Lowdown on our slowdown

2011 has been disturbingly slow.  Through April, the number of patients I saw in the office was 140 less than in 2010.  That may not sound like a lot, but it's about 2 patients a day.  Add that up over the entire year, and it's real revenue we have to do without.

For those who aren't aware, here is an overview of my medical practice.  It is located in Naperville, IL, an upper middle class suburb southwest of Chicago, with a population of 160,000.  We have in excess of 6000 active charts (patients seen in the last 36 months), with a demographic breakdown of 20% pediatrics, 60% adults, and 20% Medicare (or patients aged 65+).  It is, in my opinion, what the prototypical family practice should look like.

Our office hours haven't changed at all. We are open Monday, Tuesday, Wednesday, and Friday 8 to 5, Thursday 11 to 8 pm, and Saturdays 8 am to 12 pm 2 out of 3 Saturdays.  We haven't decreased our support staff, so wait times on the phones are < 5 minutes, and typically < 2 minutes if you don't call between 8 and 9 am.

So the question is, why are our numbers down?  I have a number of theories.

First, pharmacy run clinics.  There is one located in the Walgreens up the street from our office.  These clinics are staffed by nurse practitioners, with evening and weekend hours.  Patients are choosing these clinics, paying a premium (usually around $75) for the "convenience" of walking in without an appointment, even if there is an hour or two wait.

Second, time off of work.  We have seen a significant increase in requests for appointments after 5 pm.  Patients simply won't take off work to come in when we have appointments.  What is amazing is that my Thursday evenings, when I work until 8 pm, are rarely booked out.  Same thing for our Saturdays.  People want to be seen on their way home from work (between 5 and 6 pm), or not at all.  My staff offers multiple appointments to these types of patients, with no luck.  They want to come in when they want to come in.

Third, out-of-pocket expenses.  Deductibles have risen to the point where people are choosing to "wait and see" when they get sick.  These acute care visits are the ones we've seen decrease - colds, coughs, headaches, etc.  These are the bread and butter visits of most primary care offices.  Higher deductibles, high unemployment, high fuel prices,  higher food prices; all of these have made patients think twice about what and how much they can/want to spend on healthcare.

Lastly, mediocre flu seasons.  We used to be able to bank on the January to March window to give us a healthy bump in visits because of influenza.  Not any more.  The H1N1 outbreak of 2009 changed everything (for reasons unknown).  Since that outbreak, we've had 2 straight uncharacteristically slow flu seasons, and thus, less sick visits.

We are coming into the busy, school physical time of our work year.  I am beginning to worry that the nurse-run, deep discount school physical clinics put on by companies like the Visiting Nurses Association are going to further dent our appointment base.  I'm going to post a blog at a later time about the real risk of these bogus school "physicals", which are really just appointments to complete forms for school.

It may seem counterintuitive, but these are the times when I am happy I own my practice.  I can't imagine what it's like for physicians who are "owned" or are part of large mega-groups when their numbers go south. The factors that have caused this decrease in patient visits aren't going to improve any time soon, and if we continue to see a deterioration in our visits, I have the ability to make adjustments in my overhead, unlike employed physicians.

Here is hoping (tongue-in-cheek) for a nice outbreak of influenza sometime soon.