Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, November 05, 2007

What Does "Solo" Really Mean?

Twice in recent weeks I've seen mention of "solo" docs...with multiple offices staffed by an assortment of PAs and NPs. One was a Medical Economics discussion of EMRs; the other was a recent comment about the inefficiencies of automated telephone answering systems for solo offices.

A practice with 1 doc, 2 NPs and 3 MAs may not be able to just pick up the phone, but it also doesn't seem to have much in common with my "solo" practice. Likewise, working out of two offices with 4 PAs and 3 NPs doesn't feel very "solo" to me.

Granted the practices above have only a single doctor in the practice, but the practices still have multiple practitioners. Perhaps we need a different term for "mixed level provider" offices owned and run by a single physician. Frankly, it seems to me that the practices above are misrepresenting themselves. Their management and financial issues are more in line with a single specialty small group practice, yet they're co-opting the "warm fuzzies" evoked by the words "solo practice" when they're really running is a full-fledged clinic.

To me, "solo" means "alone." One doc; one office. The rest of you: quit trying to convince patients you're offering the same thing I am.


At Mon Nov 05, 08:52:00 PM, Blogger rlbates said...

I agree with you! I am a solo plastic surgeon, no NP or PA, and only one office.

At Mon Nov 05, 09:01:00 PM, Blogger Dr. Rob said...

Agree - you are solo PCP. I don't think I would have survived without partners. I have a huge amount of admiration/pity for docs in your situation. I do really think it is the combination of solo and PCP that make you very much a dinosaur.

At Mon Nov 05, 10:03:00 PM, Blogger Dr. A said...

Well said.

At Mon Nov 05, 11:38:00 PM, Blogger Dreaming again said...

For the patient the end result is the worse.

If they have other practitioners in the clinic, the chances of getting to their own doc ... decreases with the number of people the doc hires in his place.

At least in a clinic with multiple doctors, the doctors each have their own patient load.

In this scenerio, the patient is told it's a solo doctor ...and then they get farmed out to people under him and only get to see their doctor 'when it's important' (yes, that phrase has been used!)

At Sun Nov 11, 03:52:00 AM, Anonymous Anonymous said...

You nailed it.

I saw that ME article & thought the same.

At Mon Nov 12, 09:04:00 AM, Anonymous Anonymous said...

As a nonmedical type person who seldom needs a doctor, when I make an appointment with one, he/she's the one I expect to see. Making an appointment with Dr. X but (without forewarning) being seen and treated by an NP or PA feels like a bait-and-switch to me.

The PAs, Nps might do better to start their own business and have a contract with a doctor for specific supervision and referral. Then, a PATIENT would have the choice -- whether he wants regularly to see second-levels or a doctor.


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