Physiatry Practice Management Resources

After residency, she worked for four years in a three-physician, hospital-owned practice in Augusta, ME. On call every third night and facing a grueling pace both in and out of the office, she felt frustrated and unappreciated. "For four years, all I ever heard was that I wasn't doing enough to earn my paycheck," Antonucci says.

Leaving that practice, she went to a rural health clinic, which local patients used when they didn't want to travel to their regular doctor. The discontinuity of care bothered her, and on one occasion, it almost caused her to give a child a medicine she was allergic to.

Her last job before opening up her micropractice was in a VA hospital, which she found a miserable experience, albeit a well-paid one. As she says: "I sat in a tiny room, and most of the patients I saw simply wanted their medicines, which the VA wouldn't give them unless they were examined by a doctor. But I didn't function as a doctor—I functioned as a clerk."

Today, Antonucci has put the bad memories behind her. Armed with cutting-edge technology ("I simply couldn't do what I'm doing without my laptop, cell phone, EHR, and all-in-one copy, fax, print machine"), she's able to do more with less. She finds it especially helpful to book her own appointments, permitting patients to get the time she thinks they need.

She also tries to accommodate her patients in other ways. "Generally, I see patients the day they call. That kind of flexibility is really the 11th commandment for micropractices."

Scott E. Clemensen, FP

Canandaigua, NY

Unlike Antonucci and Brady, Scott Clemensen started his high-tech micropractice straight out of residency training at the University of Rochester Medical Center (in NY)—or practically straight out. For two months while doing start-up research, he moonlighted at a nearby family practice, an experience that convinced him that that wasn't the style of medicine he wanted.

What did interest Clemensen was the chance to put Gordon Moore's ideas to work in his own practice. (He'd known the micropractice pioneer at Rochester, where Moore was on the faculty.) A self-admitted control freak, he didn't want the pressure he'd felt while moonlighting and in residency to see patients in 10- to 15-minute blocks. By controlling his own schedule, he could delve deeply into the compliance issues and other psychosocial issues that his residency training had prepared him for. "In a micropractice, you're not standing in the exam room with your hand on the doorknob," he says.

Most of his patients like the extra attention. But a small minority, Clemensen acknowledges, "don't appreciate a doctor asking probing questions. Ironically, they prefer the traditional practice model, where they can get their issues rubber-stamped and move quickly along."

Because he doesn't rubber-stamp, Clemensen has had to cap his medical practice at 300 patients—a mark he reached only four and a half months after opening his doors last September. (He practices, alone, in a 110-square-foot room that he leases from a physical therapy office.) He assigns prospective patients to a waiting list, for which he receives five to seven new calls each week.

A licensed acupuncturist (he received his certification this year) and part-time residency instructor, Clemensen limits his full-day office schedule to Tuesdays, Wednesdays, and Fridays. For two-hours on Mondays and Thursdays, he schedules acute visits. Because, like most micropractitioners, he believes in open access or same-day scheduling, he may start his full office days with only a few scheduled patients, but see as many as seven or eight by day's end. Patients have the option of making appointments online.