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    How I built a successful medical practice in under seven years

    This author had a mountain of medical school debt, but he made savvy decisions that brought professional and personal satisfaction.

    2007 DOCTORS' WRITING CONTEST - BEST PRACTICE SOLUTION

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    Rock Springs, WY, is a beautiful rural town of about 20,000, with a mining community history. Although it's not a prime destination within the state, some key factors inspired me to start up my medical practice there. That turned out to be a wise choice indeed.

    In 2000, three internists had recently left Rock Springs, creating a clear need for primary care doctors. The town has one hospital, one urgent care facility, and a handful of primary care practices. The hospital was actively recruiting and offered a guaranteed income, not unlike what many other rural hospitals were doing.

    My motivations for staying somewhere in Wyoming were a mixture of business and personal. If I practiced in the state for three years, my medical school debt of approximately $110,000 (including interest) would be forgiven. This program was state funded through a contract program with Creighton University Medical School. Since I love living in rural Wyoming, that choice was a no-brainer for me. Yet I would still have approximately $86,000 in student loans.

    My next good move was in negotiating my contract with the hospital. I was committed to living in Rock Springs, although I had to convince my wife that this was the place for us. I negotiated an eight-year forgiveness of the approximately $220,000 borrowed against a two-year income guarantee from the hospital. This obligated me for several years but also spread out my tax liability. The arrangement proved to be a good idea; other solo practitioners with similar income guarantees with hospitals in Rock Springs have struggled to pay back the money.

    To help supplement my private practice income, I also worked for a year in the hospital's "Miners' Clinic," a state-funded facility where retired miners are treated. That brought in $1,000 per week to supplement my private practice income.

    I'd been raised in Wyoming and had recently finished a residency in Casper. People in Rock Springs welcomed me as a local boy coming back to practice medicine. (Having the surname Hunter probably didn't hurt either, since hunting is a big part of Wyoming culture.)

    My EHR gets much of the credit

    I started using an EHR on my first day in practice. This ultimately turned out to be one of my best decisions. I happened to get a demo disk for e-MD's EHR software from a fellow resident who'd picked it up in Florida at a conference. I watched the demo, was impressed, and was able to buy the software bundle for $1,250, complete with the charting, billing, and scheduling modules. This system was relatively new at that time, and I felt it was a risky selection, but it's now one of the top-rated EHRs on the market.

    I had some challenges implementing the system, but overall, it has gone remarkably smoothly—with the help of my trusted IT professional. I credit this EHR for much of my success. It enables me—and my four PAs—to practice excellent medicine, with great efficiency and very high volumes of patients per day. Each PA sees about 40 acutely ill patients daily, and I see the more complicated cases—usually about 15 per day, with visits lasting 20 to 40 minutes. The EHR has grown with us and continues to improve, as updates are offered.

    Right from the beginning, I had plenty of patients. But I quickly learned that quantity alone doesn't guarantee success. In fact, it can even work against it.

    It took six months for me to incorporate Medicare patients left behind by departing internists into my practice. I employed one of their nurses, which turned out to be another good decision. This nurse—a 17-year veteran—was quite competent and very well liked. Patients followed her to my practice, which now included me and an inexperienced office manager who doubled as a receptionist.

    Although I had an income guarantee, I had completely used it up after six months. I used $100,000 up front for capital expenses, most of which went to get my EHR up and running. I was as busy as I could be seeing Medicare patients with complex needs, but I could see that I would not be able to pay my bills.

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    Kurt Hunter, MD
    Family Physician/Rock Springs, WY

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