By now, you might have realized that I am fascinated by all the shapes and sizes and variation that contemporary medical practices represent. And I am realizing that so much of the innovation is being driven by a strong physician desire to 1.) enjoy a higher quality of life, and 2.) serve patients in a way that feels much more like what they had aspired to originally, as fresh-faced medical students.

So I enjoyed reading this article yesterday in the Canadian National Review of Medicine, about the move towards "micropractices" (I especially love all the new terminology).

The article describes the practice of family physician Dr Gordon Moore (also a researcher with the Institute for Healthcare Improvement) as follows:

"In many ways this is a Norman Rockwell practice with a 21st century technological backbone," muses solo FP Dr Gordon Moore of his Ideal Micropractice vision ......

.......... Imagine answering your own office phone and giving out your email address and cell number to patients. Throw in some same-day booking and 30 minute patient visits and you start to get an idea of how things work in Dr Moore's office. But there's a method to the madness — in fact it was his IHI research that led him to hang out his micropractice shingle. Well, that, and the pressure to see more than 30 patients a day at his former group practice in a big HMO.

Just what is a micropractice?

In an article in Modern Medicine, it's described as "a low-volume, highly efficient solo practice that uses cutting-edge technology to keep overhead low and free up time for more doctor-patient interaction."

It's a practice that has gone on a serious diet, and lost the fat of grumbling back-office staff, mumbling receptionists, mislaid paper charts, impersonal answering services, bossy office managers and crowded waiting rooms. It puts the patient squarely in front of the physician, with no buffers in between!

Dr. Moore is apparently the pioneer who has been promoting this concept. With the support of the Physicians Foundation for Health System Excellence (a Boston-based non-profit organization that provides grants to improve the quality of care delivered in physician offices), he has created a website, Ideal Micropractice, geared to creating a community of like-minded physicians, and providing them with resources.

A successful micropractice depends on:

• the use of low-cost but powerful technologies, such as electronic medical records integrated with billing and coding software, and even self-scheduling software
• reliable physician-patient interaction
• convenient and timely access for patients
• the ability to control overhead expenses
• the willingness to provide consistent, reliable clinical care

Some of the challenges include:

• a decreased earning potential (in exchange for a vastly improved quality of life on the job)
• the ability to think like a business person and "wear many hats"
• the need to become techno-savvy and keep your tech support costs down
• the ability to finance your own start-up costs
• the lack of collegiality and hallway consults if you are going it alone

In exchange, according to most of the "micropractitioners" (see - there's a new word!), you can expect to get:

• lower overhead
• better efficiency
• more time for patient visits
• enhanced physician and patient satisfaction
• the joy of being your own boss (just make sure you don't land up working for the worst boss in the world!)

I'd love to hear from anyone considering this move, or who has actually made it.