Raise your hand if these points hit a little too close to home:
  • You see more patients per day to earn as much as—or even less than—you did just a few years ago.
  • You spend additional time at work to manage EMRs, or your patients complain that you are staring at a screen during their appointments.
  • You are missing out on family and social life.
  • You got into neurology because you found meaning in care for people. But now you spend as much or more time worrying about reimbursements, meaningful use, MACRA, and electronic health records.

If these resemble your own practice enough to make you a little uncomfortable, you are not alone. Neurologists rank at the bottom of the heap for job satisfaction and work-life balance.

Some feel trapped, but others have taken steps to reclaim the passion they had in their early careers. One of the ways they are doing this is by building non-insurance based practices (NIBP), also known as direct medical care.

This is what Peter McAllister, MD, has done with the New England Institute of Neurology and Headache (NEINH). He shared his experience at the 2017 meeting of the American Academy of Neurology.

After leaving a large single-specialty clinic, Dr. McAllister took 110 patients with him. But he now has since built his practice to over 3,200 patients and added an associate. His fees are transparent and published on his website. He started as a simple fee-for-service direct care provider, and sees about 12 to 16 patients each day compared to the 30-plus he saw in his insurance-based practice.

Dr. McAllister offers traditional neurology care, along with biofeedback, massage, nutrition consults and other services in a spa-like office. Patients pay directly for these services and submit their own insurance paperwork.

While Dr. McAllister has found success with NEINH, and shared several lessons about the NIBP practice model during his talk at AAN:

  • A physician operating under a NIBP model must also be a businessperson. You need a business plan and a marketing strategy, and physicians transitioning to direct care will often carry these out themselves.
  • You can’t be too risk-averse, at least in the short term. Completely abandoning insurance may sound frightening, but McAllister pointed out that the risk is not as great as may be perceived—you can always add insurance back into your practice if it doesn’t work out.
  • Finally, you must know the process for leaving insurance plans. Each has its own fine print, and you must follow the procedures they require. In addition, if you leave Medicare, you must wait two years to accept it again.

In addition, Dr. McAllister emphasized that not everyone is cut out for this type of practice. The model is more suited to physicians who enjoy the personal interaction with their patients.

He recommends looking at your reviews from online sites such as Vitals and Healthgrades to get an idea of how you are perceived. These reviews can confirm that you are well suited for personal interaction, in addition to highlighting areas that need a bit of polish. Or they may help you realize you don’t enjoy that aspect of practice and a more regimented style of reimbursement-based practice is a better fit.

A direct-pay or NIBP model may or may not be the right approach for you. But as you ponder ways to improve your job satisfaction and work-life balance, it is another option to consider. Whatever path allows you to be the best physician you can be is one your patients will thank you for taking.