Saturday, February 24, 2007

The Solo Practitioner gets quoted in national newspaper!!

On the Friday, February 23rd edition, the Wall Street Journal ran a a front page story by Gautam Naik talking about the use of technology in the creation of a new type of medical practice for the primary care physician -- the micropractice. The main reasons for this are: 1) technology reduces costs, 2) reduces need for superfluous staff, 3) possibly eliminates the need for a costly biller (a creation in response to insurance bureaucracy) and 4) improves quality of care. The enhancements that technology adds to a practice are endless, and include electronic prescriptions, summaries of medical visits for patients, printable patient education, tracking of patients who are due for lab or health maintenance services, creation of a newsletter, and diagnosis-specific mailings to patients. How great is that! Technology can only do good for patients. And for the primary care physicians in this country, technology has come to the rescue at a time when inflation-adjusted income for this backbone of the medical profession has dropped by 10%, whereas specialist income has at least kept up with inflation. The micropractice is the answer to some of the woes overworked primary care docs face in the insurance-driven big-practice factory-style medicine machine this country is pushing its doctors into, but will inevitably FAIL!!!

So, to toot my own horn, here's the quote: "Automate, automate, automate! That is the name of the game. Make everything automatic, including billing."

The truth is where medical practice is going now with the micropractice and concierge medicine is that primary care doctors want to feel human again. The days of sacrificing our lifespans to take incomplete care of dozens upon dozens of patients are coming to an end. Seeing 30 - 40 patients a day, intercepting many more phone calls, writing innumerable medication scripts (which is what the insurance companies would have us doctors due in this current healthcare treadmill) is NOT within the human possibilities of primary care practice WHILE STILL PROVIDING GOOD CARE. Doctors, contrary to popular belief, are not superhuman. The truth is when you work that fast, you know you're missing things. You know you're not providing good quality care. Would you want to be a patient of someone operating in this model?

THE MICROPRACTICE FREES DOCTORS:
So the doctors that are choosing the micropractice model, which has a lot of similarities to the concierge model, are choosing it to practice GOOD MEDICINE again, that is also ENJOYABLE. Cause guess what, having to rush from patient to patient all day long (in 10-15 minute visits) and field call after call after call, is just not fun. It leaves you feeling inhuman. And someone who's feeling dehumanized cannot possibly provide good care to other humans. Lifestyle is once again important to doctors. We're going to fight back! And the micropractice model is just the beginning. Unfortunately, this model still functions (to some extent) within the confines of insurance payments. The best medicine would be practiced outside of the insurance umbrella dictating access to procedures and medicines and such; instead, using evidence-based care and quality of results as the rule for dictating care.

IS UNIONIZING THE NEXT STEP?
And last, but not least, beyond the micropractice, primary care doctors across this country should form a national union. Not to ever strike (for that would be unethical), but in order to form a unified, and very powerful bargaining voice with the insurance companies. As individuals, we lack power, but together we could really put a check on the insurance companies that now rule our profession with little counterbalance, other than costly and timely court proceedings (like the ones in Florida for price-fixing). In addition, a national union could lower the cost of supplies by purchasing them en-mass for its members, then reselling at a discount. A national union of doctors would actually help control the burgeoning cost of medicine in this country. The only true threat of disruption by a national or state-wide unions would be to the insurance companies. Doctors could now go to the insurance companies as a whole to meet their demands, or warn that all union members would drop that insurance plan. An insurance company without in-network doctors would suffer greatly. Patients will still get reimbursed for out-of-network care. The proposal is for a checks and balances between the insurance companies and doctors. Right now there is none, and doctors have basically sold their souls to the insurance companies for fear of losing patients. THIS IMBALANCE NEEDS TO END!!!

6 Comments:

Blogger Flea said...

We need to talk. My email is flea@blogsplot.net. I'm a solo Ped, and I'm intrigued by the micro-model. I have 1000 patients, two staff people whom I pay very well including health insurance, and I'm in a building whose floors must be made of pure gold, as I am paying $32/sq ft!

I'm at a point now where I need to decide to make moves to reduce overhead or massively increase it (hire an NP).

Serious question now: my competitors in mega-practices are making money hand over fist. The economies of scale are huge. I don't see them failing inevitably. Why do you predict this?

best,

Flea

6:42 AM EST  
Blogger Medicine Man said...

If your building floors are made of gold, mine must be made of platinum. Is platinum more expensive? Anyway, $50/sq ft/yr for office space in NYC.

11:24 AM EST  
Blogger Medicine Man said...

As for mega-practices failing, I will write here for any readers to see. Maybe it's overzealous, but if the American public wakes up and realizes that they are getting substandard care in factory-style mega primary care practices, this model will inevitably fail by supply/demand economics. The simultaneous shift would hopefully be more doctors choosing to practice primary care specialties because they will become (once again) palatable. There will be a rising supply of doctors for the new practice model in primary care medicine, and less of them retiring or choosing specialties, which inevitably are more costly to the healthcare system. We would need to educate future physicians that there is a different way to practice medicine outside of these mega practices, something that is not necessarily taught in medical school (as there are no business classes, unfortunately) nor residency (because most everybody is "institutionalized").

11:40 AM EST  
Anonymous Anonymous said...

If you want to hear Dr. Moore interviewed about his solo practice listen at http://soundpractice.net/article.cfm?id=217

10:23 PM EST  
Blogger The Independent Urologist said...

Congrats. I actually gave him your name when he called me. He stiffed me though! Again, congrats.

1:38 PM EST  
Blogger Medicine Man said...

Thanks, bud.

12:08 AM EST  

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