Saturday, January 30, 2010

The Many Demands of Solo Practice

The other day I was telling a colleague about the lives of the lawyers who attend our monthly Solo Practitioners Forum. In the process, he and I both realized that running a solo practice requires a surprisingly long list of skills. Some of them are:

· Legal/Intellectual – this goes without saying, and calls upon much of what you learned in law school and in subsequent reading and continuing education, but no one can know it all. A major problem arises when lawyers, not recognizing their limits, fail to ask for guidance from someone who knows more about a particular subject.

· Accounting – unless you have paid staff, you have to log your time spent, bill your clients, and keep track of where your accounts stand. I can’t tell you how many lawyers I have met who are months behind in billing. For some of them, it’s because they are uncomfortable asking for money, especially from clients they know are far from well off. (Naturally, this is easier when someone else asks on your behalf.) They may feel a degree of shame for billing for services that were, perhaps, not delivered in a timely fashion. Or they may just have a brain that is allergic to columns, rows, and figures.

· Marketing – there may have been a time when just being a competent lawyer would eventually create enough word-of-mouth referrals, but that is no longer enough. Aside from CPCS as a ready source of (low-paying) referrals, the solo practitioner must figure out ways to get business. For most, it’s uncomfortable and oh-so-avoidable to contact people asking them to send business your way, or, for example, to do public speaking or spend a bunch of money on ads.

· Interpersonal – a slew of interpersonal skills are required to know how to deal with a variety of clients with different personalities, not to mention legal adversaries, judges, clerks, etc. – each of whom calls for a different approach. It helps to be able to read body language, discern unspoken agendas or expectations, etc., and to consciously manage your own reactions to individuals who “press your buttons.” Some practices call for evolved skills in negotiation or persuasion. And some clients behave in ways that require diplomacy in the form of clear limit-setting so as to avoid burning out or losing your temper.

· Organizational – in order to make a living, any lawyer has to be relatively efficient and productive. Most clients would not care to pay for your hours spent in reverie, even if you are finding parallels between their case and your readings of Proust, never mind Facebook. So you need to schedule yourself, keep yourself motivated, keep on top of deadlines, and prioritize tasks by importance, urgency, etc. Those who work at law firms have others around, and to whom they answer, to notice if their noses veer from the grindstone, or if they are putting undue work into matters that don’t demand it, or if they are taking too long to get back to clients, but those in solo practice must be their own overseers.

I’m sure that there is much more, but it becomes obvious how many skills and tasks must be juggled in order to carry on a solo practice. In order to thrive, and stay out of trouble, it is important to be aware of how you are doing on each dimension – few people could be adept at all of these functions. Identifying real deficits in any of these areas calls for action, such as delegating some tasks or getting further training or coaching for yourself. Those who attend our Solo Practitioners Forum use the opportunity to clarify, vent, brainstorm, and seek solutions. But that group is not always the right option for the lawyers who come to us for assessment; sometimes the thing that helps most is a referral to, for example, an organizational coach, mentor, or counselor. We also frequently refer to the Law Office Management Assistance Program (LOMAP), which is funded by LCL. It makes sense for practitioners to make use of such resources when you realize just how demanding and multifaceted a job they face.

Monday, January 4, 2010

Universal Coverage? Not Exactly

On occasion, the “universal” health coverage system initiated in Massachusetts during the Romney administration and sustained in the Patrick years has been pointed to as a model of what might be accomplished on a national scale. As the various kinds of “public options” seem to be fading away, it looks even more similar – adding a requirement for all citizens to arrange coverage, without any substantial renovation in the system (e.g., there is clearly no appetite for adopting the kinds of systems found in most other countries, even though many of them reportedly offer better care at much lower expense). It is quite understandable that the idea of losing our familiar forms of medical coverage triggers anxiety in most of us. The Massachusetts plan does have a kind of “public option,” but it has not made coverage truly universal. The problem, and I am not claiming to have the answer on its solution, is that many citizens, having no way to pay for the mandated coverage, continue to go without it. [Let me be clear that I am taking no political side here, since there are clearly drawbacks in any approach that has been proposed – my concern is strictly for those who need care that they cannot get.]

Personally, I was very pleased when the Massachusetts plan came along, because I had been able to present few treatment options to lawyers who came to LCL (or others who consulted with me elsewhere) in need of therapy or medication but with no means to pay for it. Publically subsidized clinics and mental health centers had long since become unable to offer truly low-cost services (probably since the end of the Dukakis administration), so the main option remaining was to refer people to community-oriented hospitals drawing upon a statewide “free care pool.”

Little did I suspect that I would be faced with a significantly larger number of uninsured lawyers after the advent of “universal” coverage here in the Bay State – and virtually nowhere to send them (since the free care pool subsequently diminished or disappeared).

I don’t think that the advent of expanded coverage itself could have caused an increase in numbers of uninsured middle class citizens – that must be a reflection of the economy – and I’m sure it has reduced the number of uninsured citizens in dire poverty. [I don’t have evidence that the trend toward more uninsured even extends beyond lawyers who come to LCL, but there was no mistaking it among those I saw there.] Aside from imposing state income tax penalties on those without coverage, the new Massachusetts plan brought about two main changes in coverage options: (1) private insurers began making some more affordable plans directly available to consumers and (2) the state began offering its Medicaid plan, MassHealth, to a significantly expanded group of residents, under the name of Commonwealth Care.

But consider the case of an LCL client (or other citizen) with a spouse, 2 kids, and a combined family income of $70,000. The private insurers have developed stripped down plans, with less extensive coverage resulting in lower premiums for young adults -but not much lower for those who have reached middle age. So, what about the public option, Commonwealth Care? In order to qualify for Commonwealth Care (the application is somewhat cumbersome and processing takes well over a month), your income must be less than 300% of Federal Poverty Guidelines. For our hypothetical lawyer/consumer with a household of 4, that means under $66,168 – and he will still have to pay about $1200 a year in premiums. In order to get the least comprehensive plan and not pay premiums, the annual family (of 4) income would have to be under $33,084. An individual (family of one) would have to make less than $16,260 to receive fully subsidized coverage. (That individual can get Commonwealth Care with an income of under $33,084, but would be paying premiums.) Of course, just like private insurance, the plan also requires co-pays for office visits and prescription drugs (with an annual cap on out-of-pocket expenses).

Thus, more than one lawyer seeing me at LCL has demonstrated that, since s/he makes too much money to qualify for Commonwealth Care, there is no way to afford health insurance without giving up, say, food, the house, or the car. They can better afford the tax penalty. Certainly, hospitals will not throw them out on the street if they require emergency care. But for less urgent services, and certainly for most LCL referrals, consumers are on their own – “free care” is apparently difficult or impossible to come by. As the state’s coffers empty, the capacity to subsidize coverage may further erode. At LCL, we do what we can to help, but too often it is simply not possible to arrange the kind of treatment to which we would refer any of our insured clients. This may be the best that can be realistically expected in this place and time, but it is not “universal” care.

If you live in Massachusetts and currently lack health insurance, here is how to find out what you’re eligible for: Get on the internet (at the library if you don’t have it at home), and go to Click “Individuals and Families” or “Young Adults,” whichever applies, fill in the requested information (e.g., family size, income), and you will be led to either the opportunity to apply for Commonwealth Care or to a selection of private health plans, with information on their costs and benefits. If you are still left in the cold…. Well, let’s see what happens on a nationwide level…….