PookieMD's Blog: Where Physicians Learn About the Business of Medicine

Surfing the net aimlessly, I came across the following from Care Practice:

“We offer 24/7 Urgent Care and House Call services with an On Call Doctor available after hours and on weekends to meet patients that require Urgent Care services. Our office is open and staffed 365 days a year because patients don’t determine when they get sick.

My friend Kevin Lutz, a fellow internist and friend since medical school, is leaving traditional primary care. He was the last one of my friends doing traditional primary care. He made rounds in the morning, ran a tight ship at the office, and is well known as one of the best and the brightest in the area. He sent me an email noting that he is closing his traditional practice and is going to try a “retainer” or “concierge” practice. Given that he was the last one standing from medical school, I was curious to know why he was leaving his traditional practice.

“My revenues are flat and my overhead is 10% higher each year,” Dr. Lutz states. He is struggling to make ends meet, and job satisfaction is minimal. “I had two ‘aha’ moments,” he explains. The first occurred as he was winding up a quick visit with a patient he knew well. Dr. Lutz, with his hand on the door knob, turned as he was exiting the room and asked his patient how his golf game was. “You know, doc, because I’m short of breath, I don’t golf much anymore.” Alarm bells rang in the good doctor’s head, and by week’s end the patient was getting a CABG. Dr. Lutz says, “I want to have the time to ask patients about their lives.” He doesn’t want to have more door knob moments. His second aha moment came when he woke up at midnight asleep at the computer while researching behcet’s disease after a long day at the office. “I want to be able to provide patients with information in a timely fashion,” he states. He notes he wants to return to the days when he can make sure he has completely met the needs of his patients, and he is looking for a way to bring back joy to the practice of medicine.

Dr. Kevin Pho, well known in the blogosphere as Kevin, MD, works in primary care as well. He does NOT work in private practice, but rather for a hospital owned practice. He sees the standard 25-30 patients per day, and is office based. He enjoys his job, but states, “I set limits up front as to how much we can accomplish in one visit.” Dr. Pho says setting expectations from the get go saves a lot of frustration by both physician and patients. He enjoys the fact the hospital owns the practice, and that he doesn’t worry about the practice’s finances. He opines that,”primary care is the loss leader for the hospital,” explaining that primary care brings business to the hospital, and that this is the main benefit to the hospital. Dr. Pho notes that he may have sacrificed autonomy for job security, but feels that primary care is destined to end up with the model he works in.

I think both Kevins are on to something. Sadly, I think the days of solo physicians and small practices are over. As long as primary care is a “loss leader” and has no intrinsic value, we will continue to close our practices and become either employees, or entrepreneurs. I wish both Kevins the best, but have a soft spot for the days of old. I’m not sure I could wear the retainer hat, but I know I can’t wear the employee hat either. Perhaps that is why primary care physicians must reinvent themselves.

Just when you thought it couldn’t get worse, it just did.  I don’t know about you, but I went in to medicine to help people regain their health, and that vision  includes maintaining and increasing patients health and well being.  Unfortunately, Americans seem bent on eating, smoking and driving their way to chronic illness.  However, there is a movement afloat called “Health Coaching.”  What is a health coach?  Well, my intrepid reader, I went off to find out.

As far as I can tell, a health coach is someone, not necessarily a health professional, that will coach/mentor a client (not a patient) towards increased wellness.  Geez, I thought that was my job.  According to my research, Duke University offers some training in this and lists the following as an explanation of what a health coach does:

• Help people clarify their health goals, and implement and sustain behaviors, lifestyles, and attitudes that are conducive to optimal health.
• Guide people in their personal care and health-maintenance activities.
• Assist people in reducing the negative impact made on their lives by chronic conditions such as cardiovascular disease, cancer, and diabetes.

Hilarious.  Isn’t that the definition of what primary care is supposed to be about? But HOW on earth could you do that in 15 minutes?  Answer: You can’t.  And that is the crux of what is wrong with medicine.  We spent years learning about diseases process, pharmaceuticals, pathology and zebras, but we didn’t learn the basics of positive psychology, encouraging change and guiding patients towards optimal health.  Instead, this field will be taken over by ‘health coaches’ who have minimal training, little medical back ground, and no share in liability.

Here is what one be-a-health-coach website promotes:

1. …earn at least $121 per hour (with out having to leave your home).
2. how to find all the coaching clients you can handle.
3. How your life can take on new meaning as you begin making a HUGE difference in people’s lives and the Health Care industry in general.
4. …How you can immediately make money as a Professional Health Coach.

Now, I think we physicians SHOULD ALL BE HEALTH COACHES.  What I find so frustrating was that this is why I went in to medicine, and I can’t do it because I am constrained by the medical/legal/government/insurance bureaucracy that is today’s medicine.  Maybe I should forget that I am an MD, and focus on being a “Health Coach”.  I’d like to earn $121 per hour from home.  I think it would be invaluable to my patients to have me as a physician BE their health coach along with managing their medical problems.  Hmmm, do I smell “retainer medicine ”?