Being a primary care physician, I was afraid to start my own practice. There was discouragement from fellow physicians, hospital leaders, business colleagues, and even patients. Many said that the small practice model was not viable. With insurance mandates, mounting bureaucratic pressures from Medicare and Medicaid, increasing regulations by DEA, higher volumes of paperwork, and the health IT requirements, the task of setting up a private practice with primary care focus was considered a lost cause.
A merger of my hospital-owned practice with a big health system in Massachusetts pushed me in the right direction. After coming home one day and watching Braveheart again (notably the scene where William Wallace announces, “They may take away our lives, but they’ll never take our freedom!”), I was inspired to be free. I spoke with my wife, also a physician, and we decided to launch our own primary care practice in 2018.
The road ahead was daunting. I had to choose an electronic health record that would be able to interface with local labs and imaging of the two big systems, be user friendly, have ongoing remote support, and meet meaningful use criteria. I had to set up my LLC, get it registered, start the credentialing process with health insurers for the new organization, come up with medicolegal forms for the new practice, arrange a business loan, set up a business account, arrange space to set up the practice, and get office furniture and supplies. The whole idea was daunting. The price of freedom seemed high. However, it was the price I was willing to give to earn my freedom.
Why did I want to be free and from what? The system over the past 20 years has morphed in an ugly way, especially for primary care physicians. Independent practices are dying, and more of my colleagues are joining as employees of big systems which offer protection and financial stability. These systems would take care of IT, help understand the million coding quagmires and the perpetually changing coding requirements, help with human resources, medical malpractice and give fixed vacation and CME time. All of this can be had for the physician willing to sell her autonomy. Unfortunately, my experience with employment after coming out of residency has been that these coveted promises are nothing but a mirage. I now understand that big systems are extremely inefficient and unable to run primary care offices effectively. The bureaucrats do not understand what we do, and they end up hiring some physicians from among us who sell their souls to take the easy way out and become hospital administrators. In their roles as chief medical officer, chief technology officer, vice president, etc., they push the hospital agenda of running health care as a business. The ugly truth is that they are not good business people. The moment you hang up your stethoscope and start working out of an office, you become one of them. You start making rules and use catchy phrases like “patient centered care” and “physician health and wellness,” while implementing the very processes that hurt patient care and physicians alike, leading to physician burnout and patient dissatisfaction.
Starting my own practice in 2018, I assumed the role of CEO, president, and chief medical officer for my new practice. I cared about my patients and staff, and this made the transition easier. The business model was to provide excellent care of the patients, take care of myself and my staff, and use innovative practices for medicine and marketing. I am happy to say that in one year, I have a rapidly expanding practice, added another location, built a health information exchange, and have a happy staff. Most of all, my burnout score has gone down. I feel that I have won my freedom. I am free to take care of myself, and free to provide for my staff, patients, family, and myself.
The answer to physician burnout does not lie in yoga, meditation, and self-care. These are obvious contributors to anybody’s wellbeing. Physician happiness, which is the opposite of burnout, comes from creativity, autonomy, honesty, integrity, and overseeing your destiny. I invite my colleagues to break the chains, and let us come together to take back our health care one physician practice at a time. Physician Strong.
Talal Khan is a family physician and can be reached at Personal Primary Care.
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