Addressing Challenges in Urology Practice Management - Episode 1

Introduction: A Urologist's Experience in Practice Management

John J. Kowalczyk, DO, FACOS describes his own urology practice, touching on patient demographics, staffing, and management strategies.

John J. Kowalczyk, DO, FACOS: My name is John Kowalczyk. I am a urologist.

My urology practice is independently managed. We are a small group. We would call ourselves a small group. We are located in downtown Los Angeles, California. There are 4 urologists and 1 extended practitioner; that would be our physician's assistant. We have an internal general manager. He supervises all of our nonprovider staff. I am considered the medical director; I manage the medical staff itself. We basically don’t have an outside firm that manages our company other than our human resources team. That is a separate entity. We do subcontract that.

How many do patients I personally see in a month? I see about 350 patients in a typical month. My other associates may see a few less than I do. From my general region, this would be considered pretty standard. We are a heavy HMO [health maintenance organization] practice, which is why we see so many patients downtown. It is an urban region.

The typical patient that I see is a male patient with a diagnosis anywhere between BPH [benign prostate hyperplasia] and erectile dysfunction [ED]. We see a great number of patients who are referred to us for microscopic hematuria, which may or may not include kidney stones. We see a large number of patients with bladder cancer who I think are referred. I think this is because of our general population. We have a large Eastern European and Middle Eastern population. Both come from a culture of heavy smoking. We also tend to see a great deal of interstitial cystitis—probably more interstitial cystitis than a lot of my associates in the community; maybe it's because I have a reputation for being able to manage, to console, and to offer some guidance for patients with interstitial cystitis. We have a wide range of patients. We are a large HMO [health maintenance organization] practice. Southern California is unique in terms of what we have in our management services as an HMO [health maintenance organization]. We have the independent physician’s association that makes certain rules and regulations outside the plan. I don't think you see that in many other states.

My group and myself are not affiliated with a LUGPA [Large Urology Group Practice Association] at this time. We have looked into it, and the majority of services that we would benefit from—discounts, et cetera we are able to get through membership in our local state associations, and we have a unique affiliation with our malpractice carrier, which is not just a malpractice carrier; they also provide other insurance services and other financial services. It's called CAP [Cooperative of American Physicians]-MPT [Mutual Protection Trust]. The basis behind this decision is that a lot of the services that you would get as a member of a LUGPA, we are able to get through these particular organizations. We haven't joined or needed to join a LUGPA, although we are looking into joining, and some of the larger, evolving LUGPAs are looking at us as well.