Really solo: California physician opens one-person shop

A family physician explains why he runs a practice without any staff.

By Mike Norbut — Posted Oct. 11, 2004

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When Gary Seto, MD, a family physician in South Pasadena, Calif., decided to go solo earlier this year, he meant it.

Dr. Seto is the owner, physician partner, receptionist, nurse and back office billing staff for his practice. As its only employee, the doctor gets to take all the credit for the practice's success, and he doesn't have to look very far if things aren't going well.

Dr. Seto opened his practice in February after a long stint as a physician partner with the Southern California Permanente Medical Group, which has an exclusive contract with Kaiser Permanente. Mounting frustration with the health care system and the tragic death of his 10-year-old daughter a few years ago caused Dr. Seto to reevaluate his career. After reading an article written by Gordon Moore, MD, a family physician who runs his own one-person shop in Rochester, N.Y., Dr. Seto decided to pursue this business model.

In an interview with American Medical News, Dr. Seto talked about the framework of his practice, the money he saves, and the struggles he has had as the only employee.

Question: What convinced you to go from a traditional office setting to this model, where you're literally solo?

Answer: It was a combination of things. I had been frustrated for a while with the amount of work I was doing at Kaiser, which schedules an appointment every 15 minutes for all visits. That works out to about 24 per day or 12 per half day. Along with that, I would have to field any phone calls that would come during the day. Plus, I would have to handle any lab work and test results that came in.

I'm also the kind of doctor who spends as much time as I think is appropriate, so I would always run late and push other appointments back.

I want to point out that I think Kaiser is a great organization and for what it does, it really gives good health care. It's just a system that was not a right fit for me.

I kept asking my wife, who is also a physician [about the solo practice idea], and she was against it initially. It's tough to think about giving up your financial and job security. I met with the CEO of her medical group, and we made up a business plan. At the end, they said it just might work, so I took it back to my wife, and she reluctantly agreed. We gave ourselves two years to see if it could be financially viable.

Q: How much do you estimate this saves you in expenses?

A: I hadn't really thought about that because when we planned it out, we never really thought about how much employees would cost. The main difference between this kind and traditional practices is the lack of employees. If I had one employee for 40 hours a week, paid at $10 an hour, and add benefits, rounded off it would cost about $25,500 a year.

This concept is not about no employees, it's about keeping expenses down. To cut costs, I made the decision to go with a small office space. I'm using an electronic medical records system, so there were no paper charts from the beginning. I use an online sort of billing service. I'm actually doing the billing, but they provide me with a portal.

I don't have an answering service. I have an answering machine and cell phone instead. There's a dual reason there: it saves money, plus, it removes another barrier between the physician and patient.

Q: Is it hard to keep up with the administrative work since you're by yourself?

A: Yes it is. Part of the reason is I still have one foot at Kaiser. I'm still working part-time there, which at least provides some income. I have to juggle my schedule around my time there.

Initially, it was stuff like registration forms and designing brochures and ads that took up my time. My patient numbers have been pretty low. To give you an idea, I had 14 patients in March, five in April, 10 in May, 17 in June, 10 in July, 38 for some reason in August, and 23 so far (halfway through September), so it's going up.

I am behind on my billing, but part of that is because I'm procrastinating. Now that I'm getting busier, it's tough to find the time to catch up. At first I felt I wasn't that busy, so I could do it anytime. I've only seen a total of about 90 patients, and about half of those claims are settled.

Q: Has the practice allowed you to continue to be financially successful?

A: Not yet. It took about three months, on average, to get approved by BlueCross BlueShield, CIGNA. ... Medicare, surprisingly, was the fastest. It took only six weeks.

Coming out of Kaiser, I wasn't able to bring any patients with me because it's a closed system. It's kind of like coming out of your residency, but even a little worse. It's taken me some time to do everything, but in a way, I'm glad I'm starting slow. It's giving me some time to do the things I'm completely unfamiliar with, like medical billing and ordering vaccines. Things like vaccines are very expensive. I have to think about how much to order. I don't want to order too much and have to sit on it, but I don't want to run out, either.

Overall, it's ended up costing me more than I anticipated. I initially took out a loan of $30,000 to get started, and that has not been enough. So far, I've been needing to take out cash advances on my credit cards.

I think it will work, but it's been a work in progress. All the patients I've seen, to a man, have said it's a great idea and they ask why more doctors don't do it.

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