How to Practice Independently for a Century
Maintaining an independent practice for a century requires deep investment from providers on a professional and personal level. “What drew me to this particular practice was the opportunity to tend to all aspects of my community,” says Dr. Segapeli. “It was back home, well-established, and the life-work balance allowed me time with my small children. It can be rare for physicians to get good coverage and time off with their families.”
Dr. Segapeli lauds the continuing education he has received over the years with the practice. “They don’t teach you any business in medical school,” he says, “so I wanted to learn from experienced pediatricians who knew how to run the business side of the practice. One of the most important and misunderstood elements of independent practice is the business side.” With access to a wealth of institutional knowledge, Dr. Segapeli was able to learn from mentors, and become a mentor to new pediatricians.
However, the practice has noticed a dwindling of independent providers in the region. “In our area there are a lot of practices being bought by the biggest health care entity now,” he says. “Almost all of our subspecialists have been bought up by hospitals.”
Due to the acquisition of subspecialists, Dr. Segapeli explains that, “[we] don’t have all the subspecialty care we could use in El Paso, so we refer out to bigger cities such as Dallas. It challenges some of our families if they need to leave for their child’s medical care, considering all the stressors of having sick children in the first place, and then the long drive they may need to make.”
How has El Paso Pediatrics resisted this same pressure to be bought up? “For us there hasn’t been a lot of pressure to sell as we’re a group pediatric practice,” says Dr. Segapeli. “We have extended hours and are open everyday of the week, and we do that so we don’t have to put a lot of kids in the hospital; we can track kids closely as outpatients.” The size of the practice’s staff has ultimately contributed to its independent status. However, El Paso Pediatrics has weathered some significant staff turnover in the past years.
“We had a complicated set of events in which we lost one of our Medicaid providers,” says Dr. Segapeli. “We decided that working with that provider wasn’t worth the struggle. We had a plan in place with another provider who was local and seemed more open to working with us. During this decision process, not all of our partners agreed on the changes.”
Dr. Segapeli’s biggest piece of advice for practitioners experiencing staff change is to create a space for healthy dialogue. “We had many discussions within our group of providers, so the factors that caused people to leave were out in the open. The key is to keep the discussion open to alternate strategies from your partners and really talk them through,” he says.
“Not everybody always agreed.” Dr. Segapeli explains that their practice lost a partner in the transition process. “But everybody who stayed made peace with the new plan, and we decided to work hard and make the changes we needed to make. Currently we’ve expanded to seven practitioners. When I started we were a group of four.”
During big leadership and staffing changes, Dr. Segapeli emphasizes that it is also important to call in outside objective support. “We called in consultants, including PCC and the Pediatric Management Institute. They came in, looked at the situation, and gave us objective and professional advice. When so many partners are involved, an objective outside consultant can lend so much perspective. Within a year things had turned around.”