Wednesday, December 29, 2004

Where do future family doctors come from?

I came across a recent news article describing how Tulane University is fostering future rural family doctors. There is no question that there are many medically underserved areas in this country. It is also a well documented trend that fewer and fewer medical school graduates are choosing to go into family medicine. It would seem wise to me that instead of focusing on just taking the "best" applicants, medical schools should make a more concerted effort to take the willing, those who want to practice in underserved areas.

In my 2nd year of medical school, I was one of the student representatives of the admissions committee, and we all did our best to find those applicants who appeared to be "doctor" material. Our tools: GPAs, MCAT scores, letters of recommendations, the application form with its one page essay, and for those who made the cut, the live interview. It was always interesting to come across wonderfully articulate essays, and later discover during the interview that the alleged author had at best a weak command of the English language. I learned that lukewarm letters of recommendation ("Joe was a competent student who displayed satisfactory knowledge of the subject material.") could be worse than having none at all. It was then that I realized that anyone who could appear not to be psychotic for at least 15 minutes (twice) could become a physician. This method of selection turned out not to be foolproof, as least at my school.

But it would take some kind of concerted and institutional effort by medical schools to instruct their admissions committees, most of whom are not in primary care, to go after students who showed promise and interest in practicing primary care in underserved areas. A difficult, if not impossible, task. But if our admissions committee had been given specific criteria on what to look for, I'm sure we would have complied. At least, I would have.

From the article:
The school is looking for students like Dr. Margeaux Coleman Walker, who has known she wanted to be a doctor since she was 11 or 12 and helped her grandmother clean the doctor's office in Church Point, a town of 4,700.

But she wants much more than a medical practice. "Hopefully, when I want to retire, I'll be able to say, 'I worked hard and I made a difference in people's lives."

And more:
"If you're looking for more of a 9-to-5 practice where you can sign out and someone's going to cover for you," rural medicine isn't for you, said Dr. James E. Devlin, a graduate of the program.

He's a solo practitioner in Brockway, Pa. (pop. 2,500), checking his hospitalized patients seven days a week. It's hard to find someone to do that if he wants a vacation. But he knew growing up that he wanted to go into practice with his father, who has since retired.

He said he loves being a big fish in a little pond. But more, he loves knowing his patients as friends, as church members, as people. Being part of their community. "I wouldn't trade that for anything," he said.

That's the heart of the matter for Coleman Walker, too. She has done month-long medical school rotations with the current doctor in Church Point, and wants the sort of bond he has with his community.

"He's not only the family doctor - he's a teacher, kind of like a big brother, a dad, because he has to reach out to the young kids and help them, guide them," she said.

OK, I'm not a rural doctor in an underserved area. But I'm trying to bring a similar kind of close patient-physician relationship back to the suburb where I'm at. I think there's a need for this kind of care anywhere. We need to find more doctors and future doctors who are willing to serve people in need. Like in family medicine.

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In the meantime, I've been spending a lot of time trying to catch up on my medical billing. I'm learning if it is worth it to wade through telephone trees and wait on hold for 15 minutes (or more) just to get the health plan to give me 10 more dollars for an injection administration fee that I forgot to bill. Or to find out the reason they denied the $160 charge for a well child exam is because it is a non-covered benefit. For now, I guess it is, because I've got nothing else better to do as I continue to wait for my patient panel to grow. And fortunately, it is growing.

Wednesday, December 22, 2004

The newest medical tool: an iPod

How's this for convergence? Radiologists at UCLA (Go Bruins!) have figured out an excuse a way to use iPods in their medical practice. Their (free!) product is called OsiriX and helps to manage medical images on the iPods hard drive.

Now if only some bright person could come up with a medical application that primary care doctors could use on an iPod, then I'd have an excuse, uh, I mean, justification to buy one of those little guys. Besides listening to music, that is. C'mon, Epocrates! Port your drug reference over to the iPod, and you are guaranteed an instant market.

Merry Christmas, Happy Holidays, and Happy New Year!

Saturday, December 11, 2004

From (flu shot) famine to waste

Like many doctors, I had my order of flu vaccine cancelled because the company I ordered through was selling the Chiron product. Luckily, I had ordered some pediatric doses of flu vaccine just a few days before the bombshell news so I eventually got 10 pediatric doses. Since I didn't have any eligible patients under 3 years of age, I combined 2 doses to make enough for an adult dose and was able to give it to 5 eligible patients. However, I was surprised that even in my small practice, I was having trouble finding patients to give it to. Some of my patients who need it the most still refused to get it, saying they didn't believe in it, or that they had gotten it once and it gave them the flu.

Before I got my small shipment of flu vaccine, I received many frantic calls from patients, both high-risk and not, looking for flu shots, I recall reading about people going across the border to Canada just to get a flu shot.

Now on top of news that the US has secured additional flu vaccine, I'm not surprised to see reports that some flu vaccine may get wasted because either the restrictions were too effective, or many eligible patients are declining to get flu shots.

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I'm still in solo practice, just not blogging. I've been steadily seeing about 40-45 patients/month for the past 3 months, so I've reached some steady state for now. I think I'll need to try direct mail advertising to reach ALL the local households if I want to quickly grow my practice. We'll see how I manage that in the coming holiday weeks.