A year ago today was the "official" first day of my new practice, which makes today either our birthday or anniversary.  I'm not sure which one.  Either way, I guess we should have cake.

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On February 5 of 2013, frustrated with a delay in the inspection of our construction (and after a few angry words with contractors), I decided we'd turn our misfortune into an opportunity by making house calls to our first two families.

A year ago today, I was frustrated and frazzled at the time it took to get our office remodeled and the extra money I had to spend in the process.  I left my old practice with some resources, but it was more like a cast iron parachute than a golden one.  As we left for our first patient encounters, I was in significant debt and without a clear idea of when I'd get my first paycheck.

A year ago today we were totally unsure of how and where we would keep our medical records.  I had invested money and training into a "meaningful use certified" product that ended up being far too devoted to finding procedure codes and far too little to helping me give better care.  I was toying with several other systems, and would try a few more before deciding to build my own.

A year ago today was an exciting day, but it was quite terrifying.  Perhaps I was entering the promised land of health care - care centering on the needs of the patients, and care freed from the life-sapping demands of third-party payors.  But to enter this promised land meant that I had to turn from a wanderer in the wilderness of health care to an army that could overcome my own doubts in my ability to run a business that was quite different from any I had seen.

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A year ago today I had no clue as to the struggles, the doubts, the headaches, the heartburn, the restless sleep, and the fear I would face in the next 12 months.  I headed into my new life with faith that I'd be given the strength to get through the battles ahead, but I learned that I absolutely hate having to have that faith; I'd rather know what the future brings and be in full control of it.  Faith meant that I just could only push on ahead through each day's battle as it came to me.  Looking ahead meant taking my eyes off of the task at hand.

So where are we compared to a year ago today?

  • It's still just me and my nurse, Jamie.  After much deliberation and discussion, we do think we need to add a third member to our staff. 
  • We are now at about 420 active patients, which is made up of approximately 220 monthly paying accounts.  I am very surprised we are able to handle these numbers with just two people.  Maybe I need to buy Jamie a cape.
  • Practice growth seems to be accelerating as word of what I am doing spreads, and as those watching from the sidelines are assured that this experiment won't crash and burn any time soon.  January was one of our biggest growth months so far, fueled, apparently,  by a video of the news story we did in September going viral among locals on Facebook.  
  • Patient satisfaction still seems quite high, with a very small percentage of people who pay their first monthly payment canceling it.  

There are huge challenges ahead.  I do not feel yet secure the future of this practice.  It seems the task of sustaining and growing a business is every bit as difficult as that of starting that business.  Growing the business without decreasing the quality of the experience is a huge challenge, and my goal is to improve the quality of the experience, not to simply stay put.  In the next 12 months I plan to implement (or at least move toward implementing) the following:

  • I want a unified communication experience for my patients.  Right now we are using several different venues to communicate, all of which require their own password.  I want one log-in to rule them all.
  • I want that communication to be embedded in the patient's record.  I want that from our end as providers, but also for the patients as they ask questions and seek advice.
  • I want to do more for education of my patients.  So much of our energy has been spent on building the infrastructure of the business that I've not had nearly enough time to work on one of the key components to my practice: education.
  • I want to begin going over each person's history, current conditions, and risk factors, giving them a summary of their care up to now and a roadmap for their future care.  My goal is to help people avoid problems by reducing their risks.
  • I want to grow to the point where we can encourage other physicians to make the change to this practice model.  I want physicians to look at our practice, and others doing the same, and to see just how much better it is for both patients and those of us lucky enough to work in this model.  

A year ago today I was excited, nervous, and totally clueless about the road that lay ahead.  A year later I am still excited, less nervous, and OK with my cluelessness about the future.  My job is to work on the stuff I've got in front of me now, leaving the future to open up as I make this new land a home for me and my patients.

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