I am a solo practitioner in a small rural community of a population of 900. I absolutely love what I do!! There are 5 hospitals 15 – 25 miles in each direction so I do not do hospital rounds. I do have two clinics, Wills Valley Family Medicine and Valley Care DPC. I also see patients in a group home, two nursing homes and one assisted living retirement facility. And lastly we do home visits weekly. I have an incredible team of folks helping me in my clinics. That is the main reason I can do all that I do. I want to help other residents and medical students as well as practicing physicians know they can be solo practitioners. It gives one the freedom to practice as they would like to and not be under the pressure of a hospital or group practice and the demands that come with those types of employment. There are many fewer solo practitioners now than any any time in the past. Please join our page here and you will be able to ask any questions that may help you make this decision. What direction should we go? What do others do to make this decision? How do we avoid mistakes?

Once again, Dr. Koe’s story!
I began my practice October 2007. But my real journey began when I decided to go into medicine. I knew from the day I decided to go to medical school that I wanted to practice In a rural clinic somewhere in Alabama. I already knew that I wanted to live on a piece of land big enough for privacy and big enough to have a garden with animals. So that was the easy part.
I did think about other possibilities in medicine along the way but I kept coming back to my original goal of having a family practice In a small town. I am built for solo practice and I understand not everyone has this desire. I just want to tell my journey as it may inspire someone else to move in this I direction. It also may inspire someone not to do so!!
Unfortunately or fortunately I knew that I was not happy working for someone else. I do not like to be told what to do. That may be something one would not want to brag on. I just know that I am that way. I never really considered working for a large group of physicians. I did not really want to work for a hospital or other organization either. I had the benefit of owning my own business one time in the past, even though it was a very small business, it helped me a lot in making the decision to try it on my own. I was also fortunately not afraid to try.
I began looking for locations while I was just beginning medical school. I took the Alabama scholarship for rural medicine that paid for my entire education, including living expenses. It was a significant amount of money. The amount at that time in 2000 – 2004 was approximately $13,000. I am forever grateful for that scholarship and I do not mind doing all I can for my state and my community as they gave me this opportunity to be debt free. I never mind paying my taxes due to this gift they gave me!!
The number one thing I tell medical students coming to visit my farm is they should try very hard to stay or become debt free. That affords one much more freedom to choose the direction one can go. Not everyone can do this but I was terribly afraid of debt. I did all I could to avoid it. I was able to find a clinic to practice in during residency. I bought a piece of land in that community once I signed a contract with the hospital.
The hospital paid off a master’s program debt I had from the UAB School of Public Health. They set up my practice at no cost to me if I promised to serve the local community for three years. I knew I would live and die here where I practice. That was a no brainer!!
I did have to get into debt for the land I bought. But I was able to moon light and pay cash for a small barn/apartment that we built as I was in my last year and a half of training. I am so fortunate to have a relationship with a very talented artist/builder who could build every stick of housing, electricity and water on my property. We have solar panels and we had free hot water about 8 month of the year when I moved in. I have not paid an electric bill since 2007 at my home.
The hospital paid my salary the first year of my practice and would have continued to pay yearly if I had wished. I realized quickly I could run my practice as well or better than it was run by the hospital. They are a corporation so have to go by the corporate rules of their company. Some of the services they had in place to run my clinic were more expensive than what I would pay to run my clinic on my own. They were obligated to use what their corporation wanted them to use. I also saw the difficulties of hiring and firing people through their corporation. I ended up having 5 office managers in the first 10 months of my practice! That felt like craziness. It was not something they could easily help. But I knew I would be able to hire employees that were a much better fit for my goals and values. It did take a lot of learning over the years to find good folks who work hard and understand what I want to bring

to the community. Hiring and firing are the hardest part of owning your own business, in my opinion.
So this was essentially the beginning. Having the hospital pay the bills the first year was a great benefit as I needed to learn a lot about being out there on my own. I did feel all alone in the beginning. I knew no one in the community when I moved to Collinsville. It was a little scary. My family was not from Alabama so I did not have a “home town” to go to. But, being in a small town, and especially Collinsville, I was accepted very quickly as if I had been here all my life. I understand that being a doctor does bring along some comfort. I am not typical in that I live off the grid but it did make people very curious about what I was doing. I have never felt “weird”! I do things differently but everyone here has been so open armed and happy to have a family doctor in town.
I was also very fortunate to have a pharmacy open the exact day I opened! The owner later told me he was also very fortunate as he may not have made it had I not come to town. Everyone was so excited and thrilled to have us both!
Now I understand that not everyone will have this experience in solo practice in other locations. Rural medicine is not for everyone. Many young doctors want to be in larger towns to have the availability of more services in their community. They often want different schools, close shopping, lots of entertainment, etc. I understand. I was much older and my kids were essentially grown. They did not want to move with me to my new location. They were in college, having kids and building new relationships and their own lives. As a single mom moving away from them I did suffer empty nest syndrome. I moved away from them to a new place without knowing a sole. Tim, my partner, and I had not solidified our relationship at that time. But it was also very exciting. i hardly had time to worry about not knowing anyone.
There is always a lot to do when you own a farm. There is always a lot to do when you are running your own clinic. I did phone home like “ET” a couple of times to Tuscaloosa where i trained!! When I needed help it was there! It was really exciting to be able to build my dream!!
What I want this page to be is a place practitioners can come and find a relatable story or some help when it comes to making the decision to go solo or not. I truly believe we all have a great story and I want us to be able to share those stories including the hard and the easy of it!! I want anyone to feel free to ask questions about what it has been like for me to see if they find some things helpful. I will be adding others stories here as well as some projects we have done in our clinic. We will discuss several topics that have been tried including Centering Health Care group visits, classes, leadership training, coding training that helped increase charges by many $$$ per month giving me the ability to hire physician extenders (CRNPs), starting DPC, to buy a building or not, and many other topics. We have had a food hub in our clinic until Covid. We have had yoga classes in our clinic briefly. We have used our clinic for parties for a local community group. There are so many exciting possibilities for one who owns their own clinic and is on solo practice!! We want to also share some of future goals and ideas and would love to hear what others are doing.
If you want to contact us you may use the contact sheet to ask questions and send us your story. Thanks so much for visiting our page!!

I would love to get many family physicians to participate in our page and have them send their patients here so that we can help with educating their folks on healthy lifestyles. I am going to add a membership page in the future that will help get this accomplished by offering a low minimal fee for access to all of our education materials. But I also want to help my compadres in medicine learn how to improve their bottom line while working in a solo practice. I will post some content on this page over the coming weeks and hope that we can get some dialog going on how to keep solo practices viable. We will also have a practitioner page that is not public to discuss ideas there as well.
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