1. Happiness-Based Musculoskeletal Medicine
The Ideal Micropractice 101
2015 AAPM&R National Conference
Justin Berthold, DO – PM&R

2. Who am I?
Justin Berthold, D.O. Physical Medicine & Rehabilitation Physician Focus on restoring function and quality of life Treat the whole person and not just the injury
Rehabilitation Physicians of Pittsburgh – Founder
The Children’s Institute of Pittsburgh – Medical Director of PM&R
LECOM at Seton Hill – OMT Faculty

3. Ok, but Who am I?

4. How this all started…

5. How this all started…
Gordon Moore, MD

6. Moore’s 4 Pillars of Success
ACCESS
Patients have unlimited access to the care and information they need, when they need it.
INTERACTION
Interaction between the patient and care team is deep and personal. The care team has “memory” of the patient.
RELIABILITY
The system exhibits high reliability in that it provides all and only the care known to be effective.
VITALITY
The practice has vitality: happy employees, a spirit of innovation and financial viability.

7. A Wise Mentor’s 3 Pillars of Success
AVAILABILITY
AFFABILITY
ABILITY

9. Keep it Simple What is an Ideal Micropractice? Why do such a thing?
How to take the leap?
Pearls and pitfalls
Year 1 results

11. What is an Ideal Micropractice?
Key Principles
High-quality, patient-centered, collaborative care
Unfettered access and continuity
Extreme efficiency

14. Let’s Keep it Simple What is an Ideal Micropractice?
Why do such a thing?
How to take the leap?
Pearls and pitfalls
Year 1 results

15. Why Do Such a Thing? Why not? Unpredictable healthcare climate
Patients deserve the best of me
Will learn much more if I do this
Set up for a solid plan B

16. Physician Burnout
Burnout is commonly defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.

17. Physician Burnout
A national survey published in the Archives of Internal Medicine in 2012 reported that US physicians suffer more burnout than other American workers.[1] This year, in the Medscape Physician Lifestyle Report, 46% of all physicians responded that they had burnout, which is a substantial increase since the Medscape Lifestyle Report, in which burnout was reported in slightly under 40% of respondents.

18. Physician Burnout
In this year's survey, the lowest happiness scores at work belonged to radiologists (4.46) and, as expected, those on the front line of care: internists and emergency medicine physicians (both 4.50) and family physicians (4.52). Dermatologists (4.95) and ophthalmologists 4.85) had the highest scores for happiness at work.

20. In your job, you are running on the tracks of “the way we do things around here.” These are still not your tracks. You did not lay them. Burnout is when you figure out how to lay your own tracks or better yet, realize you are a four wheel drive vehicle – not a train on tracks. You can navigate any terrain you choose.
- Dike Drummond MD (The Happy MD)

22. Let’s Keep it Simple What is an Ideal Micropractice?
Why do such a thing?
How to take the leap?
Pearls and pitfalls
Year 1 results

23. How to take the leap
Map out your value system – your practice will be a direct extension of you
Seek advice (*not approval) from trusted family, friends, and mentors
Call yourself something, put an actual name to your vision
Step forward and don’t look back

24. Must have skills Medical knowledge/ability Compassion/empathy
Blue-collar work ethic/self-reliance
Networking/promoter
Organizational ability/motivator

26. “It’s the lack of faith that makes people afraid of meeting challenges, and I believed in myself.”
- Muhammad Ali

27. Let’s Keep it Simple What is an Ideal Micropractice?
Why do such a thing?
How to take the leap?
Pearls and pitfalls
Year 1 results

28. Pearls and Pitfalls
Start the credentialing process as early as possible
Negotiate everything; cut start-up and operational costs wherever you can
Supplement income if possible (teaching engagement, locums, etc.)
Find trustworthy staff members and train them well
Design protocols across the board (phone answering, medical procedures, etc.)
Walk in the patient’s shoes (simulate your office experience)
Stay true to your vision but always ready to adapt

29. Let’s Keep it Simple What is an Ideal Micropractice?
Why do such a thing?
How to take the leap?
Pearls and pitfalls
Year 1 results

30. Year 1 results Community micropractice model has been well-received
Local publicity has helped to develop our brand
Referral sources find value in our service
Has spiraled into other opportunities (PM&R directorship position, consultation engagements, and more)
Addition of a friend and colleague…

32. Thank you.