A Sign of the Times

Aaron Blackledge, MD, of CarePractice in San Francisco has a message that he would like to share with the public about the current state of the healthcare system.

Being a primary care doctor these days is becoming more and more discouraging with the current payment system and insurance hassles, so much so that doctors are working less hours as noted in this Washington Post article:

Average hours dropped from about 55 to 51 hours per week from 1996 to 2008, according to the analysis, appearing in Wednesday's Journal of the American Medical Association.

That's the equivalent of losing 36,000 doctors in a decade, according to the researchers. And it raises policy questions amid a looming primary care doctor shortage and Congress considering an expansion of health insurance coverage that would mean more patients.

It's not hard to figure out why.

The overall decrease in hours coincided with a 25 percent decline in pay for doctors' services, adjusted for inflation. And when the researchers looked closely at U.S. cities with the lowest and highest doctor fees, they found doctors working shorter hours in the low-fee cities and longer hours in the high-fee cities.

Unless there is meaningful healthcare reform soon, things will probably get worse before they get better.

New Look

The weather is starting to warm up a little. Spring is in the air. It was about time I spruced up the place.

But mainly it was because the old commenting system I used (Haloscan) went kaput, and I wanted to implement Blogger's commenting system in its place. All the old comments got trashed (sorry) but I had no control over that. Give the new layout a spin. Make some new comments. Click on some links. Go wild while we're waiting for healthcare reform to happen. Yep, any time now.

NCQA wants your opinion

The National Committee for Quality Assurance, better known as NCQA, wants to know what you think are the most important features are of the Medical Home. Go to this link and tell them.

Personally, I thought these listed features were all important, but narrowed it down to my top 5:

1. wait time
2. seeing the same doctor or nurse
3. listens and answers your questions (well, duh!)
4. knows you well
5. access to help without making a visit

Some of these seem so basic, it makes me wonder why they even have to ask.

Happy Anniversary

Ben Chan, a family physician, has just opened his new solo practice and writes:

It has been 8 years since I read Gordon's article. Now, I am sitting in my office in this opening day, waiting for the first patient to call and make an appointment. So this is what you all went through. Emotionally, it has been like a roller coaster ride. At one time, I am happy that I made this tiny leap. On the other hand, there are times when I kick myself and ask, "What are you doing?" For now, only time will tell. At least, at the end of my career, I can tell myself that I tried!

Coincidentally, it was 6 years ago today that I first opened my little office for business. I remember the open house I had on Valentine's Day 2004 to celebrate my new solo venture. We handed out chocolates and flowers and ordered way too much food. On my first day of business, I sat by the phone and waited and waited . . . and waited. I felt like I couldn't leave the office because what if somebody called? I was afraid of missing them. But no one called. 

The days passed, with no patient in sight. I knew it would be slow to start but yeesh— not this slow. I brought no patients with me from Kaiser and was new in the medical community. I placed some ads in the local paper. I asked friends to tell their friends. It was lonely. 

Finally, 2 weeks later, on March 1st, I saw my first patient. I saw him at 8PM, and he had no insurance and forgot to bring cash. I remember that he felt embarrassed and offered to go to the ATM up the street so he could pay me. I felt bad because it was raining, but I thought to myself, I did just provide medical care for him and if he didn't pay me now, who knew when I would ever see him again? Would he even come back after he left? 

He did come back and paid the $40 for my first visit. Six years and 5000+ visits later, I just did the 2 month old well child check for his 2nd son. He still doesn't have insurance, but I'll always remember who my first patient was. So will Ben. 

And Ben shouldn't belittle his accomplishment by referring to it as a "tiny leap". It is a huge leap of faith to leave the safety of a traditional group practice and go it alone. Some would say, it's crazy. But it's like that old Apple commercial:

Here'’s to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They’re not fond of rules and they have no respect for the status quo. You can praise them, quote them, disagree with them, glorify or vilify them. About the only thing that you can’t do is ignore them. Because they change things. They push the human race forward. While some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think that they can change the world, are the ones who do.

So here's to many more physicians like Ben who are trying to change THE world by changing THEIR world. It has certainly changed mine for the better and, I hope, the lives of the patients whom I have seen in my little micropractice.

Go get 'em, Ben.