To the Editor:

I have enjoyed Dr. Gordon Moore’s series of articles on his model of practice [“Creating a Vital, Burnout-Proof Practice,” September 2003, page 51; “Going Solo: Making the Leap,” February 2002, page 29; “Going Solo: One Doc, One Room, One Year Later,” March 2002, page 25; and “Answers to Your Questions on Solo, Idealized Practice,” May 2002, page 39]. However, some of his ideas seem contradictory. For example, to grow your practice, he recommends promising patients, “I will see you on time” and, “We will have all the time you and I need. No rushing.”

I can see my patients on time, but that necessitates limiting each patient to the time allotted. I can take all the time we need, but then I cannot predict how long it will take, and subsequent patients cannot be given an accurate appointment time. How does he propose to achieve both of these goals?

Author’s response:

In a typical office practice, doing all of these things together is impossible. On the other hand, it is possible to grow your new patient volume with open access. When I was working with a hospital system, its two pilot sites (internal medicine in the community and residency practice in ophthalmology) had prodigious growth based on the “see you today” principle alone. This experience is shared by countless other practices offering true open access.

If you’d like to do it all (i.e., “I’ll see you today,” “I’ll see you on time” and “We’ll have all the time you want and need”), you must entirely transform your office practice. Some cutting edge folks are doing this now: Dr. Linda Lee in Rochester, N.Y., Dr. Michelle Eads in Divide, Colo., and Dr. James Sturgis in Prairie Village, Kan., to name just a few. They have chosen to eliminate the bulk of their expenses in their renewed practices. By reducing their costs dramatically, they escaped the productivity death spiral, allowing them to craft the practices of their dreams.