What's a Micropractice? PDF Print E-mail
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Clemensen estimates that his current income is roughly "70 percent of what an entry-level job in family practice would be." That suits him for now, given his other interests. But he knows that, when the time comes, he could easily increase his revenue. "Building this kind of practice from the ground up, you learn a lot about the economics of medicine," he says. "It's easy to see how to improve your efficiency and bottom line."

The IMP model—not just for soloists?

The benefits of ideal micropractices—lower overhead, better efficiency, more time for patient visits, enhanced physician and patient satisfaction—certainly make it a model worth investigating. But there are downsides, only some of which can be mitigated at this point:

  • Most of the doctors we spoke to said they're making less than they could in a traditional practice arrangement. For the model to become attractive to more physicians, the gap between IMP and traditional earnings will need to be narrowed.
  • Especially for start-ups, certain resources can prove expensive. Certainly, EHRs and practice management software fit into this category, which is why experts advise physicians starting out to lease systems or buy ones with very few bells and whistles. But the cost of telephone counseling and other patient-centered services can also prove expensive for a growing practice.


For this reason, Dartmouth's John Wasson has been testing the idea of a "confederacy of micropractices," which enables IMPs across the country to share resources like patient education nurses, thereby reducing individual practice costs.

  • A micropractice "isn't for the faint of heart," cautions Michelle Eads, who says that IMP doctors must learn to wear many hats in order to keep their overhead lean. Scott Clemensen agrees, adding, "Cutting overhead is a game you play every day. If you don't want anything to do with administrative duties, this isn't the kind of practice for you."


Besides being a jack-of-all-trades, an IMP doctor must also embrace technology, and not just grudgingly. "If you're not comfortable using a computer or doing some of your own IT management, you either hit a roadblock or you end up hiring people to do it for you, which increases overhead," says Clemensen.

  • Ideal micropractices are especially well suited to primary care, where open access leads to improved doctor-patient interaction, which, in turn, leads to better care. That kind of open access might be more difficult for specialty practices.
  • Finally, if the IMP model is going to have a real effect on outcomes and rising healthcare costs, it must expand beyond solo practices. "It isn't viable for every doctor in the country to go out and work on their own, nor is it the model we're proposing," says Gordon Moore. Instead, he'd like to see "larger practices that are aggregations of micropractices." These "micro teams" might be housed under one roof and share resources, but they'd function autonomously, managing their own time, patients, and overhead without the need for middle management.


Talk of "flatter" organizations and reduced overhead is music to the ears of a growing number of businesspersons—including the National Business Coalition on Health. "Businesses are interested in micropractices not only because they have a positive impact on their bottom lines, but because they encourage more collaborative physician-patient relationships," says Andrew Webber, NBCH president and CEO. "That yields better quality care and healthier, more productive employees."

Written by Wayne J. Guglielmo
Medical Practice Management Magazine


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