A little over five years ago, I was graduating from my Family Residency program with Jackson/UHealth, and I set a goal that, in five years time, I would be embarking on opening a practice of my own. Five years seemed an appropriate amount of time to spend with a larger institution, a timeframe borrowed from history, when others tried to chart the courses of whole nations, to varied results. My plan was much more straightforward though, and well within my control. These five years would allow me more time to continue to get some experience in the field of primary care, but most importantly for me, it offered me the opportunity to continue to teach medical students, a part of the field that I love, and I know would be getting less of in private practice. One pandemic and unprecedented historical events too numerous to count later, I found that those five years went by in a flash. I was and remain more committed than ever to that plan I set long ago, and I am extremely fortunate in that I have a secret weapon in my loving wife, Sophia.
High school sweethearts, we met in the now nearly defunct Sunset Place through a mutual friend, and have remained inseparable since. She has been at my side and a source of support throughout my arduous training, and remains my perpetual cheerleader, in addition to being a certified public accountant and a steward for our finances. We were legally married, at the courthouse, on our chosen date of November 13, 2020, sharing a kiss through our masks. One year later we celebrated our union properly, with family and friends overlooking Lake Osceola at the main campus of University of Miami, where Sophia and I had both gone for undergraduate. Without her, I am not sure that my dream of opening my own practice would be possible. She supports our small family in our condo in Edgewater, where we live together with our two year old Shiba Inu, named Kenzo.
I have never been under the illusion that opening up a practice is an “easy,” thing to do, quite the opposite, it would be much easier for me to continue to work for a larger healthcare entity, where I can continue to get a comfortable wage and focus more strictly on just the medicine. However, I have chosen a more arduous path for myself. I embark on this endeavor for both personal reasons, most importantly my independence, but also for the very patients that I care for and the quality of the care I offer.
Not long ago, I was discussing the state of the business of healthcare with a mentor of mine, and in our conversation, he said something that resonated with me, it was roughly to the tune of: “you have trained for a practice of medicine that is not feasible within the traditional insurance based practice.” In order to breakeven, let alone make a profit, the amount of patients I need to see within a more “traditional” insurance based practice would be counted in the thousands. My patients would not have the access to me that they deserve, I would not be available for urgencies, and my appointments would need to be tightly timed in order to meet the volume needed to cover practice costs. We all know how the traditional medical system works, and how it often doesn't, and we all also know that we can do something better. We have to at least try.
I hope to provide more details on the business and practice plan that I have researched to help meet my goals of providing higher quality care to a smaller number of patients than under more traditional healthcare practices, but that will take some more time yet. I look to the future with great eagerness and optimism. I am excited to be able to offer my patients the time they deserve, to sit down with new patients and block out at least an hour to not only discuss their medical diagnosis and treatment plan, but to start to know them as a person. I know an emergency when it presents itself, but with this smaller volume practice, I will have appointments available for urgencies that may arise. While not all emergencies can be prevented, there are volumes of studies that confirm the obvious–when patients have better access to their primary care doctor, these emergencies are less likely to occur. The cost of medication is out of hand, but in time I have plans to arrange contracts with national and local pharmacies to help provide lower cost medications. While I was in medical school, my wife bought me an old-timey leather doctor bag, like physicians of old once carried house to house, and I will be putting that bag to good use when the occasion should demand. I have training in acupuncture, and have always taken an interest in integrative medicine. Many of these kinds of treatments can be helpful and cost effective, but unfortunately they remain notoriously difficult to cover within the more traditional insurance landscape. However in the practice I am building, these services will be offered. I can go on, but the truth is the list is not yet complete. I remain a young physician engaged in the lifelong learning process, and only seek to add to the services I can offer over time.
The practice I am building is not only a better option for my patients, but also creates an environment in which I feel more professionally and personally fulfilled; one less casualty to the increasing number of physicians who leave the field citing burnout. However, I remain early on in this lengthy process, while I remain decisive in my business decisions, I still abide by the old adage to “measure twice, cut once,” in that I hope to create a practice that can be modified in time to best suit my needs, my patient’s needs, and my greater community’s needs. My search has been broad, and extensive, but I have narrowed it down to the Miami Beach area. I look forward eagerly to sharing the news when I have signed the lease or sublease for my fledgling practice, and I thank you for joining me on this journey.