30 Years Solo: Advice From a Doctor on Staying Independent

By Thomas Miller, MD

I run a small, independent practice out of Arlington, Texas. And when I say “small practice,” I mean that it’s just me—along with my nurse and my administrator who runs the front desk. We serve everyday people in the greater Arlington-Dallas area, and most of our patients are regulars. Sometimes we see multiple members of the same family.
Next year will mark my 30th year in private practice, and I intend to keep practicing this way. I love what I do, and I love taking care of patients who are part of my community. However, it is no secret that remaining independent gets harder each and every year, with the coronavirus pandemic and the national shutdown of the economy leading to an unprecedented level of consolidation. From medical firms buying up practices, to hospital buyouts and health system mergers, being independent continues to be a balancing act of grit and reward.

However, my practice—despite tightening reimbursement prices and wild economic times—is doing quite well. Here are some tips I’ve learned over the years, all of which are founded on a simple philosophy: Caring for patients and providing good service is the primary goal. Happy, healthy patients are the financial lifeblood of any independent provider.

Operate on a single system

I was an early adopter of electronic health records (EHR), purchasing one for my practice in 2003. I’m a big believer in EHRs, but no practice should hastily adopt them. When the EHR I was using went out of business, I was in the market for a new one. But I wanted to be sure this EHR “played nice” with my practice management system and the other tech in my practice.

Over the years, I have run into situations where practice management software won’t pull information from the EHR, or a document I need to fax can’t seem to be accessed. It’s a serious hassle because all of that lost time fighting with machines results in revenue loss and patients not being seen. To make matters worse, calling customer support will just have all of these technology vendors pointing fingers at each other. It’s not a fun time. I do not recommend it.

What I do recommend is that small practices consolidate their technology use. My chosen EHR, patient portal, and practice management suite—including faxes and billing—are all services provided by a single vendor. Uniting everything this way ensures smooth operations and frees up time for me to see patients.
Further, the patient portal allows patients to fill out paperwork in advance of visits and generally makes scheduling easier. This makes them happier and gives me time to see more of them. And the more happy patients I get to care for, the healthier my practice.

Embrace telemedicine

Despite being the type of guy who embraces technology, it wasn’t until the pandemic hit that I adopted telemedicine out of necessity. I was seeing fewer patients in-house, and this was a way for me to reach them and provide them with care from anywhere.

Now, I’ll never not use it. Telemedicine has become a great source of revenue for my practice, allowing me to see patients anytime from anywhere—even after hours. From a laptop, tablet, or phone I can access the app, examine and talk to a patient, and develop a care plan. Telemedicine is easy for them, it’s easy for me, and no independent practice should be without it.

Automate claims and billing

My biggest headache has always been claims billing. Small practices like mine feel the squeeze of the song and dance with insurance companies over prices. Then, when it comes time to be reimbursed, practices can run into a myriad of snags: a claim is misfiled, a patient’s insurance has expired, not all delivered care is being billed, etc.
My recommendation is simple: Automate your claims. Each day at 7 p.m., my practice management system automatically pulls all the information from the EHR and sends claims out for reimbursement. This saves my staff time and reduces errors, which adds up to more time to spend with patients.
And spending time with patients is the goal. As doctors, it’s our job to ensure our communities are healthy—and the best care comes from independent practices. While the struggle is real and staying independent will remain a challenge, hopefully some of what I have learned can help your practice to thrive.

Thomas Miller, MD, is a family care physician who owns his practice.