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Starting a Solo Practice: Joint Surgeon Shares His Journey
Posted in Surgeon as Entrepreneur | Mar 2015 | Comments (0)
Adam Harris, M.D., a joint replacement surgeon and founder of San Antonio Orthopaedic Specialists, wanted to be in the driver’s seat of his career. This motivated his departure from a large orthopaedic group to form his own practice and focus on what he loved—individual patient care.
After establishing his practice, Harris dropped Medicare and found success by offering quality care at a reasonable price, without having to deal with burdensome government regulations. Though his journey was not without bumps in the road, Harris achieved what he set out to do and never looked back. Two surgeons have since joined him.
Dr. Harris spoke to ORTHOPRENEUR® to share lessons from opening a small practice and factors for success in doing so.
ORTHOPRENEUR: In July 2002, you started your own practice. What led to this decision?
Harris: When I moved to San Antonio, I joined a big orthopaedic practice. I found that I was not particularly fond of the way they did business. There were things over which I had no control, that didn’t seem to me to be focused on the care of the patient. It was very frustrating to be unable to set employees straight about how they deal with patients.
There were a lot of good doctors in the group, but I was just frustrated by the way the whole business was run. I said, “I think I can do it better on my own.” That was my impetus. The advantages to going out on your own are that you have control over everything. The disadvantage is that you have responsibility for everything.
I made sure that all of my ducks were in a row before I announced that I was leaving. I picked an office manager. I had a nurse who was going to help me take care of the patients. I had an accountant, an attorney and all of the major players in running an office all lined up. Many of them were already working with me before I broke off.
ORTHOPRENEUR: What challenges did you face in this endeavor? How did you overcome them?
Harris: When you leave a big group, the big group always wants to keep all of the patients. One of the things that I tried to gauge before I left was to what extent my patients would follow me. I called maybe a dozen primary care doctors who referred patients to my practice, saying, “I’m thinking about going on my own. If I go on my own, would you still send me patients?” I was fortunate, because every one of them said yes. So I knew that I still had a referral base and a patient population, and that gave me some confidence when I went on my own.
I’m an adult reconstructive surgeon. Who are my patients? My patients are old folks. The best thing that I ever did after going on my own was dropping Medicare in 2008. That freed me enormously. The vast majority of these rules and regulations have to do with care to Medicare patients.
Using electronic medical records takes longer to complete chart notes vs. dictation. As a medical student, one of the first things that I was taught about record keeping is that the person reading the record has to be able to see the person about whom you’re talking. You have to make it human. A person is coming to you with a problem. The medical record has to reflect the person, and the treatment has to fit the person, not the disease. That’s one of the frustrating things about the government regulations— they put everybody into groups. People don’t always fit easily in groups.
The hospitals run seminars teaching the executives how to discourage doctors. The whole point is to make doctors into data entry clerks and let the government make the decisions. Right now, I’m primarily a provider and less a consumer of healthcare. Twenty years down the line, I imagine that will be flipped. I want the people who are critical thinkers to be caring for me. The whole system is designed right now to eliminate critical thinking. That’s just sad.
I don’t support the government. I don’t get Meaningless Use—and that is an intentional description. What they call Meaningful Use is basically the violation of a physician/patient relationship, and telling the government everything about every patient. I opted out of Medicare; I don’t have to tell the government anything, unless they subpoena me. I don’t have to file these reports and I don’t have to establish all these electronic things that are frequently conflicting. There are very few patient portals out there that are truly very compliant. While you get dinged for not having a patient portal, you get dinged for violating HIPAA. The regulations are really schizophrenic. By opting out of Medicare, I dropped 75, maybe 90 percent of the regulations that bother me. That’s extraordinarily liberating.
I’ve learned that if you provide a good service, patients will pay a fair price for it, even in tough economic times. I dropped Medicare in 2008, right before the crash. I was a little scared that no one was going to have any money. People still had joints that hurt, and I charged a reasonable fee and people paid it. I have a service that people are willing to pay for. You have to be good enough that people are willing to buy your service, and then you can get out from under the government. That is liberating beyond description.
ORTHOPRENEUR: What are some of the greatest lessons you’ve learned throughout your career?
Harris: The biggest lesson is that you have to surround yourself with people whom you trust and to whom you can delegate important parts of running the business, so that you can focus on taking care of the patients. When I started, I had all those in line. Unfortunately, my first office manager passed away. The other office managers have not been as wonderful. The greatest lesson is that you can’t do it all yourself. You can’t be the IT person and the accountant and the doctor. If you try, you’re not going to do all of them well. Something is going to fall through the cracks. If patient care falls through the cracks, you’re in big trouble.
So you have to find the people with whom you can review with what’s going on, and also delegate responsibilities so that you can focus on why you went into medicine. That’s the greatest lesson.
ORTHOPRENEUR: What advice do you have for other entrepreneurial-minded surgeons like yourself?
Harris: It’s a gutsy move to hang your own shingle, especially today. As an entrepreneur, you’ve got to have an accurate assessment about where your patients are going to come from and how you’re going to fill your clinics. If you’ve got enough confidence that you can do that, then odds are, everything else is going to fall into place. You’ve got to have the entrepreneurial spirit. You’ve got to be able to say, "I’ve got the value. I’m good enough to make it on my own.” You’ve got to have the confidence in yourself.
Adam Harris, M.D., is a board certified orthopaedic surgeon, specializing in minimally invasive replacement of the hip and knee. He is one of the few doctors in San Antonio who provide outpatient partial knee replacement surgery (unicompartmental replacement). He is the first surgeon in South Texas and in South Louisiana to offer the Zimmer two incision total hip replacement, and the first physician in San Antonio to offer the quadriceps sparing total knee replacement. Dr. Harris completed medical school at the University of California, San Diego, and then completed his residency at Rush Presbyterian St. Luke’s Medical Center in Chicago.