Eleven years ago, I escaped the drudgery of the corporate medicine hamster wheel to set up a solo family practice where I could be my own boss and practice medicine my way.
After 38 wonderful years as a family doctor, I am ready to retire. I hope to gift my practice to a doctor eager to be independent, well compensated, and enjoy a balance between work and life.
Who might be the right doctor? Is a recent family medicine graduate eager to carve out an independent niche? Is a physician tired of running on the hamster wheel demanded of all doctors working in corporate medicine?
After 14 satisfying years at community health centers serving Rhode Island’s neediest, I joined a small family practice group. Seeing patients every 10 minutes was not for me! Eleven years ago, at age 60, I exited that profit-driven business to establish Wickford Family Medicine. Although scary, my practice soon thrived.
I see patients in my office Monday to Thursday for a total of 35 hours and enjoy a 3-day weekend every week. With total control of my schedule, if no visits are scheduled at the beginning or the end of a practice day, I block those times, adding to my personal time away from the office. I typically perform clinical duties remotely for an hour or two daily.
Long patient visits permit me to work at a relaxed pace. Annual check-in visits are 55 minutes; routine follow-ups take 25 minutes. Patients love that they rarely wait to be seen. Notes are completed during appointments. Working at this laid-back pace makes a secretary superfluous. My office answering machine and cell record messages. Buffers between all appointments permit me to respond promptly. Patients make appointments through an online scheduler. Who needs a nurse when there is plenty of time to take a history, get vital signs or perform an ECG? I do all my own billing. As a sports fan, I reconcile claims for five hours a week while watching the Tour De France or the Celtics.
Extremely low overhead means that a very high percentage of my gross income becomes net income. Employed family doctors in Rhode Island bill $350,000 annually for their services and are paid a salary of around $200,000. My gross income is on par with other RI family physicians, but I net substantially more because I pay the salaries and benefits of neither a nurse nor a secretary.
I love being a family doctor, but the intellectual challenges can fuel burnout. For 16 years, I’ve balanced the rigors of family medicine with the straightforward practice of treating addiction. Opioid-dependent patients are challenging from a psycho-social perspective, but the destabilizing yo-yo of getting high followed by withdrawal, is soon stabilized by buprenorphine. Addiction medicine is easy and rewarding. Ensure patients are not using illicit drugs through regular drug screens and delight as patients resurrect their personal and financial lives! I’m a family doc to 80 percent of my 100 stable opioid-dependent patients; frequent visits make providing comprehensive care a breeze.
My EHR is intuitive and easy to use. Moreover, the doc who follows in my footsteps will have 650 complete patient charts making the first “get to know you” a snap!
My physician suite mate is astute. She is right down the hall, ready to consult when presented with a clinical conundrum. We co-own our condo and split the cost of medical equipment and supplies. She’s a skilled gardener who generously shares everything from tomatoes to figs!
My quality of life is outstanding. I leave work every evening only after every call is answered, fax addressed, a prescription delivered, then retreat to my home a mile away. The proximity makes it easy to see patients after hours, on weekends, and on holidays; I promise to see patients within 24 hours, but I go in less than once a week. Because all patients have my office, cell phone numbers, and business email, patient questions are often answered quickly without a visit.
Happily married with two nearly grown children, we live in a federal-style 1803 home in Wickford Village. We host two dogs and a cat, who wakes me at 5 a.m. In a typical week, I listen to two audiobooks and ride a bike (road and mountain) for two hours several times year-round. An avid gardener, I also delight in affixing antique stamps to postcards and sending them off. In the summer, I race weekly on a 22-foot catboat and love being out on Narragansett Bay.
Recent events remind me that life is a fragile gift. In 2018, a good friend and patient presented with hematuria. In July of this year, he died of metastatic bladder cancer. In August, my younger sister entered a long-term skilled nursing facility. At 71 years of age, I am ready to stop working,
I will miss the wonderful patients I’ve had the privilege to serve. Cookie lady who makes the world’s best chocolate chip and shares book suggestions. The best electrician ever. A high school teacher turned me on to thriller writer Daniel Silva. The young man who aspires to become the next Oscar Peterson. The inspiring entrepreneur, who’s been my patient for 25 years, started with nothing, worked two jobs, and recently bought a triple-decker to start his real estate empire. The MBA who shares insights on the markets.
My original retirement plan was to walk away on June 30, 2024. But I’d be abandoning patients who would struggle to find a new family doctor. Better to entice an able, affable and available physician to take over. Mine may prove a pipe dream, but could also be a dream come true for the right physician.
John Machata is a family physician.
Image credit: Shutterstock.com
Primary Care
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