Pulse
Is Solo Simpler?
A Coon Rapids obstetrician/gynecologist leaves a big practice and its bureaucracy to strike out on his own.
John Wust, M.D., is in some ways like the settlers who hitched up their horses and headed west. Only his frontier is his independent obstetrics/gynecology practice in Coon Rapids, and his Conestoga wagon is the health information technology system that runs on his network.
Two and a half years ago, frustrated by his inability as president of Multicare Associates, a Twin Cities medical group with three clinics, to make the kinds of business and cultural changes he felt were necessary for success, Wust left to create his own kind of practice. His core beliefs were that less could be more, and that technology could allow a small, independent clinic to compete in a health care game dominated by big players.
Although it looks from the parking lot like any other small clinic, the practice Wust created, Northern Ob/Gyn Associates, is different. It has no support staff, no medical records personnel. There is a receptionist nook but no receptionist. The four people in the office—Wust, his partner of six months, James Buss, M.D., a licensed practical nurse, and a medical assistant—all answer the phones. And there are networked PCs hardwired in every exam room, which keep Wust and Buss apprised of all aspects of the practice, from who is due for a colonoscopy to whether all implanted IUDs have been paid for. The records system provides instant, unlimited information on quality, history, and cost.
When asked whether running such a practice is simpler or more complex than overseeing a larger one with support staff, Wust laughs. “It’s both,” he says. “It’s simpler in terms of the systems that make up the immediate practice. Fewer people work here.”
But practicing in this way also makes more demands of Wust and his employees. For instance, his LPN learned to create Excel spreadsheets, download patient lists, and print labels. “It makes everyone’s job more interesting, and it has the result of making individuals more marketable because now they have management and administrative skills that others out there don’t have,”
he says.
But obviously, there is a lot that needs to be attended to. Wust himself must doff the cap of physician from time to time and get involved with bookkeeping, human resources issues, training, and systems troubleshooting.
“The EMR was the hardest part,” he says, acknowledging that the early days of installation, configuration, and aggravation were dark ones. “Like everything in life, you underestimate its difficulty. But once you figure it out, it solves all kinds of problems. The software performs internal quality surveys for us, and process conformance is fully automated.”
Once the systems were in place and working, everything changed. Paper charts went away. All prescribing is now done electronically. If a patient needs a certain screening, the system reminds the physicians. And at billing time, it automatically generates invoices.
From Bureaucracy to Babies
John Wust’s journey into medicine started when he became frustrated working as a chemical engineer for Exxon in his native Louisiana back in 1984. “In the energy business, there isn’t much of a sense of mission beyond meeting profit goals,” he says.
He wanted a career where he could directly touch the lives of the people he served. Wust studied medicine at Louisiana State University in Baton Rouge, did his residency in New Orleans, then moved to Minnesota in 1996 because of the opportunities for OB/GYN physicians here.
His desire to be independent developed gradually. As president of Multicare, he became interested in clinical office design. He wanted to find better ways to handle details that could bog down staff and take time away from patient care. Gradually, the idea of a technology-driven, Internet-based practice began to gel.
Virtual Partnerships
Wust understands that to many physicians, his do-everything-yourself approach to medicine is a little off-putting. And, he says, it’s a mistake to think of him as a one-man band. “An independent practice can’t be completely independent. In truth, we have to partner more than anybody,” he says. “Ideally, we take all those functions that are not central to our mission, and we pass them along to partners outside the organization.”
The practice relies on outside sources to handle everything that is not what he considers a core competency. A bank in Minneapolis handles financial duties, a St. Cloud company does the Internet-based data hosting, an asset management firm in San Francisco manages the practice’s 401k plan, accounting for the 401k is done in Mankato, and IT and back-office support are handled by a firm in Plymouth. He says insurance companies act as his accounts receivable partners. “They collect money far more efficiently than we ever could,” he says, adding that the practice- management software tracks whether patients’ co-pays and deductibles have been received.
Taking on Buss as a partner last year was a major decision. “A clinic with nine doctors that adds a 10th increases its practice capacity by just 10 percent. But a practice of one doctor that adds another doctor boosts its capacity by 100 percent,” Wust says. “But I talked to some older physicians, and they said I should go for it, that it was good to work with someone else. And they were right.”
By staggering their work schedules, Buss and Wust allow the clinic to stay open from 7:30 a.m. to 7 p.m.—10 more hours per week than during Wust’s solo days.
Although the clinic isn’t comfortably in the black yet, Wust, who has delivered more than 200 babies with Northern Ob/Gyn, thinks that too much success could threaten the kind of lean practice he has fashioned. Should his caseload suddenly grow, he might be obliged to hire people to run the front desk and back office. Although such growth would constitute conventional success, it would sound a death knell for his micro-practice dream.
Wust acknowledged that there is one major shortcoming to running a nearly solo practice: the hours. He says it’s been hard to find time for a vacation.
Still, he has no regrets. “I would do it again if I hadn’t done it. But I wouldn’t do it again,” Wust says, smiling. “It’s a great experience for a physician to have, but it’s just not an experience you want to repeat right away.”—Mike Finley