Wednesday, September 19, 2007

We've Been Boarded by Pirates!

What do you get when you cross "Talk Like a Pirate Day" with Universal Health Care? Why, a song, of course!

You also get this video below describing the exploits of the dread pirate, Captain Blue Shield:

Saturday, September 15, 2007

Going It Alone

From the Seattle Times: "Doctors find going solo painless":
If patients getting a checkup at Dr. Donald Stewart's clinic in Sammamish feel at ease — like they're visiting the family doc at his home — it's because they are.

On July 28, Stewart began his new life as a downsized solo physician, chucking his previous career running a group clinic.

With high-tech help and by cutting his overhead — such as buying furniture on — he now can work out of what used to be the mother-in-law apartment in the basement of his home.

"It's the most fun I've had since I started in medicine 25 years ago," said Stewart, who is 57. "Now, I'm having enough time with patients so I can enjoy working with them."

Stewart is part of a small, but growing, trend among family-practice physicians.

They're going it alone.

OK, going solo as a micropractice is not painless but it is very, very fun.
At her Bellevue clinic, Dr. Gwen Hanson also is not accepting new patients. She went solo in December 2004.

Her goal is to let patients make same-day appointments, Hanson said. If patients have to wait more than 15 minutes after arriving, she gives them a $5 Starbucks gift card. If they bicycle or walk to her office, they also get a gift card.

It's not the $5 that matters, Hanson said, it's that patients know she appreciates them.

She has 400 to 600 patients, Hanson said. She works two full days and three half-days. She takes seven weeks of vacation a year. She can spend time with her husband and three teenage daughters.

Hanson said her overhead is around $1,800 a month, which includes office rental and malpractice insurance. After those expenses, her before-taxes annual income is $110,000.

Drs. Stewart and Hanson are both on the IMP Map.

Hmm, 3rd article about micropractices in the past week. Okay, I think this is a genuine trend now.

Smaller is Healthier

Anonther micropractice article from the Lincoln County News in Maine.

It might seem like a good idea at the time, when the thought first enters an administrator’s mind, but layers of bureaucracy and multiple steps in the chain of command can eventually mire the patient-doctor relationship in layers of inefficiency.

The answer is not more bureaucracy.

“The goal is to give patients unfettered access to the doctor,” said Dr. Walter Love of Waldoboro, “to get rid of all the people in between the doctor and the patient.”

Following a new model for Family Medicine that has grown into a national trend over the last few years, Love and his wife, Dr. Margaret Webb, set up a shop as a “micropractice” in Waldoboro last year when they established Medomak Family Medicine.

Drs. Love and Webb are both on the IMP Map.

Not feeling rushed

From the Albany Times Union: "Doctor cuts staff, buys time"

One thing about Dr. John Pramenko's new practice: Patients won't feel rushed.

The 41-year-old family physician is opening one of the region's first micro-practices, a relatively new model in health care that has no nurses, office manager or receptionist. Patients make appointments online, and records are kept electronically.
Without the staff, the practice can operate much more cheaply. And with lower costs, doctors can afford to take fewer patients a day. That means more time for each patient.

"I have colleagues who see 30 patients a day," Pramenko said Thursday. "When you're seeing that many patients, it's really hard to have a good relationship. Every visit, you have your hand on the doorknob."

These days, in my micropractice I rarely ever talk to patients with my hand on the doorknob.
The micro-practice movement began in 2001 with a Rochester doctor named Gordon Moore. Like Pramenko, Moore had been bothered by his limited time for patients. It was his idea to use computer technology to create a self-sufficient practice.
"A lot of doctors are becoming increasingly disenchanted in what they're experiencing," Moore said. "I was about helping patients. A lot of things happening around health care have made it very hard to help patients. We don't have time."
Since he opened the first micro-practice in Rochester, Moore has acted as a spokesman for this new style. Now he sees patients only a quarter of the week, and uses the rest of the time to help other doctors set up similar practices around the country.
Today, more than 100 exist around the United States, including Dr. Padma Sripada of East Greenbush. A computer list-serve on the topic has 475 members, with doctors signing up at a rate of three to four a day, Moore said.

Drs. Pramenko and Sripada are both on the IMP Map.

What makes this even more interesting is that only 2 weeks earlier, the same newspaper published a story about a family doctor closing down his 26 year practice due to poor reimbursement. His office is located about 45 miles away from Dr. Pramenko.

Sometimes I wonder if the Ideal Micropractice movement will really be able to bring about meaningful change in America's healthcare system, or if we're just part of primary care medicine's slow death spiral, and all we are doing is delaying the inevitable. Whatever, whichever, I'm not going down without a fight.