The Reports of the Death of Private Practice Are Greatly Exaggerated: Two Practices Share the Keys to Their Success

By Bissan Biary, MHA, MMS Senior Practice Solutions Specialist

COLLABORATIVE, INTEGRATED CARE IN WESTERN MASSACHUSETTS

In a heavily consolidated market like Massachusetts, many things go into creating and sustaining a successful private medical practice. In the last decade, Katherine Atkinson, MD, and her team have created a collaborative, integrative primary care practice. Today, Atkinson Family Practice has close to 50 employees, with offices in Northampton and Amherst.

In their integrated model, medical, behavioral, and complementary practitioners collaborate to deliver care for the whole person and his or her family. In addition to providing primary care, Atkinson’s practice also offers nutrition, counseling, massage, psychiatry, psychology, somatics, health coaching, functional medicine, physical therapy, and lab services. Patients can take classes on weight loss, exercise and hands-on cooking, stress management, and sleep approaches, among other things. Studies have shown collaborative care to be a cost-effective approach that improves health outcomes. Dr. Atkinson cites the care model as one important reason patients stay with her practice. “Our patients have a true medical home. It’s one-stop shopping where we really care about them in the context of their health and help them get the services they need to stay healthy,” she says.

The Collaborative Care Model

Dr. Atkinson discovered the collaborative care model early in her career. “When I was in residency, I trained with a psychologist who presented a medical-behavioral care model to us,” shares Dr. Atkinson. “What became quickly clear to me was that not only was this something that people were okay with, but they wanted and really needed it.” And her staff members were equally satisfied with the model, as it helps them take better care of their patients — especially their most complex ones.

Staffing in a Collaborative Care Model

Staffing the practice has at times been challenging, particularly finding psychologists, who are much in demand these days, according to Dr. Atkinson. And as the staff gets larger, the practice has had to work hard to ensure that its core values — comprehensive, integrative, compassionate care — stay front and center. In general, staff find the care model rewarding, but Dr. Atkinson is always aware of the potential for burnout. She has asked her staff to tell her what brings them joy and then tries to integrate those things into their jobs. “[This exercise] helped me think about how we can free up our schedules so that staff can be employed where their greatest skills and interests lie.”

Keys to Sustaining a Successful Practice

Success, admits Dr. Atkinson, has required “a lot of trial and error… I think one of the most important things is that we have a rule in our practice that we don’t make any big changes to policy or procedure until we’re in a full staff meeting,” she notes. This ensures that those involved get to weigh in and all voices are heard. Dr. Atkinson knows that many people believe private practice is no longer doable. “It’s very feasible,” she says. “You get to call the shots and make your own decisions and have the practice you want. Don’t let people talk you out of doing it.”

A new online CME activity, Evolving Models for Sustainable Medical Practice, gives helpful information about private practice models, including Dr. Atkinson’s. Visit massmed.org/evolvingmodels for more information.

COMPASSIONATE CARE IN THE BOSTON SUBURBS

Pamela Weinfeld, MD, co-founded Wellesley-based Dermatology and Skin Care Associates 12 years ago with Rashel Goodkin, MD. Its success lies not only with the high-quality clinical services it provides, but also with the compassionate care and relationship building that have become hallmarks of the practice.

Dr. Weinfeld says that when they founded the practice, “we had a very similar vision: to create a place that was very friendly and warm for patients.” While dermatology might seem like a specialty that focuses mostly on episodic treatment, much of the care is long-term, as skin cancer can be a chronic disease. “Usually it’s people who are very fair-skinned. They have had a lot of sunburns and so you’re working with them to not only treat the skin cancers, but also to modify their lifestyle risks, work on their sunscreen habits, and convince them to wear sun-protective clothing,” explains Dr. Goodkin. “It’s a lot of talking with them about their lifestyle and not just treating the skin cancer.”

And like other specialties, dermatology requires caregivers to help patients confront the emotions their diseases and conditions can elicit. “Teenagers with acne can feel so humiliated that they don’t want to look you in the eye,” says Dr. Weinfeld. “Then you put them on Accutane and a few months later they walk in, head up high, all smiles, and you realize that you really changed someone’s life.” Psoriasis can also have an emotional impact on patients. “We focus on treating not only the immediate, short-term aspects of the condition, but the long-term as well,” notes Dr. Goodkin. “With psoriasis, we work to overcome common misconceptions held by the patients’ loved ones. Sometimes the spouses of psoriasis patients are worried that the condition is contagious, so they don’t want to touch the patient. I reassure them that it is not contagious. By clearing up some misconceptions, I am able to help both the patient and family member in a different, yet crucial way.”

Keeping the Patients’ Best Interests in Mind

On the practice’s cosmetic side, Dr. Weinfeld says she and her colleagues build trust with patients by carefully evaluating new treatments and technologies before making them available. “One of the things that you have to balance is offering the latest and greatest stuff, but not wasting patients’ time or money on treatments that don’t work,” she says.

Secrets to Sustaining Private Practice

There is a lot that goes into sustaining a private practice, but for Dr. Weinfeld, it comes down to the way you treat your patients. “If there’s a secret to it, I think it’s that patients will be loyal if you give them your attention and time and make them a partner in decision-making,” she concludes. Dr. Goodkin adds that creating a collaborative, supportive environment for office staff is also key to their practice’s success and the high-quality care it provides.