Doubling down on solo practice

At an age when many GPs might be dreaming of retiring, Auck­land specialist GP and distin­guished RNZCGP Fellow Ashwin Patel doubles down.

Not only does Dr Patel buy a place in the country with his wife and practice manager Shila, he follows up by open­ing a second practice.

Dr Patel has been the solo GP at My Doctor Parnell for 20 years and is also developer of the practice management system MyPractice.

In 2019, he and Shila bought a 6ha property near Matakana, an hour’s drive north of Auckland. A previous owner had moved a 1930s’ villa from Remuera, Auckland to the site and ex­tensive gardens were added.

Extensive may be an understatement. An aerial view shows vegetable gardens, a grass tennis court, numerous hedges, a camellia maze and fruit trees includ­ing citrus, plums, figs, nectarines, fei­joas, nashi pears and apples. Needless to say, the Patels are keen gardeners; it’s a four-hour ride-on lawnmower safari to cut the lawns.

The couple’s love of their country home saw them torn by end-of-week­end departures back to Auckland. But, instead of retiring, Dr Patel’s solution was to ignore what he says is becoming the accepted wisdom – that solo prac­tice is yesterday’s model – and set up a second practice in Matakana and be its solo GP.

Once the decision was made, it took four to five months to set up the prac­tice, which opened in December, Dr Patel says.

It turned out to be good timing; the practice delivered COVID-19 vaccine boosters to 1500 people – a great way to promote itself to potential patients.

But exactly how does it work, asks New Zealand Doctor Rata Aotearoa. How does Dr Patel serve patient populations in two localities, in two different PHOs?

In a typical week, the couple spends the weekend in Matakana. Dr Patel holds a clinic on Monday morning be­fore driving to Auckland at lunchtime for an afternoon clinic in Parnell. He’s in Parnell all day Tuesday and available for phone or video consults for his Matakana patients.

After a morning session in Parnell on Wednesday, he heads back to Matakana for afternoon consults and morning consults on Thursday morning. Then it is back to Parnell on Thursday after-noon until Friday lunchtime, when Matakana patients beckon.

It sounds like a mission but, as Dr Patel points out, it’s only one trip more than they had been doing previously, and driving at lunchtime does not present the problems of rush hour.

Shila is practice manager, doing the accounts and also, when needed, providing support for users of MyPractice. Neither practice has a nurse, but the Matakana practice has a receptionist who arranges same-day video or phone consults, or next day face-to-face appointments.

Dr Patel says they will consider adding a practice nurse or nurse practitioner as the practice grows. My Doctor Matakana is not the only practice in town. The Wellsford-based general practice Coast to Coast Health Care has a satellite clinic there.

Dr Patel concedes owner Tim Malloy was not initially thrilled by his arrival in town, but says there is a lot of unmet need in the area, particularly patients with chronic conditions.

Dr Patel says the practice has enrolled 250 patients and growing. It is fully booked most days – “it is a nice success-ful business”, on track to 500 or 600 patients in the first year.

Eight hundred patients are enrolled in Parnell and it is apparent from our conversation he would be reluctant to leave Parnell, at least for now.

His success, he says, is built on the fact he knows his Parnell patients well. And the timing is right, because it is easier to support people at a distance. “We are accessible five days a week.”

Physical examination is important, to rule things out, but the key element of an effective patient consultation is listening, Dr Patel says.

“Having said that, most patients want to see you in person.”

Dr Patel does not see solo practice at the end of its useful life. He says people do still want to see the same GP again and again.

Part of the success of the venture comes from the support of fellow GPs in Parnell who, he says, work well together with a nice “locality” feeling

. It leaves him wondering what the future holds with the localities on their way as a result of the health reforms. And this is one reason his Matakana practice sits with Comprehensive Care PHO while the Parnell one comes under ProCare.

As the changes loom, Dr Patel says he can see little point in My Doctor Matakana being the only ProCare practice in its area.

And, he adds, it’s nice to get the experience of two PHOs. As a PMS provider, he has worked with different PHOs and generally finds they have more similarities than differences.

Dr Patel says he was hoping to retire sometime in the next five years, but adds: “If you are really enjoying what you are doing, there is no reason to rush out of it.”

And, I notice, he has hardly stopped smiling the whole time we have been talking and looking at photos of the new practice.

As long as Shila and he can regularly see their grandchildren – which was made difficult by COVID in recent years – they will keep working for now.