Fresh out of his residency training in family medicine, Jerad Widman hung out his shingle in Spring Hill and prayed for patients.
By ALAN BAVLEY
The Kansas City Star
Two came through his door that first day back in March 2005. Widman now sees two dozen or more patients each day. Hes the only doctor in this town of 5,600 about 11 miles south of Olathe.
But Widman, 40, is barely treading water financially.
The system is stacked against me, he said.
Making it today as an independent primary care doctor is tough enough. For the dwindling number of doctors like Widman who practice solo, it has become a constant struggle.
Thirty years ago, more than 40 percent of all physicians were in solo practices, according to the American Medical Association. By last year, it was down to 18 percent.
Just 1 percent of doctors in their final year of training say they want to go into a practice on their own, a survey by the Merritt Hawkins recruiting firm found.
Widman said he lost money the first five years he was in business. Hes breaking even now but is saddled with debt.
He puts in 60-hour weeks but brings home significantly less than the $175,000 income of the average family medicine doctor.
Medicare reimbursements havent kept up with the costs of running a practice. And commercial insurance payments for many of the services that primary care doctors offer have actually been shrinking.
Insurance companies last year paid about $70 for a common type of routine office visit to a primary care doctor. Thats down from $92 the year before and just 56 percent of what they paid in 2006, according to annual surveys by the Physicians Practice website.
Solo doctors have to bear all the overhead costs of their practice alone; large physician practices share the expenses. Employed doctors can rely on their hospitals to pick up the tab.
Widman has thought about selling his practice.
Ive run my numbers doing the same work for a hospital system, he said, and I would have doubled my income.
Almost all the primary care practices near Widman are owned by hospitals.
Olathe Medical Center alone has more than 60 physicians staffing 18 primary care and pediatric practices. Shawnee Mission Medical Center also owns primary care practices in Johnson County.
So does HCA Midwest, which operates Menorah Medical Center and Overland Park Regional Medical Center in Johnson County. A year ago, HCA bought College Park Family Care Center. With 60 physicians, it was one of the regions largest independent primary care practices.
Widman wants to remain independent. He considers medicine his calling. Keeping his patients healthy and out of the hospital is his goal.
Patients come in, and I listen, but Im looking below the surface for reasons why theyre in here, he said.
A patient with sinus infections, say, may need antibiotics right away, but getting their allergies under better control may stop the infections from recurring. Widman said he takes the time to explain this connection and how to use a nasal spray for allergy symptoms.
That extra time with patients is something that Widman wasnt sure he would get as a hospital employee.
In a hospital setting, there are top-down encouragements to see a certain number of patients a day, he said.
Although employed physicians may have fewer administrative aggravations, they also have less autonomy, said Jeffrey Cain, board chairman of the Leawood-based American Academy of Family Physicians.
Systems make systems-based decisions, Cain said.
Small practices see the same patients over and over, and are more likely than large employed groups to foster long-term doctor-patient relationships, he said.
They also have more leeway to adjust their charges for uninsured patients, Cain said. Theres more charity care among independent than employed doctors.
For Widman, established doctor-patient relationships are one of the great joys of practicing medicine. Most of his patients have been with him four or five years. One of the patients he saw the day he opened his practice still comes to him.
When patients have trouble paying their bills, he said, we do what we can to help out.
Solo practitioners are looking to different business models to survive.
Some are switching to concierge practices: Patients pay subscription fees, usually about $150 a month, to get same-day appointments and longer visits with their doctor. Other plans that can cost $15,000 or more a year may provide the doctors cellphone number and 24-hour access, along with executive-level physical exams and wellness programs in spa-like settings.
Widman is taking a different tack. He recently opened a small urgent care center wedged between a Chinese restaurant and a Pizza Hut down the street from his office. A newly hired physician assistant sees walk-in patients for cuts, scrapes and colds for double the profit margin of his regular practice.
Widman is banking on this service to bring in the added revenue he needs to continue caring for his patients in the way he thinks best.
My approach has been the right thing for my patients, he said. Is it financially feasible? Ask me in a year.