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Medical Summer Camp: High-Schoolers Get a Taste of Career in Medicine
Medical Summer Camp: High-Schoolers Get a Taste of Career in Medicine By Phyllis Zorn, Staff Writer, Enid News and Eagle
ENID, Okla. — High school students got a taste of what a career in medicine might be like at a one-day camp Tuesday in Enid.
Oklahoma State University College of Osteopathic Medicine presented the camp, called Operation Orange, on the campus of Northwestern Oklahoma State University-Enid.
About 25 high-schoolers learned about anatomy with the human heart, lungs and brain; learned how to intubate a patient; practiced clinical skills by listening to a patient’s heart and lungs; and learned how to check blood pressure and examine ears.
Sand Springs student Marissa Barcetti peered down the throat of a mannequin, using a laryngoscope to open the throat wider, and struggled to see the lower airway so she could insert a breathing tube.
“I can’t get it in,” she told Scott Stroshine, one of 12 OSU medical students on hand to assist with Operation Orange.
Stroshine gave her a little extra coaching, and Barcetti mastered the technique in time for the “fastest intubation” contest.
Lori Santine, communications specialist for OSU, said the camp at NWOSU is the second of four such camps the medical school is presenting around the state. The first was held last week in Lawton. The other two will be in Tahlequah and Ada.
The camp is for a bigger purpose than merely having fun.
“For high school students considering a career in medicine, our summer camp is a fun opportunity to explore what it’s like to be a medical student,” said Dr. Kayse Shrum, OSU Center for Health Sciences provost and dean of the College of Osteopathic Medicine. “Operation Orange participants will try everything from basic suturing to checking blood pressure, as part of what it’s like to experience caring for a patient.”
Robert Sammons, northwest regional coordinator for the Center for Rural Health, said the camp is one of an array of initiatives by the medical school, with the hope of increasing the number of future physicians who practice in rural areas. The medical school offers a rural medical track starting this year, Sammons said.
“Our goal is to set up a curriculum in introduce students to rural medicine, in the hope that they will go into rural medicine,” Sammons said.
Santine pointed to Schrum’s belief that medical students who hail from rural areas make the best rural physicians, because they understand the culture and way of life in rural areas.
Source: EnidNews.com, Oklahoma, June 11, 2013 (http://enidnews.com)
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Four Things to Consider When Integrating Your Medical Practice with a Bigger Group
Four Things to Consider When Integrating Your Medical Practice with a Bigger Group By Paul Adelizzi
During the early 1990's, many solo family practitioners got caught up in the growing trend of joining a larger group. Today, those larger groups are again looking to combine to take advantage of what size has to offer in the field of medicine. Here are a few things to look for when integrating medical practices.
1. Employment Agreements
Upon integration, do all physicians have satisfactory employment agreements? Are they too restrictive? Do they clearly spell out compensation and how the profits and bonuses are going to be split? Do they allow for an easy exit if it just isn’t working out? A key factor in this discussion is the patient — who gets to call them their own? Clearly a patient will go to the physician who they feel most comfortable with, but will it ’cost’ you to claim them? It is best to try and cover this potentially sticky area up front’ no one wants to argue over money!
2. Employee Benefits
Did your health insurance plan cover things that the new plan doesn’t? Do you have any employees with special or customized health insurance needs? Nothing can dampen the morale of employees more than the idea of shocking their system with first a merger then second, less benefits which will be detrimental to them financially. In terms of retirement plans and vacation/sick leave, are the employees being treated after the merger in a similar fashion as to before the merger? Did their up to a 6 percent match of contributions turn into a safe harbor 3 percent? Did their three weeks of vacation turn into two? And do they still get the same holidays off? And about that maternity leave … anything less than a lateral benefits move could prove disastrous long term.
3. Look for What the Larger Practice Can Offer You
Are you coming up a little short in the IT department? What about your skill set in marketing and practice development? Have you been able to properly recruit the right professionals to satisfy your needs and to keep stability within your practice? And the ‘big one’ are your third party insurance contracts competitive or are you continually being squeezed? Hopefully, the bigger entity will help you satisfy some of these concerns and enhance your competitive balance within your marketplace.
4. Office Logistics
Generally speaking, patients that are comfortable with their physicians will not mind a slight deviation in their travel to see their favorite doctor. But, is it easier to park at the new offices? Is the waiting room clean and open or is it congested? Has the waiting time for patients decreased or increased? These logistics matter and should be taken into account when considering a practice merger.
During the vetting process it is wise to talk to staff level employees. They always seem to have their finger on the pulse of what is really going on in the office. It is always important to test the waters before diving in.
Source: MEDCITY News, May 27, 2013 (http://medcitynews.com)
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Growing Farm-Fresh Physicians
Growing Farm-Fresh Physicians By Mara Knaub
In a time of national doctor shortages, Yuma Regional Medical Center is taking steps to “grow farm-fresh family physicians.”
Six newly graduated physicians – five women and one man – will begin their postgraduate training on July 1, kicking off a new era at the hospital.
The first residency program at YRMC will focus on family medicine, with Dr. James Lenhart at the helm. Recently recruited from Las Vegas, Lenhart is considered a national leader in the field.
Dr. Edward Paul will lead the overall Graduate Medical Education program. Paul previously served as program director of the Family Medicine Residency program at the University of Arizona.
“On the one hand, this is the culmination of a 10-year process to bring the ethos of teaching hospital status to our community,” noted Dr. Stewart M. Hamilton, who retired last year as YRMC chief medical officer.
“And on the other, the start of a journey that will help recruit new blood to the medical staff and help maintain the high standard of medical care that is provided within their ranks.”
The three-year residency program will put the trainees on their last leg to becoming family physicians and board certified.
“These young doctors have graduated from college, they have graduated from medical school. This residency will be their last step to being able to go out on their own and practice,” Lenhart said.
Addressing shortages
Hospital officials started with family medicine because of the lack of primary care physicians, and in particular, family physicians. They hope to expand into internal medicine and other specialties.
Lenhart hopes that some of the residents will stay in Yuma after their training. “Data shows where residents do their residency is likely where they will practice.”
On average, about 50 percent will stay in the same community, meaning that three graduates will likely stay in Yuma.
“We will be growing our own farm-fresh physicians and ensuring a continuous pipeline of family medicine physicians,” Lenhart said.
A “continuous pipeline” would also address turnover, as doctors relocate, retire or move into non-patient care fields, he noted.
Rural Arizona in particularly is experiencing a shortage in doctors. “In fact, we already have less than half the average number of physicians per capita than the rest of the nation,” Hamilton pointed out.
‘No small task’
Hamilton explained that “it is no small task to enter the field of graduate medical education. In fact, it has been 10 years since the first possibilities were discussed in then-CEO Bob Olsen’s office. Since then, there have been many discussions, meetings and documents generated.”
Once the hospital gave the go-ahead last year, program leaders had to obtain accreditation and federal funding.
Then came multiple visits from medical students interested in completing their postgraduate studies here and finally “the match” – a computerized process whereby student and hospital rank each other based on interest.
The “painstaking” process to find matches started last August, Lenhart said.
The hospital received 800 applicants, interviewed 46 and ranked 33 before whittling it down to the six residents.
The candidates were ranked beyond academics, test scores and advanced degrees. The ability to speak both English and Spanish ranked high on the list.
“Four of the six are fully bilingual. We’re very excited about that,” Lenhart said.
‘Bumps in the road’
Paul and Lenhart also looked at life experiences and “bumps in the road” that could have “matured and cultivated them into much better people,” he said.
They looked at their volunteer record.
“Did they serve in the Peace Corps? Did they serve the underserved? Did they volunteer at a research mice lab or at a homeless shelter? A homeless shelter got more points because it shows dedication to service, humanness. We were looking for caring, compassionate people,” Lenhart explained.
“We’ve very proud of how it played out. We think we got an outstanding group.”
Just the fact that they applied to a new program showed them to be risk-takers, he added.
“Some wouldn’t even apply here. It’s a brand-new program, and Yuma is not what some consider city life.”
On the other hand, some applicants liked that it would be a brand new program and they would have seniority. Some liked the “down-home community” feel of the city.
Change in culture
Lenhart expects the program will “change the culture” of YRMC as he believes the residents will challenge all doctors to improve.
Fresh out of medical school and the university environment, the residents will know the latest techniques and research that they can share with and inspire doctors who have been practicing for several years now.
“It will make everybody step up to the plate,” Lenhart said.
He noted that the program will teach the residents that “health care goes beyond the domain of the physicians’ office. We all have a responsibility to be citizens.” The trainees will be encouraged to volunteer in the community.
The program will also address bedside manners.
“There will be an emphasis on the delivery of a personal, literally ‘hands-on’ type of health care, and good ‘bedside manners’ will be actively taught,” Hamilton said.
“While the theory of bedside manners can be taught in a classroom setting, there is no better way to learn for many of us than to see such care being delivered.”
In addition, teaching hospitals attract qualified physicians interested in teaching, something that Hamilton believes will prove valuable in recruitment efforts.
“(As the) physician shortage rises to a crescendo in the U.S.A., YRMC and Yuma will stand out as a beacon, haven, oasis and jewel of health care in the Southwestern desert while other communities and hospitals will struggle and living standards fall for lack of medical care,” he said.
Source: Yuma Sun, May 9, 2013 (http://www.yumasun.com)
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Study Demonstrates Value of Practice Supports During PCMH Transition Process
Study Demonstrates Value of Practice Supports During PCMH Transition Process By James Arvantes
Small and solo primary care practices are more likely to achieve improvements in efficiency and quality of care, as well as cost savings, when transitioning to the patient-centered medical home (PCMH) model if they have access to care-management services and other key practice support during the transition process. That’s according to a new study conducted by researchers at the University of Connecticut’s Health Center (UCHC) and published in a recent online edition of the Journal of General Internal Medicine.
The study evaluated 32 primary care practices during a two-year period and randomized them into two groups: an intervention and a control group. The intervention group, made up of 18 physician-led primary care practices, received a three-part support package that included practice redesign support, embedded care managers and a revised payment plan to help them achieve PCMH recognition status. It also included per-member, per-month pay-for-performance incentives. The remaining 14 control-group practices received only yearly payments for participating in the study.
All of the physician practices participated with EmblemHealth, a health insurance plan in New York that provided the support package for the intervention practices. The size of the practices varied from solo to medium-sized practices with as many as 10 physicians.
The study found that the intervention practices achieved statistically significant improvements in two of 11 quality indicators: hypertension control and breast cancer screenings, as well as in one of 10 efficiency indicators: reduced emergency department (ED) visits. Practices without support failed to achieve significant improvements. “For the most part, quality and efficiency of care provided in unsupported control practices remained unchanged or worsened during the trial,” according to the study.
Judith Fifield, Ph.D., director of the TRIPP Center at UCHC, is convinced that the study has enormous policy implications. “Providing these kinds of supports will enhance the ability of practices to make the transition (to the PCMH model) and to show quality and efficiency improvements in a short time frame,” said Fifield, who also serves as a professor of family medicine at UCHC.
Within the intervention practices, hypertension control increased 23 percent, and breast cancer screenings improved by 3.5 percent. Moreover, the intervention practices saw a drop of 3.8 fewer ED visits per physician per year, which corresponds to savings of $1,900 per physician per year.
Still, said the study authors, “Despite these improvements, we did not observe significant cost savings, and ED costs continued to rise over time, even with the significant reduction in visits observed.” They attributed this “to the rising cost of ED visits reported by EmblemHealth and the relatively modest reduction in ED visits.”
On the other hand, said the study, although not dramatic, the savings achieved have a cumulative effect, which could result in significant cost savings in certain circumstances. For example, although the fewer number of ED visits in the intervention group was modest, it would be substantial when applied to a large number of physicians.
“For instance, if panels were similar in size and complexity across the 142,000 in-network physicians in EmblemHealth’s Group Health Incorporated plan, a supported PCMH transition across all physicians would be expected to save $270 million each year from ED visit reductions alone,” said the study.
Fifield also pointed out that primary care practices in the study provided care to a general adult population rather than a specialty population, such as high-risk elderly patients. As a result, the savings and cost improvements achieved by the intervention practices are modest compared to what likely could be achieved in practices with high-cost patients.
The UCHC researcher speculated that case management was the single biggest factor in driving cost and quality improvements. For example, the case managers worked with hypertensive patients on a regular basis and helped them adhere to their medication and food regimens, which played a major role in improving hypertension control rates, Fifield said. “This study points to the improvements that can result from care management and coordination. The changes could probably be larger with more intensive efforts.”
The findings represent the second part of a two-part study. The first part of the study, which also was published in the Journal of General Internal Medicine, showed that small and solo practices can achieve PCMH status within a relatively short time with practice redesign support, embedded care managers and a revised payment plan to help them achieve PCMH recognition status.
In fact, most of the supported practices in the earlier study became recognized medical homes within a year when given access to these practice support features, the study found.
Source: AAFP News Now, April 26, 2013 (http://www.aafp.org)
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Rising Costs, Regulation Turn Solo Doctors Into Endangered Species
Rising Costs, Regulation Turn Solo Doctors Into Endangered Species By Tom Kisken
Ted Hole knows he’s a dinosaur.
In an age of electronic records, the 63-year-old family practice doctor from Ventura tracks hundreds of patients in paper files that layer shelves and weigh down filing cabinets.
Doctors in the large health care systems that may be the future of medicine employ administrators to deal with an avalanche of federal regulations and insurance mandates. Hole tapes a paper note to walls. “No injections on same day as visit,” it reads.
At a time when solo-practice doctors face odds that would scare an inveterate gambler, Hole is more solo than most. On days when his only employee — a nurse who has worked with him for 30 years — is out, Hole answers the phone. But it won’t stop ringing. Patients are waiting. Insurance companies need paperwork. So Hole offers a white lie.
He tells callers the doctor can’t come to the phone. He’s too busy.
More than half of the nation’s doctors worked in solo or independent practices 13 years ago, according to estimates from the Accenture consulting firm. The consultants predict that number will fall to 36 percent by the end of this year, with the decline driven by the cost of running a business.
A 2012 survey from the Association of American Medical Colleges showed one in 100 of the nation’s medical school graduates planned a solo-practice career. More than six in 10 wanted to work in medical groups, in partnerships with hospitals or at a university.
Some observers contend solo doctors will survive. They say the old-school physicians who pride themselves on medical autonomy and their bond with patients will find ways to deal with administrative burdens, federal reform and changes in the way they’re paid.
Others say the tar pits are waiting.
“They don’t have a future, not in the new health care paradigm” said Jim Lott, executive vice president of the Hospital Association of Southern California. He contends the only private-practice doctors who will survive are those who partner with hospitals and medical groups or reject insurance altogether and accept cash only.
“The others are just in denial and have their heads in the sand,” he said.
SCARY PROPOSITION
Hole’s office is decorated with muted blue wallpaper. It hasn’t changed since he took over the office 21 years ago.
Every morning, Hole arrives at 7 a.m. to do paperwork. He calls it “parasitic drag” as part of a rant against insurance companies and nonstop government regulation.
“Insurance companies are getting more aggressive in trying to control the medications to treat patients. The goal is obviously to maintain their profit margin,” he said one morning as he scrambled for the insurance forms to continue a prescription for an asthma patient. The request was ultimately denied.
Years ago, he would make hospital rounds every morning to see his patients. Reductions in insurance reimbursement for hospital care and the reliance of hospitals on their own doctors curtailed that practice. Now his practice revolves around his office, on the corner of a modest sprawl of medical suites sandwiched by two hospitals on Loma Vista Road in Ventura. When his patients call, they don’t need to use their names. Hole has treated some of them for so long he knows their voices.
Marlene Reinhart, who is 81, has been seeing him since 1992. She remembers how he met her at the hospital when nerve problems in her mouth made her feel as if her head was going to explode.
“He came when I needed him,” she said, trying to explain how well they know each other. “He can tell when I’m feeling low about something. He can tell when I’m elated about something. He can read me.”
She winced at the notion that his practice — that solo doctors — may be obsolete.
“How long is it going to be where I have to go to the other kind of system, where I’m just a number, where the doctor looks at me and doesn’t even know who I am?” she said. “I find that very scary.”
PERFECT STORM
Reimbursements already have been pushed down by large companies that control the insurance market and send patients to medical practices. The Affordable Care Act provides incentives for doctors to join new networks — accountable care organizations — in which they work in sync with other doctors, hospitals and insurance companies.
Bonuses are paid when the accountable care organizations reach goals for improving quality of care and reducing health care costs, which increase with unnecessary care and hospital visits. The concept is that though doctors may make less initially, the bonuses will offset the loss.
The government is also paying as much as $63,750 over six years to doctors who have installed high-priced computer systems and are meeting government standards for using electronic medical records. But a price that can reach into five figures or higher and a transition that can cost practices more money scares away many solo doctors.
Other pressures include the rising administrative burden of running a business and the availability of jobs in medical groups in which doctors have time to lead lives outside work.
“It’s kind of like the perfect storm,” said Troy Fowler, of the Merritt Hawkins physician recruiting firm. “Many physicians are saying, ‘I’m seeing more patients than I ever did. I’m working longer hours and making less money.’”
Some large health systems have bought out smaller practices in a nationwide trend. In Ventura County, clinic systems ranging from Kaiser Permanente to the Ventura County Health Care Agency have opened new facilities or renovated old ones.
A foundation linked to St. John’s hospitals in Oxnard and Camarillo has started a group of primary-care doctors. The hospitals are also teaming up with a coalition of more than 250 local doctors in a partnership designed to grow into an accountable care organization.
LEARNING TO ADAPT
Extinction is not a foregone conclusion. Dylan Roby, a health policy professor at UCLA, noted that solo-practice doctors have been adapting to changes in insurance and reimbursement for 20 years.
They will survive by joining loosely formed networks that allow them to integrate with hospitals and specialists but maintain some autonomy, Roby said. He predicted others will form concierge practices where patients pay for care not through insurance coverage but through regularly paid membership fees.
“I don’t think private-practice doctors will have to go away,” he said. “I just think they’ll have to adapt.”
Doctors worry that if they don’t join a group or an affordable-care organization, large insurance companies won’t contract with them, said Dr. Jim Hornstein, a solo-practice physician in Ventura.
Hornstein has no immediate plans to join a new network or to dramatically alter a 25-year-old practice in which his duties include checking supplies of office toilet paper. He’ll keep his overhead low, maintain a staff that handles administrative duties and focus on caring for his patients.
His confidence in survival is driven in part by Obamacare provisions that are expected to provide coverage to 32 million Americans nationwide and 40,000 people in Ventura County.
“There’s going to be plenty of people to go around to fill up all of our practices,” he said.
Other doctors are already changing. After 13 years as an independent pediatrician in Oxnard, Dr. Imelda De Forest said her costs kept rising and her income kept falling. So she joined 10 other doctors in a Ventura medical group.
She believes money will determine whether solo doctors will survive.
“The bottom line is who can afford it,” she said.
LOSS OF INNOVATION
Private-practice doctors worry medicine controlled by groups means they’ll lose autonomy. They think their patients will be less like family and more like widgets on an assembly line.
They worry about a health care system that increasingly ties reimbursement to care called evidence-based. The label means medications and other treatments match standards verified by research.
The result is doctors have fewer choices in treatment, said Dr. Geoffrey Drew, a solo-practice physician from Thousand Oaks. Doctors won’t find ways to deal with mystery illnesses because they won’t be allowed to try.
Drew’s answer to the pressures is succinct. He’s retiring. At 65, he plans to work as a mission doctor in his native South Africa.
“With all of these bureaucrats looking over our shoulders, innovation and modification is going to be virtually impossible,” he said. “ … It’s going to cause medicine to be stifled and stagnant.”
But if solo doctors worry about what is being lost, many others focus on what is gained. They note that health care reform emphasizes the importance of dealing with chronic illnesses and keeping people out of hospitals and emergency rooms.
Integrated care means doctors work together to figure out what a patient needs without repeat appointments or duplicated tests, said Dr. Paul Phinney, president of the California Medical Association and a pediatrician affiliated with Kaiser Permanente.
If a patient comes to a primary-care doctor with a mysterious mole, a medical assistant can take a digital photo and send it to a dermatologist. The doctors can confer on a speaker phone while the patient listens. In one visit, the doctors can decide on the best treatment.
“That makes the care of the patient not only more convenient but more cost-effective,” he said.
Phinney thinks integration can improve care.
“It’s not going to be Marcus Welby anymore,” he said, referring to the 1970s television doctor. “It’s going to be something new and different.”
OLD-SCHOOL DOC
Hole came to Ventura 37 years ago in the same year Jimmy Carter was elected president. He learned to be a family doctor in Ventura County Medical Center’s residency program, working 80 hours a week.
If he was 26 again, if he had to choose again, he wouldn’t go into medicine. He worries the focus is moving from care for the patient to the process of how care is delivered.
His goal is to survive for a few more years. Then he’ll retire.
“It makes me really sad,” Hole said, “because I know one day that I’m going to get taken care of in this system, and it’s not going to be the way it was in the past.”
Source: Ventura County Star, April 6, 2013 (http://www.vcstar.com)
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The Days Of The Solo Medical Practice Are Waning, But Some See Positive Aspects In The Changes
The Days Of The Solo Medical Practice Are Waning, But Some See Positive Aspects In The Changes By Carolyn Kimmel, Body and Mind staff
“The days of physicians coming out of medical school and hanging out their own shingle to practice medicine are over,’’ said Dr. C. Richard Schott
Dr. Scott Setzer knew when he chose to become a family doctor, he wasn’t going to make the money a specialist would, but that was OK.
He didn’t go into medicine to make money – although, of course, that would be nice.
Mainly he just loved the idea of building relationships with people in a way that could really make a difference in their health and quality of life.
But in his traditional practice, he started seeing the business aspects interfering more and more.
“I found myself spending a disproportionate amount of time on billing and coding, arguing with insurance companies over why I prescribed the drug I did rather than a cheaper one, trying to demonstrate ‘meaningful use’ of electronic patient records in order to receive an incentive,” said Setzer, who said he has watched the nature of primary care change since he began practicing here in 1997.
As Setzer experience first-hand, the business side of doctoring is changing. The number of solo practitioners who are members of the American Academy of Family Physicians fell from 44 percent in 1986 to 18 percent in 2008.
Moving forward, doctors are either joining health systems or hospitals or turning, as Setzer did, to what has been called “concierge medicine,’’ where patients pay a fee that ensures them access and gives the physician financial breathing room to schedule longer visits.
“The days of physicians coming out of medical school and hanging out their own shingle to practice medicine are over,’’ said Dr. C. Richard Schott, president of the Pennsylvania Medical Society.
“Doctors coming out of medical school today aren’t considering that and there’s very little training for how to run your own business,” Schott said. “The economics of practice, regardless of which venue you choose – solo practitioner or employed physician – are quite different than 10 to 15 years ago.”
The benefits of being part of a hospital or health system
More than 60 percent of doctors age 40 and younger are employed by a hospital, physician group or other entity, according to a survey done last year by The Physicians Foundation, which sent more than 630,000 email questionnaires to doctors and received 13,575 responses. Merrit-Hawkins, a physician search firm that assisted in the survey, reported that only 1 percent of their search assignments last year were for solo physicians compared to 22 percent in 2004.
But the move away from solo practitioners does have positive aspects Schott said.
“You are seeing movement away from a volume-driven reimbursement system towards something that is more value-based,’’ Schott said. “Traditionally, doctors haven’t paid attention to cost. These changes cause doctors to look at the appropriateness of what they order vs. cost.”
There are definite positives for doctors who are employed by a hospital or health system, said Schott, a suburban Philadelphia cardiologist who used to be in solo practice.
“They enjoy the fact that a hospital gets reimbursed substantially more from Medicare and private insurance than a doctor doing the same thing in his own office would get,’’ Schott said. “Employers can offer salaries and benefits that exceed anything a doctor could make in private practice.”
Richard LaVanture, senior vice president and chief strategic officer at Holy Spirit Hospital in Camp Hill, said working in a hospital or as part of a health system allows doctors to spend more time focused on patient care. As part of a larger organization, doctors don’t have to worry about core services such as billing, coding and documenting, technology support and marketing, he said.
“In this perfect storm of health reform mandates, the economy, high-deductible insurance plans and a diminishing workforce as baby boomers are aging, the trend away from solo physicians, especially in specialty areas like cardiology and oncology, is definitely increasing,” LaVanture said. “And now that perfect storm is making its way into primary care as well.”
It’s a win for patients as well, who enjoy more focused attention of a physician who isn’t worried with running a business and a higher level of care coordination with available services within the larger health system, LaVanture said.
“Doctors do give up full independence, but what they gain is substantial,” he said.
Not all doctors are happy about the changes they are seeing, however.
The Physicians Foundation report found three quarters of physicians are somewhat or very pessimistic about the future of their profession. It noted that those in the field longer had a dimmer view as opposed to a generally more positive outlook among younger physicians. The report also found that more than 50 percent of physicians surveyed said they planned to cut back on patients, work part-time, switch to concierge medicine, retire or take other steps that would reduce patient access to their services.
A different model for solo practice
Dr. Christine Cassel-Mackley, who owns Brownstone Dermatology Associates in Hummelstown, used to work for a medical center but opted to open to her own business to gain back time with her children, now 7 and 9.
The only reason she can afford to fly solo is elective cosmetic work, which clients pay for out of pocket, she said.
“About a third of what I do is cosmetic work,” she said. “I could definitely see it becoming difficult to be on your own if you didn’t have that option.”
While she loves the flexibility of her schedule, she said, “There are business aspects I’ve had to learn and there is a lot of fear going out on your own – you don’t know if you’ll have enough patients and be successful.”
Setzer knows that fear well – he faced it head on when he decided to leave the traditional family practice of which he was part owner and open his own concierge practice in October 2011.
“It was a huge decision for me to leave my patients of 14 years, but the way I rationalized that is that I was losing those relationships anyway because of the way I was forced to practice,” said Setzer, who describes his Lemoyne practice as “relationship-based continuity of care.”
Yes, he’s a solo practitioner, but not in the traditional vein. Patients pay $2,000 annually to have 24/7 access to Setzer and the guarantee that when they call the office, they will be seen that day or the next. In the office, patients get hour-long appointments; two and a half hours is allotted for annual physicals. There are no co-pays and no costs for in-office testing.
“This is really my passion – the synthesis of the science, the people stuff, the good feeling you get when you really help people,” he said.
Setzer was pleasantly surprised by how easy it was to build his patient base – he passed 200 patients at the eight-month mark, about half of whom followed him from his other practice. He is currently expanding his office space and adding an aesthetician and leasing space to massage therapists.
Concierge medicine is sometimes criticized as being healthcare for the wealthy, and Setzer acknowledges it can be expensive. He offers a discounted price of $1,200 for children ages 10 to 25 to help defray cost for a family.
Setzer doesn’t participate with insurance, but upon request, patients can get a summary of services to submit on their own. Often, though, claims are refused because he doesn’t assign a dollar value to services.
He said he would like to see employers offer to subsidize concierge care for their employees and insists they would reap benefit in healthier employees who are enjoying a higher level of care.
Patients have his cell phone number and his email address. If a patient can’t get into the office, Setzer is happy to swing by the house for a home visit.
“In truth, people have such good access to me that they don’t call me much after hours. I’ve only been woken up twice in the middle of the night,” he said. “Part of it is, we have a relationship and they value that. This is how old-fashioned medicine is practiced. When there’s a personal connection, it’s better.”
Source: Penn Live, The Patriot-News, Central Pennsylvania, March 17, 2013 (http://www.pennlive.com)
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