Editor's Note: Small-practice series highlights day-to-day struggles

Small medical practices, like all small businesses, struggle with staffing issues, adapting to new technology and surviving in a competitive market. Add to that the challenges unique to medicine, such as proper storage of vaccines, protecting patient privacy, and the paperwork involved in billing a network of public and private insurers, and it's not surprising that many small practices are struggling to keep afloat.

In this issue, Jessica Berthold wraps up her six-part series on small practice issues, based on the ACP Center for Practice Innovation's visits to 34 small practices around the country. Interestingly, some of the problems the CPI staff found had little to do with size or financial resources. An employee's resistance to change, for example, or a physician's poor management skills, can drag down an entire office's morale and productivity. In other cases, practical, relatively inexpensive steps, such as installing an automated phone system or tweaking the schedule to reduce wait times, led to measurable improvements.

Once made aware of a situation, most physicians followed the CPI's advice on how to improve. Some problems, however, were more intractable. Go to the story to find out how these practices dealt with the shift to electronic medical records (some stuck with paper), pressures to switch to electronic prescribing and other challenges.

Of course, physicians in small practice must juggle running day-to-day operations with keeping abreast of the latest public health issues, including the emerging health threats posed by climate change. Stacey Butterfield kicks off a new series focusing on the connections between environmental issues and medical practice. It may not be easy or even possible to reverse global warming but there are ways for physicians to prepare for its potential effects, such as the increasing risks of heat-related illnesses and severe allergies.

Also in this issue, don't miss the latest ethical dilemma with guest commentator Paul S. Mueller, FACP, on the questions that arise when a patient refuses life-sustaining treatment. If these or any other topics in the issue catch your interest, consider posting a comment on our new blog. . We hope this online forum will spark discussions among readers and encourage interaction with our staff and other contributors to the publication. Please give it a try and let us know what you think. I look forward to hearing from you.

Sincerely,

Janet Colwell
Editor