When Dr. Lisa Larkin started her practice in 2002, she traded in a stable, academic career for nightly call and a $150,000 business loan.
Today, the Cincinnati practice is thriving, with about 4,800 patients and seven providers who work as a team to provide comprehensive care. And Dr. Larkin is able to practice medicine on her own terms—providing patients with a medical home and offering her all-female staff of physicians the opportunity to work flexible, part-time schedules.
“I really have a model that's working great that I think both patients and physicians are really, really happy with,” Dr. Larkin said.
But getting to that point was a challenge. Dr. Larkin, who spent more than a decade working at the University of Cincinnati, decided in 2002 to strike out on her own and build an innovative practice. So with the help of her medical assistant—now her practice manager—and a hefty business loan, she started a solo practice.
For the first year, she worked 5 days a week and took call every day. She didn't make any money in the first 12 months. Even though some of her university patients followed her.
“It was a big financial gamble, but something that I really felt like I wanted to do to create a model that wasn't being done elsewhere,” Dr. Larkin said.
One of the big differences between Dr. Larkin's practice and most primary care practices is the length of patient visits. New patient appointments are 40 minutes and follow-up appointments are 20 minutes. On average, Dr. Larkin and her colleagues each see about 22–24 patients a day, not the typical 35.
To support coordinated care, Dr. Larkin subleases space in her office to a variety of subspecialists, such as gynecologists and cardiologists. She works with other providers to offer a group weight-loss program, monthly diabetes classes, and special lectures on health and wellness topics. She also distributes a regular e-newsletter and plans to expand access to the lectures through a podcast featured on her Web site.
The other focus of the practice is on customer service. Dr. Larkin said the staff aims to be as accessible as possible by phone and e-mail for billing questions, health advice, and appointment scheduling. The staff also tries to go the extra mile for patients when they run into problems getting insurance authorization for medications and tests.
Staffing was one of the areas where Dr. Larkin wanted her practice to be different. Rather than recruiting a full complement of full-time internists, Dr. Larkin made a point of looking for female physicians who were interested in part-time medical practice. The plan fit in to her goal of providing more opportunities for women in their childbearing years, and it turned out to be a recruiting advantage because the large primary care organizations in the Cincinnati area weren't interested in hiring part-time employees.
“I really want to make it work for other women,” said Dr. Larkin, the mother of two teenagers. “I believe that it can work. I believe that women bring tremendous things to the practice of medicine and really offer things different than men sometimes.”
Managing the schedules of several part-time employees isn't as straightforward as a traditional work schedule, but it can be achieved with effective communication, a supportive team environment, and creative scheduling, Dr. Larkin said. Currently, she is the only full-time physician in the practice; most of the other physicians work 2 or 3 days a week. In order to keep the exam rooms full and appointments running on time, the physicians plan their group schedule a year in advance, and they cover for each other when their colleagues are on vacation.
That type of teamwork and camaraderie is central to successfully creating a medical home for patients, said Dr. Eric Warm, an associate professor of clinical medicine at the University of Cincinnati, who is familiar with Dr. Larkin's practice.
In an effort to cover rising costs, Dr. Larkin has introduced an annual administrative fee in her practice. The fee—$75 the first year and $50 a year thereafter—covers administrative services not covered by insurance.