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It's about time, say doctors in vanguard

With `micropractices,' they give patients better access and cut overhead costs.

July 10, 2007|Kathleen Kerr | Newsday

MELVILLE, N.Y. — In a 150-square-foot tin-ceilinged office in a building that once housed a speakeasy, Dr. Moitri Savard checks her laptop to see whether any patients have scheduled themselves to see her.

Wait, scheduled themselves?

Yes. Savard's patients decide when they want to see her and then let her know by filling in a date and time on a calendar on her website. Patients with no computer access can phone for an appointment.

Savard, 36, a graduate of the Stony Brook University School of Medicine, is in the vanguard of a small number of physicians who are experimenting with a new family-practice business model.

It's called a micropractice.

Savard has no nurse but shares a receptionist with several other solo practitioners and does her own paperwork. Mostly, she runs her office electronically -- lowering her overhead because she has no salaries to pay.

She keeps patient files on her laptop and will soon be billing electronically too. She uses software to process insurance claims. Patients make their own appointments on the website, and she fits her schedule to meet their needs.

One more thing: Savard estimates her income will remain about 10% less than if she were in a group practice with a full staff, which is just fine with her. She makes her own schedule and works four half-days a week.

"I'm not being controlled and being told when I'm on call," Savard said during an interview in her Queens office. "I don't think I could ever go back to group practice."

Savard rents a long, one-room office from a chiropractor. A Japanese-style shoji screen in the office provides privacy for patients in the examination area.

An acupuncturist, a physical therapist and a massage therapist also rent space from the chiropractor, and together they call themselves QueensWest Health & Wellness. Despite sharing a receptionist, they have separate practices.

Savard began establishing her practice last fall and has 200 patients so far. (The average family doctor has 2,500 patients, one expert estimated.) Before her micropractice, she worked as a salaried doctor at a group practice.

Savard said she now had more time to spend with her 3-year-old son, Milan, and her husband, Peter, who also is a physician and a Stony Brook medical school graduate.

Savard started her micropractice after reading an article by Gordon Moore, a doctor in Rochester, N.Y. Moore says micropractices give patients "unfettered access" to doctors at a time when some physicians have overloaded their practices with multiple employees and too many patients.

"There's nothing new under the sun here," Moore said. "We've got the Norman Rockwell thing going plus the software."

Moore said a key element of the micropractice is time management and keeping patient loads manageable.

Moore, 46, was in a group practice for seven years before switching to his family micropractice with 400 to 500 patients. Now, he said, he is not making as much money as before but is "making a very good income" without shortchanging patients on time.

Ten minutes for an appointment "is inadequate," Moore said. "Half an hour is good. It gets us back to the caring that a lot of doctors got into it for."

A push for high income is one reason some doctors take on too many patients, Moore said. "The expectation is set pretty high," he said, noting that doctors with micropractices often have lower income targets.

Moore says that there is a network of about 425 known micropractitioners across the country but that there are probably many more who don't participate in the network. He has taught many doctors about the benefits of using software to manage scheduling, billing and insurance.

"You do have to understand the crazy system that's been set up for how insurance is billed," Moore said.

Dr. Bruce Bagley, medical director for quality improvement at the American Academy of Family Physicians in Leawood, Kan., calls Moore "the spiritual leader of the micropractice movement."

Bagley said he wasn't sure micropractice was the answer for all family doctors.

"It's one mode of practice; it's what's called a low-overhead practice," he said.

If all family doctors were to convert to micropractices and limit their patient loads, there wouldn't be enough physicians to go around, he said, given what he cited as an average load of 2,500.

"It's hard for us to support that as a solution to the nation's healthcare problems," Bagley said.

Still, Savard is enthusiastic. "My patients are incredibly respectful. They know when they call, they're getting me."

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