It was 1990, and Dr. Charlotte Smith, a board-certified Neuro-Rehabilitation and Spinal Cord Injury specialist based in Austin, had what many aspire to: her own practice in a traditional office with thousands of square feet, and a full-time nurse, physician assistant and office manager.
But things weren't going as well as they could be. Dr. Smith says, "If I had kept working in that way, I'd be bankrupt by now."
She found the expenses of her practice difficult to manage. Overhead costs kept going up, but she couldn't charge patients more. More importantly, she longed to do more research and work in the multidisciplinary, collaborative environment of a hospital or research center. She did see hospital patients, but that meant less time for outpatient care—Dr. Smith is one of the few who provides spinal cord care to patients in neighboring counties. More hospital work would also mean paying for a private office that she wasn't using much of the time.
Reinvention leads to solutions
"I needed to reinvent myself, focus on what I wanted to do and remain solvent," Dr. Smith says.
Dr. Smith decided to transition to a predominantly hospital-based practice with the Seton Healthcare Network. She then started an outpatient clinic for Seton's Brain and Spine Center (located in the University Medical Center Brackenridge) by sharing a turnkey office space with other physicians. In the same facility, she helped develop a Recovery Center for patients, at which she and her colleagues pursue various research initiatives.
Dr. Smith now spends about half her time doing hospital work. At the clinic, she shares a receptionist and offers appointments only one day per week, using various EMR tools to advise patients on her off days.
"It’s a four- to five-year process — I’m not there yet," Dr. Smith says. "Not having a full-time nurse is an adjustment in itself. But I’m enjoying my profession more."
Happy wearing many hats
Since the transition, Dr. Smith has been able to serve as the Medical Director for Seton's 10-hospital network, and conduct "mind-blowing" research. At the same time, she continues to offer outpatient care. She also provides legislative medical testimony and is the President of the Travis County Medical Society.
And as if that weren't enough, Dr. Smith is active in her church, raising two children, and involved with what she calls "medical marriage mentoring" for friends and others. (Ask her what a two-doctor marriage is like, and she'll be happy to tell you about "date nights" and "veto power.")
"There's a lot of pessimism right now in medicine. I hear mature physicians tell younger people ‘don't go to medical school.' But I’m optimistic," she says. "Sometimes a traditional private practice is best. My husband has been happy doing that for years. But consider bringing diversity into your career. It’s helped me to thrive—and it’s better for my patients, too."