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Home > Archive > Politics and Medicine > January 2005 > Family Practice Design of the Future
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Family Practice Design of the Future
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| Hi!
I'm thrilled that you are so excited about this article. I've been
looking for another doctor who sees the wisdom/benefit of a new design.
Dr. Brown sounds like a great doctor, and i hope to meet him soon b/c
i'm not to far, but the pioneer is Dr. Gordon Moore and if you liked
the first article, you'll love these from the AAFP.
(http://www.aafp.org/fpm/20020200/29goin.html and
http://www.aafp.org/fpm/20020300/25goin.html ) The second one actually
lists his monthly income and expenses for an entire year (grosses ~180k
and nets ~155k) which i think is very helpful. The real kicker is that
those numbers are for 6 hrs (12 pts) a day!
If you haven't already, I'd love for you to check out my blog and read
my explanation of my future practice. Although there are several
doctors breaking ground in practice design, i think the fatal flaw is
that none (that i've seen) have compiled all the great ideas. My goal
is to design a practice model that gives more to the patient, allows
the doc to work less, and make more. My belief is that unless everyone
wins, the idea will never take off.
I think a well designed and cash-only medical office (FP) should be
able to charge $20 per 15 minute visit (or $40 for 30 min) and still
make more than the average FP. This is all explained in my blog. The
way i figure, a doc could even charge 10/hr and still make 6 figures
but it requires them to be extremely efficient, utilizing EMR's open
access scheduling, limited/no staff, emails etc.
I have a few other posts that debate the use of emails w pts and most
people seem to be against them. This is the final frontier in my
opinion. 4 years ago when i was an undergrad, i was preaching EMRs and
paperless offices to every doc i meet and they said i was crazy and
naive. Now the AAFP's goal is for every FP residency to have a full
EMR by 2006! Currently, the AAFP is missing the boat on emails, but
i'm sure they come around. I know of 2 great examples of docs using
emails - one charges around 200/yr/unlimited and one 1500/yr/unlimited
and they make an extra 200K and 450K/yr respectively.
In reference to that 'locker room talk', I remember hearing that as an
undergrad as well. In fact, i worked for a plastic surgeon who was
miserable b/c he was getting $200 for a bilateral breast reduction. He
actually gave me a raise when i told an insurance company that he could
make more digging ditches 
I'd love to chat with you and your wife b/c you're in a prime position
to start an absolutely ground breaking practice that can offer a whole
new level of care.
Cheers,
Josh
http://freemarketdoctors.blogspot.com
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| George Conklin 2005-01-18, 7:13 pm |
|
"interleukin01" <interleukin01@yahoo.com> wrote in message
news:cs8n0l$n9m$1@news.service.uci.edu...
> I think that there are many unhappy doctors out there. I also think that
> the majority of these physicians have also experienced a big change in
their
> originally envisioned manner of practicing medicine as well as an
extremely
> increased level of "administrativa".
Doctors want it both ways: they want sky-high incomes and then not to
be involved in paperwork.
| |
| George Conklin 2005-01-18, 10:10 pm |
|
"Josh" <jumbehr@gmail.com> wrote in message
news:1106013992.687053.278680@f14g2000cwb.googlegroups.com...
> I don't think we all mean the same thing by 'business model' and/or
> 'fee for service' b/c I would classify my plans as a 'business model'
> that is definately 'fee for service'.
>
> Geroge, I'ved asked myself that same question since i have to shadow do
> many doctors. I've found that happiness comes in two types: "ignorance
> is bliss" and "control = freedom"
> Some docs have chosen to let other people (ie office managers) worry
> about the cash OR they have taken the bull by the horns and fixed their
> problems (ie cash only) Some of the happiest docs I've talked to are
> the cash only docs who've signed up for Simplecare (see
> www.simplecare.com). Because they are back in the drivers seat and
> practicing medicine they way they always wanted to.
>
The article which started this featured a doctor who did not deal only in
cash. Doctors used to take chickens and so forth. I doubt we are going
back to bartering. Further, notice that the cash doctors still want that
$150,000 a year income, about that of a college president for routine
medical care.
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| Doctors want it both ways: they want sky-high incomes and then not
to
be involved in paperwork.
Is that so bad George? That sort of demand is what drives capitalism.
People want bigger, faster, safer, cheaper, more fuel efficient
cars/suvs. Its why Wal-Mart is the Fortune 500 company it is today -
b/c people demand 'good' quality at the lowest price they can get.
As long as the docs are willing to pay for it, someone will build it.
Its the 'field of dreams' hits the market: If you build it they will
buy it. . . .
Besides, in my design, docs make more than the avg, work about the same
(avg FP works 51 hrs/wk) and make more. Not only that, but the cost is
DRASTICALLY reduced for the patient (for more time I might add). Its a
win-win scenario.
| |
| interleukin01 2005-01-19, 2:11 am |
| Thanks for the further references.
You mentioned the use of e-mail to interact with patients. I use this now
all the time. Especially with my chronic patients with diabetes that
requires careful insulin titration ( My patients never present in DKA and
once I'm e-mailing with them, rarely with out of control blood sugars). I
use it to reassure my patients, sometimes an e-mail takes me 20 seconds and
goes a long way for them. There are many models that use e-mail and there
are formal ways to be reimbursed as well---both on the private and insurance
company end. ----all HIPAA compliant. See articles by Dr. Joseph
Scherger---he was a pioneer in this regard.
The hospital system that I currently work for just invested $60M in an
enterprise EMR--w/ full integration for all other parts of inpatient
function----goal to offer outpatient integration in the next 5yrs or so.
I've been involved in this implementation and it's been a good experience.
It's all about enjoying what you do with your time...
Mario
"Do not follow where the path may lead. Go instead where there is no path
and leave a trail." -Muriel Strode
"Josh" <entrepreneur.md@gmail.com> wrote in message
news:1105682240.251338.304580@c13g2000cwb.googlegroups.com...
> Hi!
>
> I'm thrilled that you are so excited about this article. I've been
> looking for another doctor who sees the wisdom/benefit of a new design.
> Dr. Brown sounds like a great doctor, and i hope to meet him soon b/c
> i'm not to far, but the pioneer is Dr. Gordon Moore and if you liked
> the first article, you'll love these from the AAFP.
> (http://www.aafp.org/fpm/20020200/29goin.html and
> http://www.aafp.org/fpm/20020300/25goin.html ) The second one actually
> lists his monthly income and expenses for an entire year (grosses ~180k
> and nets ~155k) which i think is very helpful. The real kicker is that
> those numbers are for 6 hrs (12 pts) a day!
>
> If you haven't already, I'd love for you to check out my blog and read
> my explanation of my future practice. Although there are several
> doctors breaking ground in practice design, i think the fatal flaw is
> that none (that i've seen) have compiled all the great ideas. My goal
> is to design a practice model that gives more to the patient, allows
> the doc to work less, and make more. My belief is that unless everyone
> wins, the idea will never take off.
>
> I think a well designed and cash-only medical office (FP) should be
> able to charge $20 per 15 minute visit (or $40 for 30 min) and still
> make more than the average FP. This is all explained in my blog. The
> way i figure, a doc could even charge 10/hr and still make 6 figures
> but it requires them to be extremely efficient, utilizing EMR's open
> access scheduling, limited/no staff, emails etc.
>
> I have a few other posts that debate the use of emails w pts and most
> people seem to be against them. This is the final frontier in my
> opinion. 4 years ago when i was an undergrad, i was preaching EMRs and
> paperless offices to every doc i meet and they said i was crazy and
> naive. Now the AAFP's goal is for every FP residency to have a full
> EMR by 2006! Currently, the AAFP is missing the boat on emails, but
> i'm sure they come around. I know of 2 great examples of docs using
> emails - one charges around 200/yr/unlimited and one 1500/yr/unlimited
> and they make an extra 200K and 450K/yr respectively.
>
> In reference to that 'locker room talk', I remember hearing that as an
> undergrad as well. In fact, i worked for a plastic surgeon who was
> miserable b/c he was getting $200 for a bilateral breast reduction. He
> actually gave me a raise when i told an insurance company that he could
> make more digging ditches
>
> I'd love to chat with you and your wife b/c you're in a prime position
> to start an absolutely ground breaking practice that can offer a whole
> new level of care.
>
> Cheers,
> Josh
> http://freemarketdoctors.blogspot.com
>
| |
| George Conklin 2005-01-19, 2:11 am |
|
"interleukin01" <interleukin01@yahoo.com> wrote in message
news:cs7o94$2t7$1@news.service.uci.edu...
> Thanks for the further references.
> You mentioned the use of e-mail to interact with patients. I use this now
> all the time. Especially with my chronic patients with diabetes that
> requires careful insulin titration ( My patients never present in DKA and
> once I'm e-mailing with them, rarely with out of control blood sugars). I
> use it to reassure my patients, sometimes an e-mail takes me 20 seconds
and
> goes a long way for them. There are many models that use e-mail and there
> are formal ways to be reimbursed as well---both on the private and
insurance
> company end. ----all HIPAA compliant. See articles by Dr. Joseph
> Scherger---he was a pioneer in this regard.
> The hospital system that I currently work for just invested $60M in an
> enterprise EMR--w/ full integration for all other parts of inpatient
> function----goal to offer outpatient integration in the next 5yrs or so.
> I've been involved in this implementation and it's been a good experience.
>
> It's all about enjoying what you do with your time...
>
From reading the articles, it is obvious that the physician in question
must have good business skills, something which is not taught in med school.
Very few graduates would have the patience to file forms, deal with
insurance (which is difficult), and handle all the other small parts of
working alone. The key here is low and close to no overhead. That is how
the old-fashioned doctor worked. They also often worked out of their homes,
and had the waiting room on the back porch. My grandfather did that when
physicians were considered a home occupation.
| |
| George Conklin 2005-01-19, 2:11 am |
|
"interleukin01" <interleukin01@yahoo.com> wrote in message
news:cs7l6k$oq$1@news.service.uci.edu...
> I remember hearing the experienced docs "locker talk" when I was a premed
> and medical student---and most were very unhappy with the direction that
> their practices were going----less control, less money, less time with
> patients, less satisfaction. When I heard this I decided that I wanted to
> avoid not only having these problems, but especially did not want to find
> myself whining 10-15 yrs into my practice about how much I hate it.
I wonder why there are so many unhappy physicians. So many have posted
here that I wonder if there are any happy doctors out there? After all,
the small business model of fee-for-service which the AMA is hung up on is
obsolete and is not going to come back.
| |
| Herman Rubin 2005-01-19, 2:11 am |
| In article <z8OFd.7087$Ii4.181@newsread3.news.pas.earthlink.net>,
George Conklin <georgeconklin1@earthlink.net> wrote:
>"interleukin01" <interleukin01@yahoo.com> wrote in message
>news:cs7o94$2t7$1@news.service.uci.edu...
>and
[vbcol=seagreen]
[vbcol=seagreen]
[vbcol=seagreen]
> From reading the articles, it is obvious that the physician in question
>must have good business skills, something which is not taught in med school.
>Very few graduates would have the patience to file forms, deal with
>insurance (which is difficult), and handle all the other small parts of
>working alone. The key here is low and close to no overhead. That is how
>the old-fashioned doctor worked. They also often worked out of their homes,
>and had the waiting room on the back porch. My grandfather did that when
>physicians were considered a home occupation.
The way to get back to this is to remove the overhead imposed
by the government and "insurance" plans. This can only be done
by essentially removing their involvement.
Go back to direct fee for service without the overhead, and
install MSAs to remove the tax advantages of prepaid plans.
Keep insurance for major expenses. Require all "plans" to
pay for the additional overhead involved, including those
coming from the government. Require physicians to discuss
with their patients, not order, and make it clear that the
patient is the boss, unless public health considerations
(those which might affect others) are involved.
--
This address is for information only. I do not claim that these views
are those of the Statistics Department or of Purdue University.
Herman Rubin, Department of Statistics, Purdue University
hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558
| |
| interleukin01 2005-01-19, 2:11 am |
| I think that there are many unhappy doctors out there. I also think that
the majority of these physicians have also experienced a big change in their
originally envisioned manner of practicing medicine as well as an extremely
increased level of "administrativa". I'm not creating an excuse for their
whining, but I do believe that newly trained doctors will do less
complaining and more changing for the mere fact that their expectations have
been tempered and they are entering the profession during a tumultuous time.
Another factor in general is that the "new physician" is more likely to
consider quality of their own life to a greater extent when compared with
"old school" docs. To be clear, I'm not talking about more money, I'm
talking about having the ability to spend time with family, enjoying some
level of professional autonomy, and not being a slave to a profession.
I have also talked with many docs, old and new that are very happy with
their professional careers. They are usually proactive people in general and
have managed to keep a healthy perspective even in the face of frequent
frustration---they generally have a clear mission in their life. Always
easier said that done.
I agree that a purely fee-for-service "Small business model" as you
mentioned is not realistic for the masses these days (possible in limited
geographic areas with the socioeconomic resources---the rich or in clinics
offering limited boutique-style medical services), especially if you are
interested in working with medically underserved as a portion of your
patient mix.........but, there are many similar variations that absolutely
can be successful. It requires a doctor that has more skills than purely
clinical and a doctor that is open-minded and willing to take risk---not
most people's cup of tea.
Mario
"George Conklin" <georgeconklin1@earthlink.net> wrote in message
news:j_NFd.7085$Ii4.4144@newsread3.news.pas.earthlink.net...
>
> "interleukin01" <interleukin01@yahoo.com> wrote in message
> news:cs7l6k$oq$1@news.service.uci.edu...
>
>
> I wonder why there are so many unhappy physicians. So many have posted
> here that I wonder if there are any happy doctors out there? After all,
> the small business model of fee-for-service which the AMA is hung up on is
> obsolete and is not going to come back.
>
>
| |
| George Conklin 2005-01-19, 7:12 pm |
|
"Herman Rubin" <hrubin@odds.stat.purdue.edu> wrote in message
news:cs8k29$4d8a@odds.stat.purdue.edu...
> In article <z8OFd.7087$Ii4.181@newsread3.news.pas.earthlink.net>,
> George Conklin <georgeconklin1@earthlink.net> wrote:
>
now[vbcol=seagreen]
and[vbcol=seagreen]
I[vbcol=seagreen]
there[vbcol=seagreen]
>
so.[vbcol=seagreen]
experience.[vbcol=seagreen]
>
>
>
question[vbcol=seagreen]
school.[vbcol=seagreen]
how[vbcol=seagreen]
homes,[vbcol=seagreen]
>
> The way to get back to this is to remove the overhead imposed
> by the government and "insurance" plans. This can only be done
> by essentially removing their involvement.
>
> Go back to direct fee for service without the overhead, and
> install MSAs to remove the tax advantages of prepaid plans.
> Keep insurance for major expenses. Require all "plans" to
> pay for the additional overhead involved, including those
> coming from the government. Require physicians to discuss
> with their patients, not order, and make it clear that the
> patient is the boss, unless public health considerations
> (those which might affect others) are involved.
>
>
None of that is going to work at all Herman. Nearly all doctors and all
hospitals charge the cash customer MORE. Further, even a HMO provides
insurance. You just want to put the limit higher. Irrelevant.
| |
|
| I don't think we all mean the same thing by 'business model' and/or
'fee for service' b/c I would classify my plans as a 'business model'
that is definately 'fee for service'.
Geroge, I'ved asked myself that same question since i have to shadow do
many doctors. I've found that happiness comes in two types: "ignorance
is bliss" and "control = freedom"
Some docs have chosen to let other people (ie office managers) worry
about the cash OR they have taken the bull by the horns and fixed their
problems (ie cash only) Some of the happiest docs I've talked to are
the cash only docs who've signed up for Simplecare (see
www.simplecare.com). Because they are back in the drivers seat and
practicing medicine they way they always wanted to.
| |
| George Conklin 2005-01-27, 8:50 am |
|
"interleukin01" <interleukin01@yahoo.com> wrote in message
news:cs8n0l$n9m$1@news.service.uci.edu...
> I think that there are many unhappy doctors out there. I also think that
> the majority of these physicians have also experienced a big change in
their
> originally envisioned manner of practicing medicine as well as an
extremely
> increased level of "administrativa".
Doctors want it both ways: they want sky-high incomes and then not to
be involved in paperwork.
|
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