Monday, February 23, 2004

They're (We're) Out There

For a change, I thought I'd link to websites of some of the other doctors taking part in this "redesign" or "revolution" in medical practice that I am trying to emulate in my practice.

It all started with Dr. Gordon Moore, who started his solo practice in 2001, and is still going strong. As he says on his website:

My goal has always been to create a practice capable of delivering care that is safe, effective, patient-centered, efficient, timely, and equitable.  I chose the "solo" option so that I could make changes quickly.  My goal was not "solo practice;" this has merely been my means to the end.

That certainly resonates with me. While I was at Kaiser, changes came very slowly. It's the difference between a blue whale turning left vs. a bottle-nosed dolphin turning left. I get to be the dolphin now. If a patient needs a prescription refill at Kaiser, they have to call the 1 800 number, wade through the phone message telephone tree, leave a message, the message goes to the pharmacy triage system, it gets typed in to an online pharmacy refill database which directs the refill request to the doctor, who is supposed to go through all the refill requests for his patients for that day. Approve/deny/change the prescription, which goes back to the pharmacy for processing. May take up to 48 hrs. Unless you need it sooner, then you need to leave a voice message for your doctor.

Even though I have no patients yet, I did call in a refill of an allergy medicine, Zyrtec, for a friend last week. I did it as a favor and refused payment. I mean, Claritin is available OTC, so how hard can refilling Zyrtec be? I called the local pharmacy and gave orders for the prescription. Done, right? Wrong. They called me back a few hours later because Zyrtec is "non-formulary", meaning it's not on their "approved" list of medications (read: it is more expensive that their formulary choice). No big deal, I said, I'll authorize that he didn't get adequate relief with Claritin, their formulary choice. Hold on, the pharmacist said. Don't tell us, you have to call the patient's insurance company's prior authorization number and tell them. Really? I said. So I called, expecting them to tell me they can't accept my prescription since I am not part of their network yet. But they just took my information and faxed me a form to sign and fax back to them. So much for being a dolphin. But now I'm a smarter dolphin and will remember where the obstacles are next time.

Another doctor who has set up his own solo practice, Dr. James Sturgis, can be found here at Prairie Village Family Medicine in Kansas:

My goal is to offer current and effective medical care in a practice recalling the best of the old-fashioned doctor's office: easy and immediate access without waiting, scant administrative hassle, lots of time spent with the doctor and a physician's appreciation for each patient's unique nature and circumstances.

Dr. Wes Bradford is another family physician who has opened his own practice in Redondo Beach, CA following this solo practice model. He comments:

A major but widely unappreciated factor is that doctors (especially in primary care) have twice as much documentation and monitoring expected now as forty years ago, but within the same allotted 15 minute visit. Imagine the stress of having to write a full-page clinical note during the visit, covering the past, present and future tests, consultations, medications, patient instructions and legal requirements, often for several separate problems in the same visit. This can easily take 10 minutes of the 15 minute visit, leaving little time left over for meaningful interaction with the patient. The doctor and patient both feel like they're on an assembly-line conveyor belt.

     Trying to do all of the above correctly inevitably takes more than the scheduled 15 minutes of time. Then patients still in the waiting room wonder why the doctor is never on time, while the clinical business managers say he's "unproductive and inefficient" because he "takes too much time". Nobody accounts for his having twice the workload in the same time allotment as in the past. Yet how can a doctor take twice as much time for each patient when the overhead expense is already 70 to 80%, with practice expenses climbing while reimbursements are fixed or dropping?

He goes on to describe the "low overhead" model with no employees and concludes:

By practicing in this unorthodox way, I can afford to spend twice as much time per visit as other doctors without charging more. I can maximize personal service, clinical effectiveness, and time to talk and listen, by minimizing my business complexity and overhead expense. My stress level is much lower, and I hope you will notice the difference in quality of service.

While I know of at least 15 other doctors around the country going solo, I was not able to locate any practice websites for them beyond ones just listing their name and addresses. But just so you know that they're out there, here they are:

Four Corners Family Medicine (Dr. Cindy Cote in Maple Valley, WA
Generations Health Care (Dr. Shaun Thompson in Fort Morgan, CO)
Health and Healing (Dr. Terry Merrifield in Andover, KS)
Flint Hills Family Medicine (Dr. Brent Hrabik in Emporia, KS)
Grace Family Medicine (Dr. Kathleen Meehan-De La Cruz in Hendersonville, NC)

We're out there, but our presence on the Web is not that obvious yet. Hopefully, that will change as more and more physicians learn about and perhaps try this practice model.

Oh yeah. And here's my practice website. It's a free service offered by the American Board of Family Practice, so any board certified family physician can have their own practice website through them.