Tuesday, February 01, 2005

Vanishing Doctors

From U.S. News & World Report:
'It was slow water torture," says Paul Ryack. That's how the 63-year-old board-certified internist describes his working life just a few years ago. With a few thousand patients, many of them elderly, he could barely find time to listen to halting explanations of their immediate complaints--let alone talk about the importance of lowering blood pressure or losing weight--in the 15 or so minutes he could allot to each. "I was unable to make the time to sit with patients, to get to know them, to help with preventive activities that we need and want," says Ryack, who practices in Santa Barbara, Calif. His costs were so high, and payment per patient so low, that taking even another dozen minutes wasn't possible. "You'd go broke," he says. The end result: a creeping sense of burnout.

An excellent article detailing the woes of being a primary care physician in America these days, and what effect that may have on the public. I just wish the article had mentioned the alternative practice model pioneered by Gordon Moore and his low-overhead approach, one that I am trying to emulate in my own practice.

It has been almost a year since I began, and while business has been slow, it continues to pick up. I typically spend 30-60 minutes with new patients, but then again, I see anywhere from 0-5 patients a day so far. Patients like being able to come in for an appointment the same day they call. They appreciate not being rushed and being able to get all their questions and concerns addressed. I don't charge a retainer fee, because I don't want to cater only to the more well-to-do. It is certainly a more satisfying situation for me. I enjoy the autonomy and independence of being my own doctor, my own boss. I set my own schedule. I can spend essentially as much time as I want with a patient, and feel like I am practicing medicine the right way, the way I was trained to do. And now that I have finally caught up with my medical billing (yes, I do that myself, too), I feel like I am starting to make some money. Or at least break even.

Dinosaurs once ruled the earth. Then a meteor hit and they vanished, leaving only those creatures who were nimble enough and adaptable enough to the new environment to survive. Managed care = dinosaurs. Me = mouse. Which animal is still around today?