Dr. Jay Douglas says being a solo practitioner allows him to spend more time with patients without feeling the need to us a "15 minute slot for a 45-minute problem."

Dr. Jay Douglass, a Lake Oswego internist, occasionally receives notices about job openings that pay much more than what he earns as a solo practitioner.

But he’s never tempted to cast his lot with a large medical practice.

“I know I could quit my job and get a raise,” Douglass said. “But this allows me to practice medicine the way I think it should be practiced.”

That way includes spending as much time with patients as he needs to and not feeling he has to rush to see a set quota of patients during the work day.

“When you’ve got a 15-minute slot for a 45-minute problem, you don’t have time to truly help that person,” Douglass said.

Doctors like Douglass aren’t exactly a dying breed, but solo practices have been diminishing nationwide. According to a survey of 20,000 physicians commissioned by The Physicians Foundation, 17 percent of physicians were in solo practice settings in 2014, down from 25 percent in 2012. This compares to 53 percent who described themselves as employees of a hospital or medical group.

Family time

Douglass, 38, had a role model for his decision to go solo: His father, Dr. George M. Douglass, helmed an internal medicine practice at the same location. The elder Douglass died right before Jay started medical school at Oregon Health & Science University.

Douglass wasn’t sure he wanted to go to medical school, much less what he’d want to specialize in.

“Once I got in, I was shocked to discover I really liked vascular and cardio-thoracic surgery,” Douglass recalled. But his mentors were often on their second or third marriage and scarcely saw their children, due to the long hours.

“It didn’t strike me as a good option,” Douglass said. “I wanted to be good at what I did, but have some semblance of life balance.”

He also wanted to practice both in an outpatient setting and hospital. Internal medicine would allow both. He is now housed at Olson Memorial Clinic, which is something of a hybrid model. Five internal medicine doctors share on-call duties, a front office, answering service and overhead expenses. But each practice is a separate business with its own panel of patients and medical assistants.

“The benefits you get are a fair amount of independence and say in contracting and how many patients you see,” Douglass said. “The downsides are you’re really available a lot. The other thing that’s intimidating and lacking in our education in health care is the business side of things. A lot is learn as you go. It’s, thankfully, worked out.”

Pressure buildup

The reason so many practices have melded into larger groups derives from financial pressures. Electronic Health Records and other technology and equipment are pricey. The amount of data doctors must report is overwhelming, especially if they can’t afford a large staff to handle it. And Medicare and Medicaid don’t reimburse providers as much as they’d like.

A larger system “can afford to accommodate your loss as a provider at an individual level because it makes money off the ancillaries associated with you — lab tests or physical therapy,” Douglass said.

But that’s not his business model.

He might suggest that a patient skip an expensive lab test if there’s no evidence it would be worth it. And instead of just prescribing a sleeping pill and moving on, he will take the time to ask a patient with insomnia about their sleeping habits to try to arrive at a better solution. He sees anywhere from 10 to 14 patients a day.

“I’ve been pretty blessed,” Douglass said. “I’m still paying my school loans off, but I’m paying them. You cannot complain. I still earn a favorable wage for the work I do.”

Elizabeth Hayes, Staff Reporter

Portland Business Journal