01/27/2015    Greg Amarantos, DPM

At Career Crossroads

You are 58 y/o and have a successful practice, you
GET IT. You have successfully navigated the
changes in our healthcare system, from fee for
service, DRGs, HMOs with capitation, PPOs and
going forward, ACOs and ACEs. Unless you have the
temperament for a paradigm shift in the way you
practice, you should keep it simple with low
overhead.

You know your demographic mix and your patients
see you because of your skill set. I assume you
have some type of EMR and digital radiography,
sending the message to your patients that you
practice according to the expected standards of
care in the community.

Regarding the IT issues with penalties, I say "who
cares?" Let Medicare take their %. Will a 7-10%
decrease in Medicare reimbursement really change
your quality of life? The decreased stress and
costs of reporting will improve your quality of
life and allow you to continue to practice
successfully and I believe will actually improve
your interpersonal relationships with your
patients, as they see you are listening to them
instead of looking at a computer screen, checking
boxes for Medicare.

That being said, you could also add a young
practitioner to your practice, setting the
boundaries from the beginning that this is the way
the practice will be run. You can discuss a buy-in
strategy for the new doctor and dangle the carrot
of ownership to them. This will allow you to plan
for a timely transition while actually growing the
practice, increasing the value, and creating a
win-win situation for yourself and the new doctor.

The unknowns include where you are presently
practicing, urban or rural community. Is there a
dominant healthcare system in the area, are most
practices hospital owned or independent? What is
your referral base? All in all, whatever decision
you make, take a deep breath and realize change is
inevitable. You were smart enough to become a
successful physician and certainly your added
years of experience have exponentially increased
your wisdom.

Greg Amarantos, DPM, Chicago, IL

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