Dr. Robin Warner is very independent. She described herself as such during a recent phone interview. “I’m strong-willed. I’m independent.” She added, laughing warmly, “I’m a control freak.”
“My parents taught me to fight for myself from a very young age. That can be a good character trait or a bad one, depending on the situation.” As a solo practitioner, her independence and ability to advocate for herself have served her well. “I can determine my own path, choose what kind of things I want to focus on in my practice, and decide what kind of brand I want to portray,” she said.
In September 2007, Dr. Warner opened the doors of her own practice: Union Pediatrics in Union, Kentucky. Union is a small city of about 5,600 near the Ohio border and only 20 miles from Cincinnati. Dr. Warner is the only pediatrician in her zip code which helps new patients find her online. The practice is on the outskirts of town, close to both a country club and rural farm land, resulting in a demographically varied clientele. The newly remodeled office has a small, homey waiting room. There are no TVs because Dr. Warner said she thinks kids get enough screen time at home. Instead, there are lots of toys and puzzles. “I have a hard time getting kids out of the waiting room sometimes,” she said. There’s also a secondary waiting room for siblings if parents bring more than one child to the appointment, which is often the case.
In every detail of the practice, from the location to the design of the waiting room, Dr. Warner has made each decision thoughtfully and without having to get anyone’s approval. Nine years after opening she’s never looked back.
Before Going Solo
Dr. Warner didn’t always have the freedom to make these kinds of decisions. Before opening her own practice, she worked for a primary care group for seven years. The group mainly consisted of family practice doctors, with only two pediatric-specific offices out of fifteen.
“The administration did not understand the business of pediatrics,” said Dr. Warner. “All of the contracting was done based on the needs of the family practice doctors, and so we would accept lower payments for things like well-child exams and immunizations.” Because of the “eat what you kill” payment structure, Dr. Warner said these decisions primarily affected pediatricians in the group.
In addition to lower payments for staple pediatric services, continuity of care was often overlooked in favor of cost savings and convenience. Dr. Warner said that during her time there, the family practice doctors didn’t give vaccines to the pediatric patients they saw, but instead sent them to the health department for immunizations. “Vaccine administration was just not something that was very important to them,” she said. The group’s management also grumbled about the high overhead costs of vaccines and didn’t understand the importance of well-child care, said Dr. Warner.
Although she was frustrated with many aspects of the group’s management, Dr. Warner was not yet in a position to break out on her own. “I had a child who needed multiple surgeries and was in the hospital a lot. I didn’t have the extra energy to devote to running my own practice at the time,” she said. However, she quickly found her resolve when she fully understood how little her services were valued.
In May of 2006, the group’s new interim medical director came to the office and told them he planned to propose cutting ties with the pediatric offices. “He said he didn’t see the value in having pediatrics as part of the group since family practice doctors can see children, too,” said Dr. Warner. Although the measure was ultimately voted down by the board, Dr. Warner had decided it was time for her to go. She attended the American Academy of Pediatrics (AAP) National Conference & Exhibition that fall to arm herself with the knowledge she needed to open her own pediatric practice. Then in May of 2007, Dr. Warner gave her notice–just one year after she’d made her decision to leave. She opened her own solo practice a few months later.
