Managing a small practice

Answers in Practice

Elizabeth Jacobson, MD

Elizabeth S. Jacobson, MD, talks discusses managing a small practice while ensuring quality and timely patient experiences.

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Dermatology World: Tell us about your practice.

Dr. Jacobson: Inverness Dermatology & Laser now has three physicians, Shellie Marks, MD, Kathleen Beckum, MD, and me. We also have one physician assistant, Mary Beth Templin, PA-C, and 17 amazing staff members. Our practice sees about 150-180 patients per day. This number will increase as our third physician builds her practice.

Dermatology WorldYou were in a multi-specialty clinic for about seven years before starting your own practice. What inspired you to go the private practice route?

Dr. Jacobson: I was hesitant to go out on my own because I was not experienced in business and was busy with three children, including a new baby. My former practice had wonderful patients and I enjoyed having interaction with the other multi-specialty doctors. However, I wanted to run a smaller practice where I had better control. The multi-levels of management of my former practice made improving efficiency difficult and I was extremely frustrated with the infrastructure of the practice.

Dermatology WorldWhat challenges did you encounter in creating your own practice?

Dr. Jacobson: In the middle of the recession — when obtaining financing was no easy task, even for a physician — we built a building and started a practice. At first, my top priority was getting patients to come to me. What if no one came?! We had our first and only employee scheduling patients on Yahoo scheduler from her cell phone before we had a building completed. We did everything from the ground up which was a lot of work and 24/7 for about two-and-a-half years. I even designed our first website (and I am not a computer person). We planned that I would not expect a salary for the first six to eight months. It was hard work and great fun designing the building, developing the practice, and deciding how we were going to do things.

Dermatology WorldWhat are the advantages and disadvantages of running a small practice?

Dr. Jacobson: The advantage is that you get to do things the way you want to do them. You get to try out your ideas and decide how you want to run that practice. That concept makes it sound like you are carefree and living the dream, but it actually comes with daunting responsibility. You really have to structure your practice to work well for your patients and your employees which is no easy feat. When it’s your practice you’re the one who always takes a pay cut when the money is short, you’re going to be the one who works extra hours or days when nobody else wants to, and you’re going to be the one to worry about the overflowing toilet when everyone has gone home on Friday.

Dermatology WorldHow have your hours changed since moving to a private practice from a multispecialty practice?

Dr. Jacobson: I absolutely work longer hours. I’m doing more things on weekends and at night. When I am on vacation or choose to take a day to be the Mystery Reader at my child’s school, I am all too aware of the financial impact of my time away from work. My husband, Keith, is the practice administrator, so it could be 8:00 pm and we’re trying to watch Downton Abbey and I say “maybe we need to change this on the website” or something like that. It’s really part of our day-to-day life. Our kids observe us working together as parents and business partners and I think it is a unique situation for them as well.[pagebreak]

Dermatology WorldHow do you and your other physicians ensure the practice has appropriate coverage?

Dr. Jacobson: It’s very rare that one of us has to be out due to illness, but if that happens we just cover each other’s patients as best we can that day. We always try to have an MD in the office so the other physicians and I are almost never out at the same time. We don’t go to the same meetings for coverage reasons. We don’t take the same time off. We’re very good at working it out. We never have an issue where we all need to be out more than one or two days.

Dermatology WorldHow do you handle the administrative workload (meaningful use, PQRS) with a small staff?

Dr. Jacobson: I found that if you can get the providers on board for the changes with the right attitude, then the staff follows as well. For example, when we switched to a new EHR system, we were able to switch completely from our old method of scanning our notes, to learning and implementing our new system in two weeks with no schedule reduction. It was a painful two weeks but we have benefited greatly from the change. It was having the right attitude and saying “we’re going to do this and it’s going to be great” and our staff followed this positive example. A provider that’s resistant and has a negative attitude about change will negatively influence the staff and lead to failure implementing a new idea.

Dermatology WorldWhat are some time-management tactics that you and your staff employ?

Dr. Jacobson: We play with the scheduling quite a bit to make improvements to the clinic flow. There are not a lot of static decisions. We are always changing, always evolving. A week doesn’t go by where someone doesn’t say “should we try this or perhaps change that?” We have “idea” contests in the office. Everyone comes up with three ways to improve the patient experience or an office process and if we implement your idea you win a gift card or pair of scrubs and are recognized for your contribution. I’ve practiced for 12 years, and staff comes up with things that I cannot believe I have not done before. For example, one of our employees suggested that we make the intake sheet follow exactly the questions on our EHR so we’re not skipping around entering information. It is a simple and easily implemented idea and it greatly increased our speed in triaging patients. Also, someone suggested we make all the emails from the website go to everyone on a single email so that anyone who has a few minutes can address a couple of emails. These are simple things that have made huge positive impacts on our practice!

Dermatology WorldHow do you gauge patient satisfaction?

Dr. Jacobson: We occasionally survey patients on how can we make things better. We do receive complaints from patients and we try to use these complaints to make positive changes. We also get very nice comments and notes from patients and we put them in an album in a lobby. I think that is wonderful for new patients to start out with us with the thought that they will be treated well and that we truly care about them.

Dermatology WorldAs a small practice, what type of marketing do you employ?

Dr. Jacobson: Having patients sent to us by word of mouth is our favorite way to get new patients. They are already coming to us because a current patient is happy with our care and that starts us out on the right foot. Nothing promotes our practice better than a current patient saying, “I really liked them. You should go to them.”

Dermatology WorldWhat is the key to running a successful small practice?

Dr. Jacobson: In addition to practicing medicine, while running a business you have to wear two hats and that’s very difficult without having a really great staff that you can rely on who pay attention to details and care for your patients. Without my office manager of seven years, Lindsey Schoenfeld, who manages our employees, billing, and basically every detail and hiccup in our day-to-day operation, we couldn’t have the business we have today. My husband — as the practice administrator — does the banking and accounting, dealing with vendors, managing banking issues, paying bills, managing employee benefits like our 401(k), profit-sharing, health insurance, etc. He is excellent at managing this practice as a successful business. I believe that our practice is one of the most efficient and well-run practices. We are very good about staying on top of things and making sure that we are running things as efficiently as possible without cutting corners in providing excellent dermatologic care for our patients.

Dermatology WorldWhat advice would you give a physician considering starting their own practice?

Dr. Jacobson: I would recommend that everyone start at an established practice because I think you must first develop confidence in your clinical skills. It is also crucial to see how businesses are run because we’re not taught that in residency. I really benefited from having several years of observing the management of my former practice and developing my own ideas about how I wanted my practice to be.

Dr. Jacobson is in private practice at Inverness Dermatology and Laser in Hoover, Alabama.