Learning to Fly


This is my new office.  I signed the lease for this property yesterday – another big step in the process of getting my new practice off the ground.  I should feel good about this, shouldn\’t I?  I\’ve had people comment that I\’ve gotten a whole lot accomplished in the 4 weeks since I\’ve been off, but the whole thing is still quite daunting.  Yes, there are days I feel good about my productivity, and there are moments when I feel an evangelical zeal toward what I am doing, but there are plenty more moments where I stare this whole thing in the face and wonder what I am doing.

I walked through the office today with a builder to discuss what I want done with the inside; it quickly became obvious that there was a problem: I don\’t know what I want done, and nobody can tell me what I should do.  Yes, I need a waiting area, at least one exam room, an office for me, a lab area, bathrooms, and place for my nurse, but since I don\’t really know which of my ideas about the practice will work, I don\’t know what my needs will truly be.  How much of my day will be spent with patients, how much will be doing online communication, and how much will be spent with my nurse?  I want a space for group education, but how many resources should I put toward that?  I also want a place to record patient education videos, but some of my \”good ideas\” just end up being wasted time, and I don\’t know if this is one of them.

I come across the same problem when I am trying to choose computer systems.  I know that I want to do that differently: I want the central record to be the patient record, not what I record in the EMR.  I want patients to communicate with me via secure messaging and video chat, and I want to be able to put any information I think would be useful into their PHR.  So do I build a \”lite\” EMR product centered around the PHR, or do I use a standard EMR to feed the PHR product?  Do I use an EMR company\’s \”patient portal\” product, or do I have a stand-alone PHR which is fed by the EMR?  I have lots of thoughts and ideas on this, but I don\’t really know what will work until I start using it.

Here\’s the real rub in all of this:

  • There\’s a large group of patients waiting for me to open my doors and take them in as my patients.  These people will need excellent care and all that goes into providing that care.  I am confident in my care as a doctor, but the doctor is only a part of the equation; there are referrals, labs, and other care-coordination services that need to be done.  If people are going to be trusting me enough to pay a monthly fee in exchange for better care, I have to deliver on that.
  • This must become a viable business.  I quit my other job, and now will rely on this new business to support me and my family.  The incredibly low overhead of it all helps a lot, but the final say of any business is this: do I offer a service that is worth what I am charging?  Decisions like how to redo the office, or what computer systems to use have a twofold impact on this: they impact the quality of the care, and they cost money.

It feels like I have been given the task of learning how to fly in three months.  But instead of taking flying lessons and flying in the conventional way, I have to build a whole new kind of airship from the ground up.  I need to design it, build it, and then learn to fly well enough to take passengers.  My ideas were good enough to take this challenge, and I have lots of smart people willing to help me, but I will be the one who has to make it fly.


That\’s scary.

Some of this is ego.  I wouldn\’t have quit my old practice for a new way of doing things if I didn\’t have the confidence to pull this off, much less write about it for thousands of people to see.  So when people give me advice, my ego wants to assure them that I know what I am doing.  I want to say, \”well, that may work for you, but I am doing something different.\”  But then there\’s the small fact that I don\’t really know what I want, so I should at least listen to any advice I get.

In the end, all that matters is that I give good enough care for my patients that they are willing to keep me in business. Keeping that reality in front of me as the center of my focus will give me the best chance to get this baby off the ground.  Once I am flying, it will be much easier to know how to improve it from there.

In the mean time I just pray that I don\’t crash.

15 thoughts on “Learning to Fly”

  1. Keeping you in my thoughts and prayers, everything is going to work out!!! We have the upmost confidence in you as a person and your decisions for our health care and have for over 15 years. Just keep on keeping on and things will work out , just wait and see I have no doubts!!!!!

  2. I have a suggestion for you to think about. You have probably already thought of and rejected it, but here it is:Get a small group of pre-alpha testers and just try something that you think will work and see what happens. The testers will know up front that it won’t be a smooth ride so they won’t be disappointed. Give them free months of care for twice as long as they are testers.
    I have no idea if there is a seed of anything helpful in this suggestion.

  3. Re: the place for recording patient education videos, have you considered your personal office being more of a multipurpose space and including that in your specs for it? I’m sure you have, but figured I’d throw that in there anyway. I work for architects and occasionally I start thinking I have a clue…

    I’m really impressed with what you’re working toward and with how much you’ve accomplished — looking forward to seeing how it plays out!

  4. The one person that could help you within the situation would be a nurse . They are used to ‘ running ‘ the areas , and should give good advice .

  5. When you succeed and the initial start up is complete (1-2 years), it might be interesting to franchise your approach- I am sure I’m not the only one out there who shares your vision. Good luck.

  6. I love the look of that place! That looks like a great choice. Knowing some of the things you don’t want, will help you figure out the rest. It’s scary, but I think you will do well.

  7. I am inspired by your endeavor and willingness to share your thoughts with the community. I believe the best approach to doing something new is to start before you are ready. Good luck!

  8. I have thought about this, but that’s getting way ahead of things right now. I first have to succeed to have a model worth propagating.

  9. Thanks. No doubt I just have to start doing it and then I’ll be able to figure out how to develop it further. I can only anticipate so much ahead of time.

  10. Yes, I want to have some way to record videos in my office with perhaps a convertible space that could be quickly turned to those needs. I am also considering re-entering the world of podcasting, although in a more natural format to what I did as the House Call Doctor.

  11. Yes! I will definitely do that with the software and am becoming convinced that bringing patients to the office to get their ideas will be prudent as well.

  12. As a longtime reader of your blog in its various incarnations, I just wanted to wish you the best of luck in this new endeavor! It will be interesting for your readers to see where exactly this goes, and I like the underlying concept of increased patient involvement that I see running through your plans. I admire your willingness to discard the old model and start from scratch; I don’t know as I’d have the necessary frame of mind to do that. Keep us posted whenever you can…

  13. Justoutofresidency

    I wish you the best of luck. You may very well be in the vanguard of my future.

  14. I got a designer experienced in medical office design involved for my second office. ( By then I had another doc with me.i) t was helpful in terms of placing sinks handicapped bathrooms etc.After previous experience, having given measurements of an exam table, and that I did not want the table aimed toward the door, in case someone were to burst in, I ended up with a room so small I had to sit on the windowsill to do a pelvic.You probably need 2 exam rooms to stay on time.

    The design of the place is limited by things like plumbing- the pipes determine where the bathroom and sinks can be, which orients the space. ( This is where the designer is a godsend)
    Whatever you do- ask for twice the number of electrical outlets and computer /DSL ports than you think you will need- it allows you to move the room arrangement around if needed. Make sure the apps offered are beyond beta testing.
    I saw the suggestion for sharing your office space- I find I need an office that I in which can close the door and concentrate ( sharing the ADD here- there are too many distractions with the computer, and constant questions from staff,)

    I noted the EHR you chose- or talked about before-ask around about support, and and hidden charges. We chose that one. We have discovered that whatever it is , there is a charge, and it seems to be at least $400.00. However, you have the advantage of being in a public forum. It is not as flexible as one might like

    I really admire your vision, and even more so with a growing family- best ok luck- we are all rooting for you!

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