The Wellness Center Solution: How Physicians Can Transform Their Practices, Their Income, and Their Lives

CHAPTER ONE

You Take Care of Everybody Else’s Pain — But What about Your Own?

Doctors have it made, right? We get respect, we own practices and live life on our terms, and we, of course, make lots of money. At least, that is the general consensus among laypeople. However, as most of us have learned firsthand, physicians know the truth. The truth is that the medical profession is in crisis and the whole system is under strain. Doctors are now putting in more hours and making less than ever before, hardly able to keep up with bills, dues, and payments on their student loans. Gone are the days when going to medical school meant that you had it made.

Most people don’t go to medical school for the money. They don’t do it for the prestige. They go to medical school because they genuinely want to be doctors. They dream of one day opening their own practice and having their own patients. Like all people, we just want to serve and lead the good life. We just want the same American Dream as anyone else while keeping our communities healthy enough to achieve the same.

But for too many physicians practicing today, this dream is anything but a reality. Physicians across the nation are waking up to an American Nightmare. They thought that medical school was the ticket to the good, easy life. They thought it was a way to earn a good living while also serving the community. However, what they are discovering is that it has never been harder to make a good living as a doctor. In fact, it is getting harder each and every year. This, in turn, makes it increasingly difficult to serve your community.

That’s a triple-lose situation. Community health systems are eroding. Patients are paying more money for a lower quality of care. Doctors are struggling to get by in a way that they shouldn’t have to after ten or more years of higher education and the smothering debt that comes with it.

No one wins here. We all lose.

I DIDN’T SIGN UP FOR THIS—DID I?

If you picked up this book, you probably already know what it’s like owning your own practice today. You thought that you’d be making the big bucks once you got through medical school and residency.

What’s more, you didn’t think you would have to struggle. It is thought that referrals will come in from other doctors, especially for specialists, and that the insurance company will take care of reimbursement. Historically, this has been the case, yet reimbursements are down and insurance companies seem to change what they are willing to cover every month. You’re constantly getting calls and emails that this service, that medicine, this treatment is no long covered under the patients plan.

Even if insurance is willing to pay for services, your patients still have to be able to afford them, and this is becoming harder each day. Most insurance companies incentivize patients to go to in-network doctors by offering plans with high out-of-network deductibles. This can result in out-of-pocket expenses that may be well in excess of $3,000-5,000. I once had a patient with a $46,000 out-of-pocket deductible! Additionally, patients are feeling this squeeze too. Most health coverage plans now have in-network deductibles too, something never seen before! If patients cannot afford to pay their out of pocket expense, they’re going to the cheaper in-network providers whether they want to or not.

You may be tempted to join an HMO and become an in-network provider, but the insurance company negotiates very low, predetermined rates for in-network providers. In order to keep your income from falling, you have to see four or five in-network patients for every one out-of-network patient you used to see. You end up working harder to make the same amount. There are only two alternatives in this situation—either you accept the rate and the additional work hours it entails or you stay an out-of-network provider running your own practice. Neither choice currently yields an optimum solution to your dilemma.

Unfortunately, physicians running their own practices, refusing to join an HMO and accept the stipulations that go along with being in-network, often see their volume of patients and total reimbursement going down year after year. They’re trying to maintain their practices, but aren’t getting ahead. They’re asking themselves: Now what? How do I make a living after I have invested my life’s work and hundreds or thousands of dollars on my education?

If you’re not willing to join an HMO, only one answer presents itself: get more patients. Patients are the lifeblood of a practice. They are essential to generating new business. They are the new business. The only way to bring in more money when the insurance companies are reducing reimbursements is to increase patient volume. Assuming you can even find enough patients able and willing to pay their out of pocket expenses and meet their out-of-network deductibles—and that’s a big if—you’re still working harder seeing more patients. In order to do this, you have to work longer hours—often much longer. You start taking patients in the office six to seven days a week, week in and week out. You’re pulling ten-hour shifts regularly, longer if things get busier. And that’s just the time you spend with patients. Running a practice means running a business. There are administrative responsibilities, staff management, executive duties. Before you know it, you’re easily racking up eighty hours a week. Suddenly your take-home pay, when you break it down by hour, doesn’t look so good. You start to envy all your friends who studied computer science who have cushy forty-hour-per-week jobs as programmers. Even your friends in finance and big law jobs seem to be working fewer hours than you—and they paid off their student loans ten years ago!

Around all of this you need to squeeze in yearly continuing education credits. You end up spending your vacation time in order to attend several education seminars just to keep your license.

The work is nonstop. It’s a raging river bearing down on you. You look forward to weekends not for leisure, but to finally catch up on the administrative work you need to do on the practice. Weekdays you’re too busy taking patients. You can’t start catching up on notes, paying bills, doing the books, and business planning until Saturday. Most of the weekend, you spend trying to cut expenses. You’re always trying to cut expenses.

The first thing you do after waking up isn’t brushing your teeth. It’s not coffee. Okay, maybe it is coffee, if it helps you trudge to the computer to check your bank accounts. You want to be sure all your payments cleared and you haven’t bounced a check. It’s a struggle just keeping the practice in the black. Payroll is an issue. Overhead is an issue. You have to make tough choices about which personnel to keep. You’re always pinching pennies around the office, sometimes for things as simple as office supplies.

You’re asking yourself, how did it come to this? Sure, you’re a physician and you’re getting by. You’re even making good money by objective standards. But you’re not thriving. You didn’t spend ten years in medical school and go hundreds of thousands of dollars into debt just to get by. You owe hundreds of thousands of dollars for medical school, probably have undergraduate loans, and racked up living expenses for ten years of schooling. You can be half a million dollars in debt easily by the time you open your practice. There’s no escape button. You can’t discharge your student loan debt. You can’t let the practice go under because your employees and patients are all counting on you.

You might have been okay with it if you were just making what you made last year—but you’re making less. And next year you’ll be making even less. And there’s nothing you can do about it except turn the wheels harder, see more and more patients. The insurance companies keep cutting reimbursements.

All of this is taking its toll. You can’t sleep. You’re always worried about where the next patient is coming from. Your reimbursements are going down. There are delays in reimbursements. (Sometimes they take a year to come in—that’s happened to me on numerous occasions.) You’re working constantly, with little time to spend with friends and family. Your spouse feels like they are becoming a stranger to you, as you miss your children’s birthdays and sports games. You cannot remember the last time you had a moment to yourself or your hobbies. All you have time for is work.

The financial pressures of the office, let alone