I’m spending time with two different family doctors in town who recently graduated from my training program. They both run what is called the “Ideal Micro Practice”. This style of medical care is quickly gaining national attention and is becoming something of a national movement.
The basic idea is to return family medicine – any primary care specialty could do this, though – to the days where most of the visit is comprised of doctors working with their patients. The way to achieve this is to cut out ALL middle-men. And I mean everybody. As you might imagine, there are LOTS of people who make enormous amounts of money on doctors. The doc I was with today said that he’s pretty sure M.D. stands for people on whom you can “Make Dough.”
So, here’s how his practice works: He sees patients for anywhere from 30 minutes to an hour. There is no receptionist, no nurse, no medical assistant, no biller. The office is the same room as his single exam room. The computer is connected to a second monitor that faces the patient while s/he sits in a comfortable easy chair and talks about the medical issues they’re working on. Any labs, imaging or handouts are visible on the screen right in front of the patient, and all of them can be printed out or emailed at the patient’s request. The doc is available by email virtually all the time and has data-enabled cell phones that allow them to upload patient information when they are not in the office. Patients make their own appointments on-line. The cost is roughly the same as any doctor.
If the patient goes to the hospital, a staff hospitalist will do the admission and in-hospital care; the micro-practice doc will come see them socially. Both docs will have no more than about 400 patients on their panel, and they know each patient or family personally.
One of the doctors has limited his practice to ONLY the best insurance companies, which according to him is 4 of them. The rest suck. They don’t pay on time, they often don’t pay at all, and generally have no incentive to be honest with how they work with doctors. The flip-side is that he doesn’t have a full patient panel yet, but has no urge to allow anything but exactly the preferred companies because he works part-time for another practice that more than pays his bills. So, he is building his practice slowly and keeping total control over how things progress. The other doc is subsisting only on his private practice and has thus taken on crappier insurance payers. He recently acquiesced and hired a biller to deal with the paperwork and administrative overhead those insurance agencies generate.
Both doctors believe deeply in the IMP model. They’re evangelists for the cause and they believe this will be the wave of the future. Certainly I can see that they are both making money, although probably not as much as they would if they were pounding through 20-40 patients a day in a high-overhead typical practice. In general, their revenues are miniscule to the typical family practice, but they keep so much of what they bring in that the differential is negligible.
Everybody’s trying to either fix American medicine, or they’re running scared as fast as they can to other fields. I applaud these docs for trying to come up with a new world order. I think the biggest drawback to practicing medicine in America today is the lack of freedom, largely due to influences outside the sacred doctor-patient relationship. If I have to be kept from spending time with my beautiful children and wife, I would like it to be because I am working with a patient. Most other reasons – generally some version of paperwork – just aren’t worth it. IMP’s provide hope that medicine can return to it’s roots – to the days when doctors helped their patients, and nothing more.