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Bucking The Trend: Primary Care Doc Practices Solo

Aug 25, 2010

First of the three-part series “Primary Care Under Pressure” from NPR

Conventional wisdom is that the age-old model of a single doctor serving patients out of a small office is rapidly going extinct. Doctors need to evolve or die. That means fancy new computerized medical systems and bigger groups to handle the overhead.

But Cathy Crute wants to get one thing straight from the get-go: She is not a dinosaur.

"No, no. I think patients love a small practice," she says from her rather Spartan office. "My receptionist can recognize a lot of patients' voices over the phone. They know who they're talking to every time. They don't have to go through a whole chain of command."

And the patients in the waiting room of her Portland, Maine, office seem to agree with that assessment.

"I just think it's better service to come to the same person all the time and have one person overlooking you," says Laurie Warhol, from nearby Waterboro. She's been coming to Crute for more than a decade. "I think they know you better. They know your problems better. You don't have to remind them of everything all the time."

Patient Mike Greenleaf says he likes not just the doctor, but the entire atmosphere of the practice. "The staff's great, and they know you on an individual basis. And it just makes you feel that much better than if you just go sit in a room full of people and have someone call your name that doesn't know you," he said.

Crute actually came to her solo practice late in her career. She was one of the first doctors to become a certified family practitioner in the 1970s. She worked in a small group for 10 years — and, later, a larger one — before she realized that wasn't where she was comfortable.

After talking with some friends who were practicing solo, but covering for each other on nights and weekends, she decided to strike out on her own. "It was like, 'Yeah, I guess I can do it, too,' " she said.

A Tight Ship

That was 10 years ago. Since then, she's built a tight, efficient little team around her. So efficient, in fact, that Crute works only 3 1/2 days a week. She gets in around 8:15 a.m. and says she rarely leaves the office after 5:30 p.m.

Crute credits office manager Amy Asali with keeping the practice financially viable. Crute says Asali's always on the lookout for various hospital, state or insurance incentives to boost cash flow.

But Asali, who chats between answering phones and greeting patients on the receptionist's day off, concedes her job is a challenge. "It's definitely a juggling act without having the overhead of a larger practice helping us," she says. "It's a game week to week, making sure we've got enough patients on the schedule."

Crute, however, says as long as the bills get paid, she's OK. She says she's definitely not in this for the money. "I'm driving a 10-year-old car," she admits with a laugh.

What Keeps Crute Up At Night

One thing she does wish, however, is that she and her staff could spend less time on insurance company bureaucracy.

"We have a part-time person just doing referrals," she says. "We also spend a tremendous amount of time on the phone with prior authorization for medications," which is medical speak for getting permission to prescribe a specific drug.

But what really keeps Crute up at night is what will happen to her practice — and her patients — when she retires. She's 63, and she says she plans to work for only about three more years.

So she's spending some of her time trying to recruit her replacement. Among her targets: the family practice residents currently in training at the nearby Maine Medical Center. She has all their photos hanging on the bulletin board in her office. But she knows that finding one to take on a solo practice won't be easy.

"It's probably going to have to be someone who doesn't have a huge debt," she says.

"I just think it's better service to come to the same person all the time and have one person overlooking you," says Laurie Warhol, from nearby Waterboro. She's been coming to Crute for more than a decade. "I think they know you better. They know your problems better. You don't have to remind them of everything all the time."

Patient Mike Greenleaf says he likes not just the doctor, but the entire atmosphere of the practice. "The staff's great, and they know you on an individual basis. And it just makes you feel that much better than if you just go sit in a room full of people and have someone call your name that doesn't know you," he said.

Crute actually came to her solo practice late in her career. She was one of the first doctors to become a certified family practitioner in the 1970s. She worked in a small group for 10 years — and, later, a larger one — before she realized that wasn't where she was comfortable.

After talking with some friends who were practicing solo, but covering for each other on nights and weekends, she decided to strike out on her own. "It was like, 'Yeah, I guess I can do it, too,' " she said.

A Tight Ship

That was 10 years ago. Since then, she's built a tight, efficient little team around her. So efficient, in fact, that Crute works only 3 1/2 days a week. She gets in around 8:15 a.m. and says she rarely leaves the office after 5:30 p.m.

Crute credits office manager Amy Asali with keeping the practice financially viable. Crute says Asali's always on the lookout for various hospital, state or insurance incentives to boost cash flow.

But Asali, who chats between answering phones and greeting patients on the receptionist's day off, concedes her job is a challenge. "It's definitely a juggling act without having the overhead of a larger practice helping us," she says. "It's a game week to week, making sure we've got enough patients on the schedule."

Crute, however, says as long as the bills get paid, she's OK. She says she's definitely not in this for the money. "I'm driving a 10-year-old car," she admits with a laugh.

What Keeps Crute Up At Night

One thing she does wish, however, is that she and her staff could spend less time on insurance company bureaucracy.

"We have a part-time person just doing referrals," she says. "We also spend a tremendous amount of time on the phone with prior authorization for medications," which is medical speak for getting permission to prescribe a specific drug.

But what really keeps Crute up at night is what will happen to her practice — and her patients — when she retires. She's 63, and she says she plans to work for only about three more years.

So she's spending some of her time trying to recruit her replacement. Among her targets: the family practice residents currently in training at the nearby Maine Medical Center. She has all their photos hanging on the bulletin board in her office. But she knows that finding one to take on a solo practice won't be easy.

"It's probably going to have to be someone who doesn't have a huge debt," she says.

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