Doctor's solo practice goes against the crowd

Dr. Christopher Wenner used to complain that he never had enough time with his patients.

But when Audrey Schaefer arrived for her checkup last month, Wenner was in no rush. "Let me hang up your coat," he told Schaefer, 72. While he drew her blood and listened to her heart, they chatted about her vacation and her husband's write-in campaign for mayor of Rockville.

After 45 minutes, he was still in no hurry to end the visit. "Well," he said, "Do you have any other concerns?"

Wenner reminds her of the country doctors of her childhood, Schaefer said. "If a doctor only sees you for 10 minutes, they really don't get to know you," she said. "This is the best."

As health reform sweeps more Minnesota doctors into large health care organizations, 40-year-old Christopher Wenner is happily swimming against the tide. Three years ago, he decided to try something so old that it's new again: a solo medical practice in his hometown of Cold Spring, Minn.

He's part of a fledgling national movement that's using technology and an entrepreneurial spirit to try to recapture what some say has been lost in the march toward corporate medicine.

"A doctor, a nurse, a secretary who knows you as a person," said Dr. L. Gordon Moore, a Seattle physician who created the Ideal Medical Practice (idealmedicalpractice.com) model, which Wenner has embraced. It's a practice, Moore said, "that treats you as an individual and not a disease." Not a step backward, he adds, but a "Norman Rockwell practice with a 21st-century central nervous system."

As a family doctor, Wenner had few role models when he decided to strike out on his own. In Minnesota, only about 3 percent of family doctors -- 34 people -- were sole owners of their practice in 2011, according to a survey by the Minnesota Academy of Family Physicians.

Historically, Minnesota has always had fewer solo docs than the rest of the country, in part because of the strong "group practice" influence of HMOs and the Mayo Clinic. Now, doctors nationwide are fleeing private practice in record numbers for steady jobs at big clinics and hospitals.

In part, it's driven by the 2010 federal health reform law, which encourages hospitals and clinics to be more accountable for the patient's total care. Before long, with the impending merger of HealthPartners and Park Nicollet, which will bring 1,500 physicians under one roof, most Twin Cities doctors will work for one of three big corporations.

But Wenner, who used to work for a large medical group, said he grew frustrated with the pressure to see so many patients per hour -- what's known as "throughput."

"A typical day would be, oh, 25 patients," he said, for an average visit of 10 to 15 minutes. "It was just the most uncomfortable situation when I had five minutes with a patient and they had a big list of questions," he said. "It was never enough."

His wife, Jen, an occupational therapist who is now a stay-at-home mom, said her reaction was simple: "Let's go for it." Even if it meant some belt-tightening, she said, "I just had faith that he was doing the right thing."

Low overhead, lean years

For Wenner, the key was keeping overhead to a minimum. He rented two rooms in a small strip mall, barely visible from the street, in Cold Spring, and literally scrounged for equipment. (The exam table came from Goodwill.) He has no nurse, no receptionist. Except for help with the billing, he does everything himself: answers the phone, draws the blood, cleans up the exam room.

At the same time, he invested in a state-of-the-art electronic medical records system and freely encourages patients to e-mail questions or comments through a secure portal. He considered charging for e-mail exchanges, but "it was too much of a hassle," he said, "and then I felt like I was nickel and diming patients." Besides, he said, he wants patients to feel free to ask him questions, and even gives them his cellphone number. "That's part of the deal," he said.

Getting started was harder than he expected. "I had lean years," said Wenner, who has three kids. He took no salary for months, and moonlighted at a jail and urgent-care centers to bring in money.

Some colleagues were skeptical that he could make it, he said. But coming from a family of doctors, he also had plenty of cheerleaders. "I never doubted him for a minute," said his 36-year-old sister, Dr. Rachel Wenner Ruzanic, a dermatologist in St. Cloud. "He's a man of deep convictions. He always does what's in the best interest of his patients."

She noted that her brother is a lot like their grandfather, Waldemar Wenner, an eye doctor. "People would say that with my grandfather ... when he was in that room with you, you were the only person in the world to him," she said. "Now I'm starting to hear those same stories about Chris."

After three years, business has picked up, and this month Wenner is expanding into a renovated bank on Main Street. He also became one the first certified "medical homes" in Minnesota -- a designation that, under health reform, would qualify him for extra payments to coordinate patients' care.

Ironically, it's the same concept driving so many mergers across the country-- the effort to manage patients and the cost of their care. But Wenner and others like him say it can be done on a small scale, too. "That's what primary care doctors are," he said.

Going it alone "is not for everybody," he said, adding that it takes some "intestinal fortitude." At this point, he's now earning close to his old salary, he said, but that's only part of the story. "There's just this great sense of being able to be a small-business owner, being in charge, being able to dictate how you want things to be done," he said. "You can't quantify that."