Profiles in VUCA

Tell us about your practice and how it differs from what we’d expect.

I created a micro-practice in downtown Orlando. It’s a 200-square-foot room in a renovated Victorian house, furnished with plush arm chairs, a desk and, of course, an exam table.

When patients come to my office, I like them to feel like they’re in my home, talking to a girlfriend who just happens to be a doctor. I spend time getting to know my patients—their dreams and goals—because my goal is to treat the whole person and get at the root cause of medical issues, not just prescribe medication.

At traditional practices, the bulk of your interaction is probably with the receptionist or physician’s assistant. Here, there’s no interaction with anyone other than myself. I do the medical history, conduct the physical exam, and schedule your next appointment.

It’s reminiscent of an older time where physicians really took care of their own communities and they knew everybody in their town. Even my payment policy is inspired by that bygone era. I have a direct payment structure, but I don’t turn anyone away for lack of money. I offer discounts for people who need it, and I am open to bartering for goods or services.

It’s the past but it’s also the future. I feel like if everyone cared for their own community, there would be much lower insurance and prescription costs. It would pretty much be better for the entire system.

 

How did you decide to take this route rather than working for a hospital or typical practice?

Well, I’ve actually tried those models! I started in a private group practice where I was on call every third night and every other weekend at two different hospitals and two different offices. I did that for two years, then I had my first child. There was a point where I had rounds so early and got back so late that I didn’t see my baby with her eyes open for a whole week.

That’s when I decided I had to do something different to be there for my kids and also be more fulfilled at work.

Over the next four years I tried different positions and settings, but it always came down to revenue value units (RVUs)—payment based on how many patients you see instead of the quality of the care you provided to each patient.

For many of us, this runs counter to why we got into medicine. This system leaves doctors frustrated, emotionally burnt out, and fatigued. You can get cynical and resentful, and I just didn’t want to go down that path.

I came to the conclusion that the only way to practice the style of medicine I wanted was to set out to do it myself.

 

Are you an outlier or is this an industry trend you’re seeing?

When I was in medical school, nobody was going into private practice as a solo practitioner anymore.

Now, there’s this grassroots movement with more physicians starting micro-practices like mine, where they’re really focused on doing a great job with a small amount of people as opposed to assembly line medicine with three-minute appointments and 6,000 people a year.

More and more are popping up around the country as physicians try to give patients the best service possible and also take back control over their careers.

There have been at least 300 micro-practices that have popped up in the last year or two and I think we will see more.

 

How does each part of the VUCA acronym manifest in what you do?

The first example that comes to mind in my particular field is the the pap smear. It kind of revolutionized medicine and we started to see cervical cancer rates drop off steeply once we developed this really good screening technology.

Since then, we’ve gotten all of these other new technologies that are coming out. Take the HPV vaccine; essentially you can get a shot to prevent cancer. It’s still incredibly important to screen at the recommended intervals, but there’s been an incredible amount of progress since, say, the 70’s.

We’ve made some great strides in medicine, but we’ve also taken a lot of steps back. Take, for instance, doctors being in the hospital for 24, 36, or 72 hours straight.

There are always arguments made that the airline industry has much better safety protocols in place for their pilots than physicians do, and there are similar life-and-death implications.  

There’s a lot of good that’s happened, there’s a lot of bad.

There’s a lot of uncertainty in general in medicine right now—what will happen with Obamacare or Planned Parenthood? Will certain care providers be able to take certain insurance plans? What happens if medicare gets cut?

The main way for physicians to prepare ourselves no matter how the politics plays out is to set up your own practice the way you want. It’s taking back control and insulating ourselves from the whims of the political leaders.

Who knows how long it’s going to take for them to decide or when it’s going to be solved?

Back in the day, you could just set up shop and that was it. Now there are so many moving parts, so many new changes and new laws that allow various bureaucrats to have their hands in medicine.

There are many more factors you have to consider when you want to open your own practice. In a group practice, you have a relative army taking care of much of that red tape for you.  

Our work-around is to be a cash-based practice so you don’t have to deal with insurance companies. That eliminates a lot of complexity and stress so you can focus on spending quality time with your patient.

I think few saw the micro-practice movement coming. It’s disrupting the status quo and changing people’s minds about health care delivery.

People have asked for a long time, “how do we fix this broken system?” Micro-practices are a potential solution that people haven’t considered, and yet, many patients find it to be a breath of fresh air.

Beyond that, the population is getting sicker and sicker. I wonder how that’s going to play out in the future. As our society grows heavier, children are starting to die before their parents and that’s never happened before in the history of our humanity.

If kids aren’t living long enough to take care of parents now, it’s difficult to imagine the impact on our economy and healthcare in general.

I feel that this kind of model would help to be one piece of a solution for something like that.

 

When you think of all these VUCA elements together, how do you process it? How do you react?

I’m in a state of peace because I know that I’m doing my part. Recently, in the last 3 months, I helped 3 other physicians start their own micro-practices.

I’m peaceful because my trust isn’t in the system and my trust isn’t in government. If my trust was in any of those things, it would be a really scary time for me. But my trust is in God.

If I have to make a decision and it’s not going to bring me either peace or joy, then I don’t do it. That’s pretty much my compass and what drives everything.

It’s such a simple way of looking at things, but with that being my driver, I can’t help being in that state of peacefulness and joy.

 

How do you react to VUCA?

Dr. Lewis embodies one of the core tenets we have at The Futures School—you don’t have to just stand by and wait for the future to happen to you. Rather, you can be proactive and strategic in the actions you take today in order to create the future you want.

This empowering mindset comes from thinking like a futurist. It also enables you to be adaptive, resilient, and transformative. Do you have these attributes? Take our quiz to find out.