Running a Successful Primary Care Practice with Less Than 400 Patients Per Physician
The Practical Economics of Practice Size
Perhaps the biggest advantage of membership-based medical practice is the smaller ratio of patients to doctors. Both sides of this relationship would agree that the benefits of more time per visit and less red tape in terms of procedural paperwork translate to a better patient experience.
But for physicians operating on the business side, one key question emerges: How do you earn a living by seeing fewer patients? On a recent episode of the ROAMD podcast, Dr. Scott Pope sits down with Dr. Radley Griffin to discuss just that.
Dr.Griffin is founder and CEO of Griffin Concierge Medical in Tampa, Florida. His journey started a few years out of training, in 2007. He explored emergency medicine and urgent care clinical practice before he landed in a high-volume, fast-paced primary care practice in New York City. He was drawn to the simplicity of concierge practice, and with help from his wife, set up his own solo practice in 2008. Starting with zero patients in Tampa Florida, he’s since grown it to 1,000 patients with four providers in the practice.
Finding Your Magic Number (of Patients)
“The number (of patients) is really important. For me it’s about what I want as a physician and how I like to practice medicine. For me that has to do with the time I enjoy spending with patients, the menu of services I’m wanting to provide, and willing to provide as well…I think that’s really individual for each physician.” Dr. Griffin describes breaking down the different type of visits (annual, wellness, sick care visits) and mapping out the workload as a first step to determining an appropriate practice size, but emphasizes that this is ultimately an individual preference, not a one-size-fits-all formula:
“A physician can determine, ‘How many patients can I handle to provide the level of care that I like to provide?’ And really, that’s with the amount of phone calls, e-mail messages, text messages, and of course the office visits. In our practice, we’ve determined that’s around a 300 patient panel for each doctor. There are 250-some-odd working days per year, that means we have to be doing 1.4-something annuals per day.”
In describing his decision calculus, Dr. Griffin illustrates how his priorities lie in quality and depth of relationships, which in his style of practice, involve an intensive annual visit. “Annual visits are a big thing. That’s when we can really tie it all together, really have a nice review, focus on prevention and wellness. They’re intense, and there’s a lot of time spent in education, sp for me going beyond two of those per day is taxing. You can imagine, having 400-500 patients, doing over three of those a day, that would be really taxing as a physician. And that’s just me personally. So we figured 300 settles in nicely, and at that number, we determined that at the practice level, we’re seeing roughly between 6-12 patients a day, and really devoting 30-90 minutes per patients, which we all enjoy as providers.”
Evolving Style of Practice
While the business side of creating a practice may be new to most physicians, Dr. Griffin explains how starting his own DPC practice has forced an evolution in his patients, as well as his own style of practicing medicine. He describes the “interesting transition” that happens when doctors go from “sick care” to “well care” by focusing more on prevention and maintenance: Patients, too, change from seeing the doctor only when they need something like a Z-pak, to being more prevention-minded.
Dr. Griffin shares that at the beginning of his career, despite being a trained nutritionist, he didn’t’ know how to help patients reach their goals. Switching to DPC “forced and motivated” him to spend his off-time researching how to help patients reach their particular goals, by looking into lifestyle motivation tools and methods. “I really saw the desire from my patients to make that change, and I wanted to help them make it. It’s a wonderful dynamic where the patient is really incentivized to improve their overall well-being.”
“Going back to the churn and burn model, I’d have patients in the insurance model who would come to me saying they’d want to drop some pounds, go to a weight loss clinic, get a vitamin shot, appetite suppressant, some sort of diet, inevitably, the patient drops some pounds. Why? They’re motivated to do so, they’re spending their hard-earned dollars to get a result.”
While these patients may see short-term success, without ongoing relationship, they inevitably gain the weight back again. He jokes that the weight loss clinics love this cycle, because they know they’re going to get a repeat customer. “In the DPC model, we capture that patient’s investment in themselves in an ongoing manner, which is great. I love the reciprocity that’s created there.” The incentives here are in complete alignment, he argues, one that “fosters a really special relationship where the patient wants to improve, and as the doctor, I want to make that happen for them.”
Work-Life Balance: An Ongoing Journey
When asked to describe his approach to maintaining work-life balance as an entrepreneur, physician, and family man, Dr. Griffin is quick to describe it as “a work in progress, for sure.” He mentions with humility how his wife Lauren has made sacrifices in her own career as a successful freelance writing career, and describes a pivotal moment at the beginning of their journey where she transitioned to more of a co-operator role, rather than just helping him with his business. In balancing this new venture, during a financial recession, with their growing family, Dr. Griffin mentions the professional and personal growth they’ve both experienced.
He brings this back to finding the right panel size for you. As the volume goes up, the frequency and duration of visits depends on how much the doctor wants to see their patients. “Each [concierge] practice is a reflection of the doctor’s practicing medicine in their own style.” He says he loves the individuality in this style of practice, as well as learning about what makes his colleagues tick in setting their own parameters.
He closes in describing how his tie-in to the community he serves is “a night and day difference” compared to the “churn and burn” days of insurance-based practice. He shares a funny story in which his first two patients offered to take him and his wife out to dinner, which threw him for a loop – he actually had to double-check with one of his brothers who is also a physician whether that was even legal. Since then, his approach has come full circle. He’s been able to build relationships with his patients, socialize with them, and be a valued member of the community.
“We could coin insurance-based medicine as transactional medicine, where you see them, they pay, they leave. This is relationship medicine. I’m an introvert…now I embrace it. In the grocery store, I sneak up on my patients, I see what’s in their cart and razz them. I just love it. I enjoy it for what it is.”
He advises new entrants: “Practice in the community you live. Be willing to explore and learn along the way, and then craft a practice you’re willing to grow with….What a joy it is to practice like this. It took me time to understand my value. I’m a valuable person, for myself and for my family. And I can’t be everything to all people, so I try to be true to myself, knowing my limitations, and I think that is serving me well. Just enjoy the ride and continue to grow.”
For more information about ROAMD, visit us online. And make sure to check out other episodes of our podcast to hear directly from physicians who have launched their own membership-based practice models.
Radley Griffin, M.D., is the founder and CEO of Griffin Concierge Medical. He is a board-certified family physician who has been practicing for more than a decade.
Raised in Ocala, Florida, Dr. Griffin and his five brothers all followed their father, a pharmacist, into the healthcare field. After completing his undergraduate studies at the University of Florida, Dr. Griffin studied medicine at Saba University School of Medicine Netherlands-Antilles. He then served as Chief Resident in the University of Florida Family Medicine Residency Program and worked as the sole emergency department physician at Shands Hospital in Jacksonville, Florida.
Dr. Griffin is passionate about personalized patient care, which is why he founded Griffin Concierge Medical in 2008 with his wife, Lauren Griffin, who serves as the practice’s COO.
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