Are the Rewards (and Hassles) of a Micropractice Worth It?

Neil Chesanow

Disclosures

September 28, 2016

In This Article

Start Your Own Practice? Today?

"Many doctors sustain trauma when they begin to practice medicine," says Pamela L. Wible, MD, a family physician in Eugene, Oregon. "You keep thinking that after medical school or residency or when you start your first job, it will get better. But for lots of doctors, it never gets better."

This is how Dr Wible often begins her motivational lectures. Her target audience is family physicians, internists, and pediatricians who contemplate leaving the group practices where they are employees—and where their professional lives are unfulfilled—to start their own small primary care practices, called "micropractices," with the belief that it will help them rediscover the joy of medicine.

With small and solo primary care practices thought to be dying out, it might seem counterintuitive to consider starting a practice of any size as a career move today. But because micropractices are so small, they are under the radar of acquisition-minded larger organizations. Dr Wible and other physicians who have started very small practices say that meeting overhead expenses is generally not a problem. She and her colleagues contend that it isn't hard to match the salary that some doctors earned before as an unhappy employee.

What Is a Micropractice?

What makes a micropractice "micro" is primarily the number of patients. Family physician L. Gordon Moore, MD, who is considered the father of the micropractice movement, began a very small primary care practice in Rochester, New York, in 2001, while concurrently holding an administrative position at a health system and serving on the faculty of the Institute for Healthcare Improvement. After 7 years of practicing part-time, his panel had grown to about 675 patients.

Dr Moore has since become senior medical director of Populations and Payment Solutions at 3M Health Information Systems. His mission, he says, is the same one that inspired him to start a micropractice: "How do we create an environment where care delivery can be brilliant even for average clinicians?"

Many micropractices are direct-pay primary care (DPC) practices, in which patients pay cash for services rendered, although some DPC practices offer discounted monthly, quarterly, or annual payment plans. Other micropractices take commercial insurance as an in-network or out-of-network provider. Some only take Medicare or Medicaid; others accept both.

Dr Wible has a hybrid practice. She accepts cash from patients who lack insurance or are in high-deductible plans, and copays from patients with low-deductible insurance.

The other feature of a micropractice is that overhead expenses are kept to a bare minimum; these include staff, office space, equipment, and other elements of a physician's office. In some micropractices, the physician works alone, without any other staff.

Robin Dickinson, MD, a family physician in Englewood, Colorado, began her micropractice in 2012 with a goal of building it to 750 patients. Family illnesses forced her to practice part-time and revise her initial goal. "I now have about 200-300 patients at any given time," she says, "but it's right for my situation."

Dr Dickinson is the administrator of a Facebook group for DPC physicians, some of whom are in micropractices. "Most aim for 200-1000 patients," she says.

How many micropractices are there? No one knows. On the basis of dozens of responses he received to a pair of articles he wrote about his experience starting a micropractice, which were published in Family Practice Management in 2002, Dr Moore guesses that the movement probably numbers several hundred primary doctors across the country.[1,2] But that perception is purely speculative, he told Medscape.

Family physician Matthew J. Priddy, MD, chairman of the American Academy of Private Physicians, a trade group, estimates that about 5000 DPC and concierge physicians are practicing nationwide. Doctors in micropractices are generally considered a subset of this group, but how large a subset is anyone's guess.

Can a doctor make a decent living caring for very few patients, some of whom may be of limited means, without charging concierge fees aimed at the affluent? Can potential earnings justify the startup costs of even a very small practice? Won't patients be calling night and day for every little thing? Let's take a look.

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