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Archive for the ‘Business of Medicine’ Category

Developing an Approach to Patient Handoffs

Posted by medliorator on November 1, 2009


Pauline W. Chen, M.D.

I worry that I am playing some real-life medical version of the children’s game “Telephone” where the complexity of my patient’s care will be watered down, misinterpreted and possibly mangled with each re-telling.

While older patients with multiple chronic conditions will see up to 16 doctors a year, some of the healthiest younger patients I see count not only a primary care physician among their doctors but also a handful of specialists. Hospitalized patients, no longer cared for by their primary care doctors but by teams of fully trained doctors, or hospitalists, in addition to groups of doctors-in-training, are passed between doctors an average of 15 times during a single five-day hospitalization. And young doctors, with increasing time pressures from work hours reforms, will sign over as many as 300 patients in a single month during their first year of training.

researchers have begun looking for new ways to approach patient handoffs, studying other high-stakes shift-oriented industries like aviation, transportation and nuclear power, as well as other groups of clinicians.

By incorporating more efficient methods of communication, the hope is that patient care transitions will eventually become seamless and less subject to errors.

When Patient Handoffs Go Terribly Wrong [NYT Health]

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Starting a Practice

Posted by medliorator on April 9, 2008

Medical practice is a business and start-up is start-up. The most important factors are access to capital, type of business, competition, and payer mix. Business that start-out with less than $5000 cash will usually fail in the first year, while those that have access to $100,000 or greater, will most likely live beyond their one year anniversary. If you want to survive, I recommend raising money, and lot’s-o-it.


Some practice’s have inherently high start-up costs while others can be started with significantly less money. For example, I started my urology practice with $40,000 down and access to $150,000 in case the unowhat hit the fan. An internist may be able to start-up for even less, while an OB-Gyn in NY will need in excess of $200,000 to start-up.


If your patients are insured, and you have enough of them, you’ll start to make money. If you practice in a very well-off area and can go “out of network” you’ll make the same money with less work and in less time. If you deal with predominantly Medicaid, you’ll probably have to move because you’ll never get there.


be forewarned: the freedom to be your own boss comes at great cost.

A reader question: How long to positive cash flow in start-up? [The Independent Urologist]

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