Fairfield County Medical Group P.C. is a five physician, multispecialty internal medicine practice with an office in Trumbull, Conn.
Dr. Fisher: Why don’t medical schools teach Business 101 to doctors planning to start and run a private practice? Medical school is the great dinosaur – it doesn’t like to change. It is an old establishment – they like to do things the way they like to do it. They don’t prepare people for the future.
Today, they may be offering more computer work, since everything is computer-based, but that’s probably just an introductory type of thing. The medical schools don’t prepare you for leaving medical schools – they never have.
Why don’t medical schools teach Business 101?
Dr. Fisher: I came to Connecticut and joined a group that was already in existence. They recruited Dr. Frank Spano, who was a friend of mine from training. Then we recruited Dr. Rich. We didn’t like our other partners, so in 1994 we broke off from them and formed the Fairfield County Medical Group. And it was my idea – I will take credit, because I was on vacation with my wife and I said, “I’ve got to go. I hope you guys can come with me. It’s a new endeavor and I know it is kind of scary.”
But they were like, “What took you so long? We hate it here.”
So, we borrowed a lot of money and made everybody sign, and off we went – and we never looked back.
Dr. Rich: Medical school teaches us almost nothing (about starting and running a practice). Dr. Fisher has quickly learned how to run a business and he has been our business manager since we started.
Dr. Fisher: It’s been on-the-job training. Nobody in the place has any training.
Dr. Rich: And these days, very few people go into private practice. The hospitals and big organizations are buying up all of the practices and clearing the market. We’re one of the last very few private practices in Connecticut.
Dr. Fisher: I describe us like Israel: a small independent nation who just wants to be left alone that is surrounded by hostile neighbors. But the challenge is recognizing that the medical business is not normal. While your costs go up and your expenses go up, you cannot pass them along to the consumer. You cannot raise your prices – those are fixed by Medicare and your contracts with the HMOs and insurance companies. It is a model for failure. How does it succeed? You have to work hard to minimize costs in every expense category. But the biggest hits are the things you cannot change: your rent, salaries, paper supplies. You do the best you can on the income level.
Dr. Rich: And physicians who make unnecessary tests in their office can make a fortune. One of the concerns we have about the medical system is whether tests are done so people can profit from them.
Dr. Fisher: We’ve been fortunate – even though we were willing to drop insurances when nobody could and people pushed their employers to take us back. And we were able to negotiate better deals along the way. We get the same reimbursement (from insurance companies) that the doctor who spends three minutes with you gets – there is no reimbursement based on quality. You have to balance your personal needs – to be a doctor – with your needs to make a pretty good income and still have some time to breathe at the end of the day.
Dr. Rich: We have been fortunate because we run a hybrid concierge practice that covers 150 patients. It’s not a huge boom, but when you’re talking margins it’s been a huge help in the cash flow. And we've been very well received – almost everyone has renewed. The only ones that did not sign up again were the ones that died – and that was not our fault! And a handful simply could not continue to afford the $2,000 a year charge.
Dr. Fisher: We also get a lot of patients from doctors that are not good anymore. And I am not talking about their medical skills – I am talking about the rushed nature and the waiting times. No one waits here.
Photos courtesy of Fairfield County Medical Group.