Micropractice

No-frills space gives docs luxury of time

From the September ACP Observer, copyright © 2007 by the American College of Physicians.

By Ryan DuBosar

Patients walking into general internist Soma Mandal, MD’s, Manhattan office in New York City see her immediately—she’s the only person in the practice. She relies on patients to complete their histories before their visit and she verifies insurance in advance. With all the paperwork addressed, she can then devote anywhere from 20 minutes for a routine visit to 40 minutes for a new patient—all of it clinical time.

The luxury of such long visits is a welcome shift from her previous work at a hurried Lower East Side community health clinic. Treating the underserved was rewarding, but the overhead of a large facility demanded she fit patients into 15-minute slots, leaving only five to seven minutes for clinical work. She moved to a large Brooklyn medical practice, but 40- to 50-hour weeks were similarly frenzied. So she began plotting how to strike out on her own.

“I realized that the only way I could take control would be to start my own practice,” she said. Unable to get a bank loan, she covered the $20,000 in startup costs herself and opened her scaled-down practice in September 2006.

By moving to a tiny office with no staff and minimal equipment, she lowered her overhead costs to an income-to-overhead ratio of 8:1. This allows her to restrict her patient load per week to about 20 patients in four half-day sessions, even while continuing to practice in New York’s Gramercy Park neighborhood.