hospital during their long admission (because I wanted to, not because I had to). I’ve called physicians about mutual patients and coordinated care across health systems. I’ve learned how to work with the biggest players in the metro — finding ways to securely log into their electronic health systems so I can seamlessly take care of my patients seeing specialists — and I’ve found camaraderie in the smallest players in the metro — my fellow DPC providers. I’ve learned what good help is and what it isn’t. I’ve learned to fire people, and I’ve learned to wait it out when hiring to find gems in the rough. I’ve learned what cleaners work on stainless steel; I’ve learned how to assemble numerous IKEA furniture items. I’ve learned how embarrassing it is to operate a business with a broken AC unit during a hot streak, and I’m trying to figure out how to (delicately) deal with parking issues as they come up.
And I’m learning how to keep the business’ doors open. I’ve done the math and am now able to figure out exactly how much it costs to provide the different services we offer. I’ve also had time to think about and evaluate the type of experience I want to be able to offer and if I’m providing that experience or falling short. When I first opened, I had a rough idea about both our costs and our services, but putting everything into action over the last nine months has made them both realities that can be judged and improved.
As it stands, we’ve been (proudly) dispensing medications that cost us a little over a cent a pill — because that’s how much they cost. But when I sat down to do the math, I found out that we are actually spending about $3.95 per prescription dispensed to fill that prescription. Most of our prescriptions are priced such that they don’t even come close to covering that cost. Oops.
When I priced out our labs, I came to a similar realization. Oops again? I had been touting that our prices were almost too good to be true, and now it seems as though they really are a little too good to be true.
So, if we are going to continue to offer low-priced labs, radiology, medications, and unlimited primary care, we need to also be able to have the resources and people around to provide those services now and into the future. The truth hurts, but we have to bump up pricing if we’re going to stick around. It pains me to do this, because it not only means that I’m admitting that I was wrong in the beginning (that always hurts a little) but it also increases the cost for my patients (that hurts a little more).
We’ve already adjusted our lab pricing, and we’ll be adjusting our medication pricing over the next month (we didn’t want to catch anyone by surprise, so we’re delaying this one a little). Our membership fees will also be increased for newly enrolling members to more reflect market value (though our pricing will still be less than the fee-for-service model, and current members will keep their current pricing).*
And this is what it feels like to be a small business owner. You roll with the punches, figure out what works and what doesn’t and you move on. When colleagues from my past job who still work in the employed, fee-for-service world eagerly ask me how I’m doing out on my own, I take a deep breath and ask, “How much time do you have?” Running a business is a ton of work, and I sometimes feel that the pressure of performing almost every aspect of running the business is going to flatten me like a pancake. But when I’m able to take a step back and reflect on the way I am practicing medicine, I realize that I’m providing healthcare the way healthcare should be practiced. And that keeps me going.
(There is a little good news in all this: if you, your friends, or your loved ones join before we raise prices on 11/15/17, you’re set with our current, lower rates! So remind yourself, your friends, your associates, and your loved ones to sign up today to lock those in.)