Growing pains: Weighing the costs of success

When your practice grows too much, you face a decision: Expand or decline new patients.

By Mike Norbut, AMNews staff. Oct. 6, 2003.

It's a situation that excites and exasperates a physician. It's a sign of success, but it also signifies an impending crisis.

The business goal of every physician is to be busy, of course, but what happens when you get too busy? When a practice reaches its critical mass, when it can't possibly handle any additional patients, it's time to decide whether to expand or close the practice to new patients.

Each decision has advantages and risks. Expanding allows you to increase revenue and see patients in a timely fashion, but it adds overhead costs and assumes there's enough business to justify the growth. Closing the practice to new patients, on the other hand, preserves efficiency and allows the doctor to continue his or her lifestyle, but it's risky to turn patients away under any circumstances.

Ultimately, the decision depends not only on the market and patient demand, but also on personal preferences.

"A lot of decisions like that come down to the personality of the physician involved," said Tom Gorey, president of Policy Planning Associates, a consulting firm in Crystal Lake, Ill. "It depends on their risk tolerance and how ambitious they are."

For some, the risk is hardly an issue, because patient demand dictates the physician's next move. Michael Fleming, MD, a family physician in Shreveport, La., started his solo practice in 1978, and new patients started flooding his office. By the early 1980s, "things got out of hand," and he started looking to hire another physician.