Dr. Elaine C. Jones
Dr. Elaine C. Jones, a colleague of Dr. Kinsella’s on the AAN government affairs committee, has taken a somewhat contrary path to getting satisfaction out of her practice by moving from an academic setting to set up her own solo practice.
She began practicing in the late 1990s at a large multispecialty group based at an academic hospital in Providence, R.I. By 2001, she was chief of neurology, but she felt as if the responsibility was not matched by an equal level of decision-making power. She decided that by going solo she could cut out the middleman on issues concerning staffing decisions, expenses, program development, and office renovations.
She consulted with other physicians in private practice, read up on various publications from the American Medical Association, and relied on her boyfriend, who had banking experience and a law degree, all of which helped her to decide which business model to use. She hired attorneys to help file the necessary paperwork to set up the practice. The hardest decision was naming the practice; she decided on Southern New England Neurology, with an eye on expanding in the future.
In 2005, Dr. Jones opened the practice in Bristol, R.I., renting space in a primary care practice building. Reaching this point had taken $40,000 in personal savings, $50,000 from a home-equity credit line, and a $30,000 equipment loan. Within 6 months, she had covered her costs, and within 18 months she had paid off the loan and was paying down the equity line.
An important initial investment was an electronic health record system, Dr. Jones said.
She began by working just 4 days a week, which gave her time for personal pursuits. But 3 years in, she had outgrown the space and the increased patient volume was taxing her existing staff. Dr. Jones was afraid to leave the bosom of the primary care group and its built-in referrals, but it had no additional room, so she decided to buy a property. She purchased a duplex and invested in extensive renovations, which took about a year to complete.
She has found private practice to be very rewarding because it gives her control over her scheduling, hours, and staffing, and no one is standing behind her pushing for an increase in productivity. But it requires a lot of focus on managing expenses.
In 2010 and 2011, Dr. Jones had a decline in reimbursement, but her patient volume was increasing. There are only so many patients she can see on her own, so she looked for ways to cut expenses and increase income. Accounting, for instance, had gone up to 20% of her expenses. She dismissed her bookkeeper and now does her own books. The health plan cost had increased by 8%, so when the policy came up for renewal, she found state incentives for small businesses, which allowed her to reduce that expense.
Initially, she had an experienced nurse practitioner on staff who helped maintain or increase patient volume. But her salary was more than she could bring in independently, so Dr. Jones decided to let her go.
She’s found ways to bring in new revenue – for instance, by offering botulinum toxin injections for chronic migraines and punch skin biopsies. Dr. Jones said that participating in Medicare’s incentive programs for meaningful use and electronic prescribing have also boosted revenue. "It’s a lot of work, and it changes how you do things, but it is a revenue stream," she said.
With demand outstripping supply, neurologists will continue to be in demand, but the Affordable Care Act and other pressures will still make it hard to practice, Dr. Jones said. She’s considering taking on some coverage with some local hospitals, but added that she’s "not thrilled with working harder" or on more nights and weekends, although she is not ruling out this option.
Nor is she ruling out selling her practice and getting out of medicine all together.
"The most important thing is, you have to pay attention and be limber and adjust your models as things change," said Dr. Jones. But, she acknowledged, "I don’t know if I’ll still be in neurology in 5 years."
Dr. Kinsella disclosed that he owns stock in Rural Healthcare Logistics and is a subcontractor for Premier Service Network. Dr. Jones had no disclosures.
*Correction, 7/13/2012: An earlier version of this story misstated Dr. Kinsella's professional position.