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IMP Forum and Future

  • 1.  IMP Forum and Future

    Posted 01-11-2019 19:21
    Dear Colleagues,

    This is a difficult message to post.   For many years, I have found the IMP forum to be valuable.  It was great to interact with others in small practices who thrived on close relationships with their patients, unhurried visits, and keeping their overhead as low as possible.   I iearned and incorporated many ideas.   Dare I say, I made virtual friendships.  When I was asked, I joined the board and became treasurer as a way to give back for all the valuable advise I had received

    For whatever reason, (I am sure we all have thoughts) our forum has become significantly quieter in the past 1-2 years and paid membership has dropped off considerably.  We are all very busy.  The cost of maintaining this forum with the current host, Higher Logic, at $700 per month has become prohibitive.

    Previously the forum was hosted on Yahoo.   As far as I know, when the decision was made to switch to HL several years ago, (before I was on the board), the organization had received a grant and paid membership was higher.  Currently, our bank account (with approximately $6,000) will be depleted before 2019 is over.

    Our three person Board had a telephone meeting last month and we discussed the financial situation of IMP, the declining utilization of the forum, and the future of the IMP organization.  If there is interest in doing so, the only way we can see this forum continuing is to migrate to a less costly hosting location.  I give Yahoo as an example, but I am sure there are other options.

    Please realize that moving the forum is not a simple task.    We will need volunteer(s) to step forward to help us do whatever is needed to set up the new forum, redirect members to a new location, understand the internet and web hosting issues, etc.

    I am hoping others will talk about if they still see value in the organization and the forum.   If so, how they would like to see it continue and what can they do to help.

    If there is not interest and assistance, we will have to turn off this forum in May, 2019.

    That's OK.   That will sadden me, but I will fondly remember the suggestions, guidance, and friendships.

    Michael Safran, MD
    Treasurer IMP

  • 2.  RE: IMP Forum and Future

    Posted 01-12-2019 04:34
    A thought - - 

    Would the AAFP, in it's attempts to embrace more dutifully (in the last few years, it seems) independent practitioners/new (new being the new "old) models of care delivery, consider a grant for the forum to find a web platform?   Diversity of practice models will stand the organization in good stead because when the current Big-Box medicine becomes unsustainable, there will be a resurgence in independent, likely cash based, physicians  .... and AAFP will want to have an "in" in the new landscape.  Keeping independent practitioners in practice independently has a benefit to the AAFP.  

    Deborah Lathrop

  • 3.  RE: IMP Forum and Future

    Posted 01-12-2019 05:01
    Thank you for your work. The IMP forum has been important to me when I started 2007 and much less so as I've been able to stride and focus on the work of doctoring. I appreciate the chance to respond to new IMP doctors questions about starting up.

    not understanding tech much the costs outlined seem very very high...I hope some durable options present and soon.

    Adam Schwarz

  • 4.  RE: IMP Forum and Future

    Posted 01-12-2019 05:17
    I have an FP colleague in private practice, now doing functional medicine and consultancy, who uses tech very expansively (not expensively).  I will also ask her for ideas of less expensive platforms, etc.  

    Deborah Lathrop MD

  • 5.  RE: IMP Forum and Future

    Posted 01-13-2019 06:52
    I was a member of the board back when we used the yahoo listserve AND when we chose this expensive solution. Basically the issue is that with the very inexpensive options there is no community forum OR there is no way to search topics. For example, I would remember reading about how someone solved a billing issue or hired staff and there was no way to go back and find that posting. 
    IMP was very dear to me, I spent 15 years in a  solo practice and could not have done it without the community of people there to help me. Having said that, I now am a shareholder in the largest physician owned company in the country, don't do my own billing anymore, still work on quality, but with the vast resources available with so many partners and there isn't a lot I can learn from the forum. Unfortunately, I feel like we spent all this time fighting for small and independent, and we lost. I think if the forum is to continue it will likely need a new focus. It seems the future of independence is only with DPC. 

    Kristin Oaks

  • 6.  RE: IMP Forum and Future

    Posted 01-12-2019 07:08
    I love the discussion group and would hate to see it go. I had no problem when it was on yahoo.

    Linda George

  • 7.  RE: IMP Forum and Future

    Posted 01-13-2019 06:38
    Not knowing the backend of this site, my first question would be how is it currently hosed? Second, how much bandwidth is it using (that can add to the monthly cost).

    There are potwntially other other less costly options available. It would depend on what the board is looking for. Hosting the site through Godaddy for instance, means you can put it on a WordPress platform. There are free member forum plugins available that can provide good functionality for group discussions.

    Thats just a thought off the off the top of my head.

    Paul Bond

  • 8.  RE: IMP Forum and Future

    Posted 01-14-2019 14:26
    I found the prior yahoo listserv very inspirational and instructional. I haven't found the current interface useful, mostly because the majority of the traffic was lost with the migration. 

    I believe the free listserv tools by yahoo or google (Google groups) are just dandy.  I can search just fine in them. No reason to pay for any infrastructure or reinvent it. The only effort needed is someone to moderate it, if desired (someone to review posts before they are posted). That job could get hard when there are as many postings as the prior group, but that wont happen for a while. 

    If I watch this current interface turn off with no alternative in its place, and no one making any other effort, I will start a Google Group in its place.  Called Run You Own Medical Practice or something like that.....

    Or - if Gordon or whoever owned that prior listserv - can just go in there and click to restart it, that would probably be just dandy...

    I don't believe the small independent practice is dead, and apparently I'm not alone - someone interviewed me a couple days ago about the topic that (he claimed) independent practices are picking up again (he was from a publication called MedpageToday). 

  • 9.  RE: IMP Forum and Future

    Posted 01-15-2019 06:00
    Actually PJ the traffic had significantly died down prior to the migration. The migration was our attempt to make the listserv more useful so people would come back. The statistics should be available in old board minutes.

    Sent from my iPhone

  • 10.  RE: IMP Forum and Future

    Posted 01-15-2019 13:43
    It was Gary Seto, and he moderates it. I think Jean probably has his contact info. At the time we really couldn't search, but mind you that seems like 8 years ago now.

    Sent from my iPhone

  • 11.  RE: IMP Forum and Future

    Posted 01-16-2019 07:18
    You know, I sent  the message hx for NOT the big list serv  but for the original  group like the core or something ...There was IMP list serv and there was practice improvement one
     Here is a screen shot The big list serv hit its peak around 2012 I think with a couple hundred posts a month People were complaining they got too many posts
    And noone searched  they  just  got on new and asked:)
     Oh well Sent the wrong thing

     Gordon started the list serv  so he is the owner? If I ask him -like I asked about the professional photographer he sent out in ROchester and we had nice IMP pictures that  were supposed to be for a web site, I am gonna get the blank look . He denies all knowledge of the photographer :)   Gary moderated it but it seems to me it would be Yahoo you ask about what to do  ??  Beats me but  the yahoo site has all that stuff

    Jean Antonucci

  • 12.  RE: IMP Forum and Future

    Posted 01-14-2019 07:10
    I started helping my wife run her clinic in 2010. Always looking for opportunity to streamline efficiencies I've learned quite a bit about tech and picked up a fair amount of programming. My big accomplishments are designing our call reminder system, in internal electronic document organization, fax OCR scanner with searchable database, a missed appointment text that instructs patient how to pay their fee (if 2nd in 12 months) and should be done with our On Call system in a week or two. Currently we pay over $300/month for an answering service, the budget for the new system is $50.

    I haven't done much forum programming but it should be pretty simple to transfer to a Wordpress front end and implement an open source Forum plug-in using something like Vanilla. Then is is just a few weekends of getting Google's API (99% free) to help out with mailing lists and signup verification.

    The timing is good if you would like some guidance. The learning curve is brutal but execution is relatively simplistic.

    Currently we are moving our internet from Blue-host to Amazon EC2. The speed difference is amazing and my budget is $40/month.
    Send me a message and maybe we can uncover something I'm not anticipating.  You should be able to run a semi complex community for $75 /month tops.

    James Randall
    Kassay Family Medicine
    Portland, OR

    James Randall
    Kassay Family Medicine
    Portland OR

  • 13.  RE: IMP Forum and Future

    Posted 01-15-2019 08:52
    Edited by Michael Safran 01-16-2019 08:38


    I would echo Adam.  Having been in an essentially identical situation about 12 years ago (too busy, unforgiving administration, burned out, threats of trying to enforce noncompete) I found a good counselor/business consultant (fortunately was the same person who I still meet with monthly 11 years later) to take care of the most important issue (you).  I ended up not wanting to go through the process of fighting a noncompete and simply did a 'fill in position' for a year more than the 20 miles away. I was also told that my noncompete started when my contract ended...not when I left. A dubious claim, but one that I did not have the energy to fight. (Noncompetes in healthcare are now illegal in NH!)  I had been in town for some time, so had a following.  That gave me the year to decompress, and do a lot of thinking about how I wanted to practice ( are the expert) then set up a business model that worked based on what we felt we should really be doing as primary care docs.Working through a business proforma... I was a amazed by the amount of overhead waste large organizations promulgate.  I was pleased to find many folks very willing to, reps from McKesson, insurance folks, even patients etc...


    We started with Soapware (now defunct) then went with Athena.

    We did not do MU/Macra/MIPS and are happy we did not (although it looks like it would be very easy with Athena).

    We do 'request' (not required) a $130 (started at $100 in 2007)  once per year 'noncovered services fee' from all adult patients...which has really made a big difference....we also opted out of Medicare (at that time it made sense). But I would submit that every IMP does things a bit differently..and successfully.


    I essentially asked myself when working for the hospital....could I see myself doing this for the next 20 years....the answer was clearly no.  Sounds like you are in the same place.  I knew I could always get a 'standard job' as an FP in some 'system' if I needed to, but wanted to give it another shot (I had run my own practice before selling it to the hospital in the mid 90s).  I too..did not want to move.  I could not be happier.  We have been able to stay in our home town....put our kids through college and (maybe) retire someday...but to tell the truth, I am thinking I really do not want to retire anytime soon if professional life continues to be so good. I also have much better 'work life' balance...although you do need to have some 'small business excites me' in you.  When we set up the practice...the first thing our 'business consultant' said was 'stop thinking like a doctor for this part'. Good advice.


    We came back and put up our shingle after being out of practice in our town for one year and a problem attracting patients, even after a year 'away'.  There are some things we did that helped this...and would be glad to chat about these, as they say...all healthcare is local and everyone's circumstances are different.  Chatting a bit with Adam or Jean or any other the other IMPs may be very useful.




    Exeter, NH.



  • 14.  RE: IMP Forum and Future

    Posted 01-15-2019 10:27
    1.  I can still see the yahoo group   Here below is the message hx ,fyi
    2  This seems to be a little bit of "you don't know what you have til its gone" based on the sudden influx of messages:)
    3  See Kris's message  "I don;t do my own billing anymore so I don't need..."   never do your own billing! Let the experts. Coding and billing  are a national shame but the list serv still can share all our varied experiences.
    4  many imps are still out there Some have joined big private groups, a potential idea that is better  if ti is available than joining a hospital
     Some incl the original hardest worker Lynn who  went DPC(just this month)
    We can still support each other, I think  most people do not go it alone- are in ACos if not employed  so get assistance that way
     But DPC cannot fly for the country as a whole  Certainly I care for disabled disenfranchised people with more social issues than I can bear.It is overwhelming here .
    I know IMps 2 hrs away who were there with us in Rochester and a have never been on the list serv but came  to conference once and are still out there  with no staff Just lost their office space so  bought their own
    Me I have made the best money ever in the last year .
    I am disgusted and cynical beyond belief though-partly at the  garbage and partly at  physicians who never speak up
    5 imp lost it s chance  to make a board of varied background and target  help  and a message to practices ;we needed to pay someone and despite lots of  hard work in  many ways ,we had  people who were spread out all over the country- a big big problem  for a little  non profit and we have people who say "I am too busy"  over and over.
     so a good list serv it is!

    I do not now how  to "turn yahoo on" but that is the way to go  Pictures are there Files are there Why  start over once again -it gives an email address for the owner     I suspect GAry Seto or  Gordon might know...
     I value being able to ask like minded people  things.
     speaking of which
    I am about to dabble in telehealth ANyone who has gone first?

    Jean Antonucci

  • 15.  RE: IMP Forum and Future

    Posted 01-15-2019 11:53
    Thank you to everyone for their responses.

    I have reached out to a member who has volunteered to assist with creating a new web site and is also working on a new forum.  But I am also getting a sense there is interest in just restarting Yahoo forum, and that is also being explored.  

    I believe we will need a new website or at lest a new place to host it, since the current website and forum are both on Higher Logic.    

    I know very little about websites, hosting, forums, etc.  So I would appreciate further suggestions and feedback and other volunteers who could help us.   


  • 16.  RE: IMP Forum and Future

    Posted 01-17-2019 05:01
    Hi. I also meant to reply a few days ago. I think I can also help with this issue.

    Before medicine, I ran a website design business for over 10 years. I lease server space with Dreamhost and when I finished residency, I just kept that going so as not to leave the organizations that I had hosted pro bono over the years out on the street, so to speak. I consider it a donation to the good people of the world and it is really very little trouble for me. I also may open my own IMP one day and plan to put a site for myself on the server as well; it's sort of a hobby for me now, so no intention of closing my account.

    At any rate, my point is that I have a server that I don't sell space on anymore, but keep for my own purposes. I host the local little league, a softball league, some random struggling artists, etc.

    If the IMP community wants it, I will happily give you free hosting for however long you want or I grow old and die (I should have a good 30-40 years left in the tank, I hope).

    It's full hosting--nothing rinky dink. There are handy little auto-install tools for WordPress and a whole bunch of other website gadgets. The only cost is the domain registration, so whoever pays the $12/year for domain, but whatever's left on that can transfer over.

    Say the word and I'll set up an account. If you already have someone with the time/energy/knowledge to set up the site, they should be able to start setting things up and port old discussions over.  If this site is already WordPress, then it can just be copied over. I can also help with any porting of the site - but would need admin access to do so.

    My story is that I found this forum during residency when I was initially planning to open a practice after graduation. After some snafus and the ever-changing landscape of independent practice, plus a great opportunity to work in Correctional Health, I ended up taking a full-time job working with the very progressive people running the health care in the NYC jails. I love the work and we are doing good things, so I stuck with it. My heart remains with my local community and I can see myself still transitioning into some kind of community based independent practice eventually. I follow the forum posts with great interest, though I have little to contribute at present. I'd be sad for the community to die. A web presence helps other people find you in ways that a listserv does not.

    Amanda Harris

  • 17.  RE: IMP Forum and Future

    Posted 01-17-2019 05:22
    Wow - that is just a super generous find for the group!!!  Thank you for the offer!

  • 18.  RE: IMP Forum and Future

    Posted 01-17-2019 06:06
    Yahoo or google groups
    Free and easy
    No reason to overdesign
    This isnt a tech issue

    Btw the old yahoo listserv says “2 members” . I emailed the owner amd didn’t hear back. So it defunct.

    I believe google groups to be a bit more robust

  • 19.  RE: IMP Forum and Future

    Posted 02-22-2019 17:03
    Hey everyone. So, I've been working with Michael to set up something relatively light and easy with similar forum features using open source software and hosting cheap and easy on my little server space. It's mostly all ready to go and I'm hoping to launch it soon and save IMP the huge bills it currently incurs. The cost to run this will be about 1/12th of current cost (i.e. for what is currently paid per month would be the per year cost). It embodies the low-overhead philosophy.

    A few things you should all know:
    1. The plan is to port everyone over from here to there and give full access, then ask for donations to keep things running.
    2. Any new people would be asked to make a small contribution first in order to be able to post questions in the forum.
    3. Everything would be locked down so that search engines and non-members can't troll, but this would require you all to set up your logins and then complete your profiles of stuff you want to share with others (this was a concern before, but the forums are definitely not locked right now, so this should be an improvement).
    4. The forum as it is now would be lost - the old posts can't be brought over without paying for it (I personally find this infuriating).

    So, on the last point, your help is needed. If you know of any gems buried in the forums that you want to save for posterity or share with future IMP-ers, take some time now to go and dig that stuff out. Put it into a some relatively digestible form and hold onto it. When the new site launches, we can put those gems into a blog post format so new members can have access to it. (Or really any format, I'm open to ideas).

    Also, you should know that there will likely be an interim URL (so a different address) to get to the site and then we will recoup the old URL. This is because we don't want to shut down the old until the new is running. Though I might just close the existing forum to new posts. Then we can collectively decide what you miss/don't miss from the old before we say goodbye to it forever.

    I assure you this is not overthought and it is not too much; it's so much less than the current set up and surprisingly nimble. I think you will all be happy with it. I am a big IMP supporter in spirit and really do hope to join the ranks some day; I want IMP to live on so that you are here when I am ready. I just really like my job right now, so it might be a while. Hang in there!


    Amanda Harris

  • 20.  RE: IMP Forum and Future

    Posted 02-22-2019 19:37
    Thank you for the good work. I will contribute.

    Adam Schwarz

  • 21.  RE: IMP Forum and Future

    Posted 02-24-2019 08:34
    Thanks for the time and effort you have invested. I have been trying to survive as independent practice and I find this group encouraging and refreshing. 
    Blessings to all!!

  • 22.  RE: IMP Forum and Future

    Posted 04-27-2019 13:10
    Hey everyone, this shift to a new site is going to happen soon. The new site is all set up and will just require everyone on here to re-set their passwords. We will send out an announcement alerting you when to stop using this site and use the new one.

    We couldn't come up with a good way to save good forum topics/discussions from this site and the folks who run this site would not give us an export without paying extra.

    What *might* work is to go to individual threads that you think are worth saving and just Ctrl+P print the entire thread to a PDF. We can then have a spot on the new site with the archived content in PDF format.

    It's a lot of threads, so maybe if we have a volunteer effort we can get this done more easily. I suggest the following:
    1. Browse through and when you find a thread you want to PDF
    2. Write a quick post saying you are turning it into a PDF (so that no one else duplicates your work)
    3. Save it on your computer
    4. Email it me later (or I will make a way for you to upload them on the new site)
    It takes a village...

    Amanda Harris