Author Topic: Mustachian post-FIRE primary care practices  (Read 5311 times)

Hamster

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Mustachian post-FIRE primary care practices
« on: April 28, 2015, 03:07:13 AM »
Quick version: I am curious if there are any primary care physicians out there who are semi-retired who have made a small low-overhead practice work as their 'retirement gig'.

Background: MMM mentioned this in his most recent blog post, so I figure there must be some of you out there.

I am a pediatrician, primarily clinic-based, although until recently I also did hospital work. I work full time at about 60 hours a week between my practice and some administrative positions I hold. I love time in the room with patients. I hate paperwork and politics. My 'not-for-profit' institution has hired a bunch of consultants who are encouraging the organization to take a very firm position against physicians working part-time, so I am strongly thinking about Plan B options.

I have enough money put away that I could probably FIRE, but I really don't want to stop working - I want to continue to 'work in retirement', but choosing a practice environment I would find more fulfilling.

My dream is to find a way to practice 20-30 hours per week, including paperwork, and dedicate the rest of my time to things I enjoy. I fantasize about the idea of getting together about 6-8 pediatricians who are all interested in sharing about 3 full-time panels, but the current regulatory climate seems like we would be swimming very strongly upstream by trying to do such a thing at a time when so many physician owned practices are selling out to massive hospital groups (like the one I am currently a part of).

I have read a bit about ultra-micro practices that don't bill insurance (although I suspect the ACA individual mandate has made that pool of patients quite small), as well as some 'direct primary care' or retainer-based medical practices like Qliance in Seattle that have an alternative model which I find appealing (I have no interest in concierge medicine that only caters to the wealthy), but I would love to know if anyone in the MMM community has direct experience in any such models, especially post-ACA.

Rural

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Re: Mustachian post-FIRE primary care practices
« Reply #1 on: April 28, 2015, 07:54:14 AM »
Any interest in rural living?  There are plenty of one horse towns out there that are a bit of a haul from the nearest sizable medical center.  Maybe go play Northern Exposure for a little while. :)


No reason it would have to be northern for this to work. The only problem with being a pediatrician coming to this area would be the number of people you have to turn down if you wanted to only work part time.

bacchi

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Re: Mustachian post-FIRE primary care practices
« Reply #2 on: April 28, 2015, 11:42:02 AM »
My 'not-for-profit' institution has hired a bunch of consultants who are encouraging the organization to take a very firm position against physicians working part-time, so I am strongly thinking about Plan B options.

The Bobs, eh?

What's the reasoning behind this? It's pretty endemic among most professions, from medicine to law to engineering.

Hamster

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Re: Mustachian post-FIRE primary care practices
« Reply #3 on: April 28, 2015, 06:33:22 PM »
I wouldn't be opposed to the idea of a small community - it is one of my fantasy alternative lives - but I don't think my family would go for it.

I am wondering more particularly about the feasibility of an independent practice in the current insurance and ACA environment - if anyone has been able to make that work, by accepting the tradeoff of lower income for a more pleasant practice environment.

Hamster

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Re: Mustachian post-FIRE primary care practices
« Reply #4 on: April 28, 2015, 06:37:52 PM »
My 'not-for-profit' institution has hired a bunch of consultants who are encouraging the organization to take a very firm position against physicians working part-time, so I am strongly thinking about Plan B options.

The Bobs, eh?

What's the reasoning behind this? It's pretty endemic among most professions, from medicine to law to engineering.

The ironic part is that it is completely counter to national trends. Physicians across the board are trying to work more part-time and regain some semblance of balance. I think a position like this is only going to make it hard for them to recruit and retain providers. By that time, though the consultants will have been paid and moved on, and we will be on to a new round of administrators - they typically look for new jobs every 2-3 years.

RootofGood

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Re: Mustachian post-FIRE primary care practices
« Reply #5 on: April 28, 2015, 09:19:35 PM »
Interesting concept.  House calls as a primary way of seeing patients?  Get a square credit card reader for your smartphone, go to where patients are.  Work M-Thu from 1 to 6 pm (when kids are more likely to be out of school).  Keep a minivan full of supplies.  Rely on technology to automate away most of the overhead tasks. 


Hmmm, conversion van with an exam table in the back.  Doc in a van.  Seems kind of creepy and low class, but hey, having a doc that visits you and can see you instantly is worth something, especially to busy jetsetting parents. 

Rural

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Re: Mustachian post-FIRE primary care practices
« Reply #6 on: April 29, 2015, 03:47:20 AM »
Any interest in rural living?  There are plenty of one horse towns out there that are a bit of a haul from the nearest sizable medical center.  Maybe go play Northern Exposure for a little while. :)


No reason it would have to be northern for this to work. The only problem with being a pediatrician coming to this area would be the number of people you have to turn down if you wanted to only work part time.
I didn't mean to imply that you had to move up north to do it.  I was referencing the old show Northern Exposure where a big city doctor moves to a small town (that in this case happens to be in Alaska or something).


Sorry, didn't mean to criticize, I loved that show, didn't mean to say you personally meant only North, just wanted to point out the options.


This discussion had me noticing: both the billboards in the small town south of here are advertising a pediatrician 40 miles and one mountain pass away (the nearest one, though).

Rural

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Re: Mustachian post-FIRE primary care practices
« Reply #7 on: April 29, 2015, 04:03:49 AM »
I wouldn't be opposed to the idea of a small community - it is one of my fantasy alternative lives - but I don't think my family would go for it.

I am wondering more particularly about the feasibility of an independent practice in the current insurance and ACA environment - if anyone has been able to make that work, by accepting the tradeoff of lower income for a more pleasant practice environment.


Too bad about the family attitude toward small towns. I don't know anything about how it works, but my doctor is an independent practice, just him. He does work full time. Must be going fairly well; he just move out of rental office space into a new building he had built.


A nurse practitioner has set up an independent practice at the foot of the mountain across the county - maybe 20 miles as the crow flies from my doctor, but 30 or more and over half an hour by roads. That's very recent, so I dont know how successful she'll be, but there was great excitement in that community and the surrounding areas, including the folks on the mountain, who are easily 50 miles from a doctor. She's in a storefront, either rented or belonging to her family - I believe it's rented, though.

ShoulderThingThatGoesUp

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Re: Mustachian post-FIRE primary care practices
« Reply #8 on: April 29, 2015, 06:56:31 AM »
I know some small communities will fly people from wherever to man their ERs. Not sure if your certifications would qualify you, but obviously they're desperate. So your family could live in the city and you could be a one-person show.

That said, what about a county of 30,000 or so? It's not a one-stoplight town, it'll have a grocery store, etc., but if it's sufficiently otherwise remote it might still be a good place for you to set up such a thing.

 

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