Dr Jim was a well known GP in town until he retired a couple of years ago. He treated me a couple of times as a child and teenager, and as a 40 something year old I returned to see him to get a couple of moles checked out.
Having founded a GP practice which had grown to 4 sites and 18 doctors I was always a bit envious of Jim. Today as I sat in his busy waiting room I remembered why.
Many years ago Jim was a partner in a multi-doctor practice in town but after a while he realised his hard work was subsidising some of the other docs who preferred shorter hours and longer holidays. He left that partnership and had been a solo GP ever since.
Solo General Practice has for many years been considered a dying business model, soon to go the way of the home visit and the GP who delivered 3 generations of babies from one family. You will have heard all the usual arguments: Too much admin, it’s unprofitable, who covers the patient when you go on holidays, professional isolation and so on.
As I watched patient after patient go into his consultation room and dutifully return to the counter to pay their $85 Fee, I suspect Jim would have had a much different take.
The economics Solo General Practice
The economics of solo general practice may not have made sense in the past given decreasing Medicare rebates (in real terms), and the capital investment required to start a practice such as a standalone server, 2 reception staff, a nurse, costly fitout, increasing commercial rent.
Many of the financial barriers to entry for a solo GP have been removed because of reduced competition and technology.
Let’s look at a few of these:
IT: It’s no longer necessary to buy a server to run your EMR. A web based application like Xestro will give you all the functionality required for your GP clinical notes and patient billing for only $50 a month. You just need a computer, printer and an internet connection.
Staff costs: It’s also not essential to have an onsite receptionist to answer phone calls and book appointments. Online booking software will remove a significant number of calls, and virtual reception companies like SOI and Office HQ can provide a full day’s phone coverage for about $20,000 a year. This is much cheaper than employing a receptionist on site and paying holiday pay and sick leave. This means it would be quite easy to have a single receptionist to welcome patients and collect payments. You could also train them up in medical assistant duties to refill medical supplies, do an ECG. I would personally have 2 part-time reception staff to build some redundancy into the staffing level so that if one of the staff is sick there may be an option for the other to cover.
Rent: Since the pandemic commercial office space has become more plentiful and available. A 50m2 office in a busy suburb near me can be leased for as little as $25,000 pa. Some may already have a fitout good to go which saves on that expense.
And let’s talk about revenue. Jim was old school. He didn’t really care about care plans, health assessments and cycles of care as he figured he made enough from his consults. He’d do them if asked for by the patient but that wasn’t that often. (No PSR audits!!) Assuming an 8 hour day of consulting, at $85 a visit and 4 patients an hour, across a 46 week year, Jim would have been conservatively billing $625K pa, but I suspect it was more than this. This doesn’t include procedures and longer consults, and he was always happy to squeeze in an extra patient if required so he was more likely seeing 5 to 6 patients an hour.
Some back-of-napkin maths (in thousands):
Revenue: $625
Less
Rent $25
Reception Staff (+ super etc) $70
Electricity $5
IT costs (EMR, Internet, printers) $3
Medical Consumables $10
Outsourced reception $20
Phones $5
Photocopiers $2
Marketing $5
Accounting Fees $10
Medical Indemnity $10
Misc Expenses $20
TOTAL $185
NET PROFIT $440
Or 70% of billings
Someone once asked me the pros and cons of owning a general practice. I said the pros are that you can pick the colours when you paint a wall. The cons? Everything else.
I still stand by that but I was referring to my decent sized organisation with 50 staff and 90,000 consultations a year. The stress that brings can be quite enormous, and the financial pay off is not worth it.
As a solo GP you can do whatever you want, when you want. From a business point of view you only have to worry about 2 staff and yourself. And I have also shown, staying small does not always have to mean a lower income.
Yes there are challenges: Who covers holidays? Do you employ a nurse? What about accreditation?
In future blogs I will cover some of these challenges of solo general practice and offer my thoughts and practical solutions. But for now I want to make the point that this practice structure should not be so easily dismissed.
Dr Jim is an amalgam of a few doctors I knew in Rockhampton who were in solo or small partnership practices. Most have now retired and their loss has had a huge negative impact on the community
I have no financial affiliation to any of the products mentioned in this blog post
