Tuesday, October 14, 2003

Getting off the hamster wheel

Nothing much is happening on the solo practice front, not until I sign the lease agreement.

But I still have my own patients at Kaiser whom I am taking care of. I have begun telling some of my more regular patients that I will be leaving to start my own practice. Everybody has said pretty much the same thing: "We're sorry to see you go", "We know you'll do well". "Can you recommend a good doctor to take your place?"

Today I saw two patients for first time physicals with me, and of course, we used up much more than the 15 minutes allotted for each visit. I felt bad when I told them afterwards that I was going to be leaving, but I felt it only fair that they know that I would not be following up with them for long.

I am supposed to write a "farewell letter" to my patients in the next two weeks. The clinic will then mail it out to all my patients. Some on my panel have never even met me, and will no doubt wonder why they are receiving this letter. However, because of a confluence of circumstances, I won't really be leaving on my final day.

I plan to continue working part-time for a few months since I won't have any regular patients of my own in my solo practice at first. It will take several months for me to get approved for participation with the various insurance carriers. Plus there is currently a hiring freeze at Kaiser so they won't be able to get a replacement doctor for my patients. My boss plans for me to continue to be the primary care doctor for my patients even after my resignation from the medical group. So even though I will be gone, I won't be.

Some days I wonder why I am leaving. I read an article today about how doctors at Kaiser are among the happiest and most satisfied in California, compared to doctors in other managed care organizations or private practice. I really do believe that Kaiser provides very good medical care. It consistently wins awards for quality of care. Plus it offers a good stable and secure lifestyle for most physicians.

But then I have days like today, when I am moving from exam room to exam room, trying to catch up, seeing patients for physicals who also have 3 other problems they want to discuss, then on to the next patient who's here for a cold, and by the way has 4 other things they have questions about, and so on. Then the next patient is sticking his head out the exam room door wondering if I've forgotten about him.

This article from the British Medical Journal describes this situation as "hamster health care." It certainly describes how I've felt about my medical practice for the past few years. This article also mentions the "Kaiser Reward", defining it as "the more efficient you are in seeing patients the more patients you get to see." Some reward.

Through the years, I've developed another interpretation of the "Kaiser Reward". The more patient and compassionate a doctor you are, the more complex and chronically ill patients you'll collect. Once you get a reputation as being a patient listener, then nurses and other patients spread the word and eventually, the patients who like to talk, the patients with 12-inch thick charts will find you. Good for them. Not so good for a doctor who only has 15 minutes per patient.

As the article says, "Systems that depend on everybody running faster are not sustainable." I agree, and that is why I am getting off the hamster wheel.

And not just because I am tired of running. I also want to walk in a new direction, towards providing *excellent* medical care. Maybe some day, I'll even get there.

Countdown: 83 days until target start date