She Loves Her Doctor

Here is a good description of "usual care" vs. micropractice care from a patient's perspective:

I've waited for three hours for an appointment. I have had the temporary "doctor of the day" in a group practice override written instructions left by my midwife (who I can't see because she has to be scheduled five weeks in advance -- in fact my monthly appointments have to be "fit in"). A number of baby books have chapters on "How to select your child's pediatrician". You might as well save your breath. No matter how carefully you research your pediatrician you will see him or her only for scheduled shots. The majority of visits (head bonks, ear infections, weird rashes -- the most important visits from the patient's/parents's point of view) can't wait three weeks, so you will be seen by a rotation of nurse practitioners, none of whom will be working for the office next time you call. I've waited six weeks to see a doctor I'd hand picked to discuss surgery options, only to discover someone had changed my appointment so I'll be seeing the newly minted MD resident instead.

But it doesn't have to be like this. And right now, it isn't. Friends of ours recommended a doctor they "really liked" -- little did they tell me this was going to be a life-changing experience for our family. The first indication was her receptionist telling us that the first appointment would be for an hour...

Any more uplifting experiences with micropractices out there?

Solo on Vacation

One of the things doctors considering solo practice always want to know about is, "What about vacations? Who covers for you when you are out of town?" Some even wonder, "Can solo practitioners even go on vacation?"

In my 4th year of solo practice, I am again on vacation, this time visiting relatives on the East Coast.

In my first year of practice, I had so few patients (plus I didn't know any other solo physicians in the community that year) that I just went on vacation to Banff, Canada and had all my calls forwarded to my cellphone. No one noticed I was even out of town. But then again, I was only seeing about 1 patient a day that first summer. Seeing the Aurora Borealis and going horseback riding with my family are still unforgettable memories for me, and I am glad I was able to be with them.

By the 2nd year, I arranged for a couple of the local solo family physicians to cover for me when I went on vacation, and I agreed to reciprocate when they went out of town. It was mutually beneficial and I never got inundated with calls from the other doctors' patients. I know they didn't get a lot of calls from my patients since I made it clear I would still be accessible by cellphone and e-mail. But the longest trip I took that year was a 4 day trip to San Francisco for the Annual AAFP Conference.

By the 3rd year, I figured out how to access my office computer remotely so that I could receive faxed lab results and other reports as long as I had internet access. Hotel rooms with internet access are pretty common now. I got to go with my family to Walt Disney World and Bar Harbor, Maine last year.

This year is a little different in that I do not have cellphone access where I am staying, so I have to call in on a landline to both my office and cellphone lines to check for any messages periodically throughout the day. Fortunately, there have been few messages, hopefully because all my patients are feeling well.

Summer tends to be a slow time of year for visits to the doctor, anyways. One of these days, I'd like to try doing an online visit using my iSight video camera and maybe I won't ever have to be on vacation at all. But wait, that's probably not a good thing, is it?

Still I wonder which option more people would prefer: seeing their own doctor via online videocamera or being seen by a unfamiliar midlevel provider in a Walmart clinic? Time will tell.

For longer vacations, I have heard of other doctors using locum tenens services. Maybe someday I'll take a long enough vacation to consider that.

I have been able to spend some of my vacation catching up on my reading. I had gotten Stardust before I realized that it was being made into a movie. Luckily I finished reading it before I read any negative/positive movie reviews and my review of the book is Two Thumbs Up. I also plan to try to implement some of the elements of the Getting Things Done system with the donationware iGTD program. One can dream, after all....

In the meantime, I already have 13 patients scheduled for next week. But for now, still on vacation for a few more days.

Another Micropractice in the Pacific Northwest

Dr. Chad Magnuson just opened his new micropractice in Vashon Island, WA. Here is a news paper article about his new venture which is starting to sound very familiar (at least on this website):

In a world of increasingly high-tech medicine and huge practices teeming with professionals, Dr. Chad Magnuson’s new office in downtown Vashon provides a striking contrast.

Walk into his waiting room — a hallway, really, with two chairs — and no receptionist greets you.

Enter his exam room — a freshly painted yellow with maple floors and a richly hued throw rug — and see only Magnuson, his exam table and a computer that holds the latest in practice-management software. There are no nurses, no labs, no large pieces of medical equipment.

“There’s just me,” Magnuson says with a smile.

Dr. Magnuson's website is here. You can find other micropractices at www.impmap.com.

Another Micropractice in New York

Here is yet another internet article about a doctor doing the "micropractice thing".

One thing you're not likely to do if you have an appointment with family physician Dr. Janice Pegels is spend a lot of time in her waiting room.

"I don't like waiting, so I don't like to make my patients wait, either," she says.

You'll also be booking your own appointment online and will get a reminder call from the doctor herself. When you come into the office (housed in a charming vintage home), she'll give you time -- lots of it.

"Appointments for new patients typically last for 60 to 90 minutes, while established patients typically get 30 to 45 minutes," Pegels explains. If your lab results are within the normal range, you'll receive them via an encrypted e-mail service and, if not, the doctor will call you directly.

If you're thinking this doesn't sound like a typical visit to the doctor, you're right. Pegels is one of approximately 100 physicians throughout the country who has adopted a new kind of practice, known as an Ideal Micropractice (IMP). She acts as her own receptionist, office manager and medical assistant. By doing so, she is able to keep her costs down, which translates into longer office visits for her patients.

High and Dry

If I don't answer my office phone for the next few days, it's because my VOIP phone provider (SunRocket) suddenly went out of business. Grrrr!

The problem with being on the bleeding edge of technology is that frequently you get cut.

Now I have to decide if I should go crawling back to the safety of a landline, or take another chance with a different VOIP provider. I'd consider VOIP with my cable provider, but for some strange reason they don't offer VOIP for business users although they do for residential customers.

This recent Google-acquisition looks promising, but they're only in beta. (No financial interest in Google!)

Two More Micropractices

Here's something unusual: TWO newspaper articles about micropractices in one day.

From today's Los Angeles Times: "It's about time, say doctors in vanguard"

In a 150-square-foot tin-ceilinged office in a building that once housed a speakeasy, Dr. Moitri Savard checks her laptop to see whether any patients have scheduled themselves to see her.

Wait, scheduled themselves?

Yes. Savard's patients decide when they want to see her and then let her know by filling in a date and time on a calendar on her website. Patients with no computer access can phone for an appointment.

Savard, 36, a graduate of the Stony Brook University School of Medicine, is in the vanguard of a small number of physicians who are experimenting with a new family-practice business model.

It's called a micropractice.

Savard has no nurse but shares a receptionist with several other solo practitioners and does her own paperwork. Mostly, she runs her office electronically — lowering her overhead because she has no salaries to pay.

And the Idaho Statesman: "Boise physician finds low overhead lets him give patients more time"

Dr. Chris Peine sits behind a desk in his 500-square-foot office. He's alone. The glass doors are dusty and waiting to be wiped clean, but he doesn't have much time to do it today. He is too busy answering phones and e-mails, treating patients, vacuuming and taking out his own trash. Peine doesn't have a single employee.

Peine (PIE-nee) follows a new model of health care called the "ideal micropractice," one of a small but growing number of physicians nationwide who are shucking large offices and big staffs to simplify their medical practices and spend more time with patients.
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Before moving to Boise with his wife in September 2005, he was a physician at a large cash-only practice in Indianapolis that did not accept insurance. He met with a handful of patients every hour, he said, and the lack of face-to-face time strained his relationships with his patients.

"I wanted to really simplify the whole health care experience," he said.

"Complexity interferes with the doctor-patient relationship."

Boy, does it ever. But thankfully, not in a little slice of Queens and Boise.

A Taste of Their Own Medicine

To this day, I still remember what it was like having a rectal exam done on me by a fellow classmate in medical school, and I think it has made me a better doctor. No camping out by the prostate for me. I think that is the rationale behind this idea of having resident physician get a taste of what it is like to be a hospital inpatient.

Clad in hospital gowns and assigned various ailments, six doctors at Presbyterian Intercommunity Hospital were poked for blood tests and had their vital signs checked regularly when they spent a recent night as patients.

"I think it's a really good experience for us," said Dr. Megan Stone, who was attached to a heart monitor for "a sudden onset of chest pains."

The fake illness was part of a special orientation for resident physicians in the Whittier hospital's Family Practice Residency Program. Six doctors from the program pretended to be patients and stayed overnight Sunday to get a taste of what it's like to be a patient, said Dr. Patti Newton, associate program director of curriculum.

"It will stick in your head if you experience it, rather than hearing a lecture," she said.

But if you really want doctors to have more compassion for patients, make them schedule themselves for an annual physical (without telling anyone they are a doctor) and see what it is like.

But the most effective way to improve healthcare in the US: require the President and all members of Congress to use Medicare.