“Making healthcare personal again.”

In October, 2005 I transitioned from an academic medical practice with the UCSD Medical Group, where I was a faculty clinician for the previous 15 years, to a solo private practice in Family Medicine in the beautiful north coastal San Diego County town of Encinitas. My goal is to provide a medical home of continuous, timely, and accessible primary care for my patients. In order to do this my practice is set up differently than most.

In a typical family practice a physician is responsible for 2000-2500 patients (sometimes more) and needs to see 20-25 patients each day (also sometimes more). That makes it difficult to see patients when they want to be seen, do so on time, and spend the necessary time to maximize the benefit from an office visit. Little time is left for other necessary office activities such as phone calls with patients and specialists, medication refills, and review of test results. My practice addresses this issue by being limited to no more than 500 patients.

I designed an idealized medical practice that meets many of the goals of the Institute for Healthcare Improvement, the Ideal Medical Practice (IMP) project, and the American Academy of Family Physicians’ “Future of Family Medicine” project. Features of my “medical home” include office visits that are same day or next day, on time, and not rushed. I’m available to my patients 24/7 by cell phone.

The "direct practice" financial model that I worked out combines 2 different practice styles that are gaining increasing popularity. One is based on a practice membership fee model that goes by various names such as boutique or concierge medicine. The other is to be a cash-only practice, also known as being insurance-free. This refers to having no insurance contracts and collecting full payment at the time of service for an office visit; this way I am working for my patients rather than the insurance companies. My fees are reimbursable by health savings accounts (HSAs), many of which now provide debit cards for easy access to account funds. My practice works best for those who want to be active participants in the nationwide movement toward consumer-directed healthcare.

My office is small but comfortable in space and minimal in patient volume. My phone is answered by my daughter Chelsea (when she is in the office helping out) or me. I take vital signs, give shots, and run EKGs. My medical records are electronic. So, I don’t need an office manager, medical assistant, or file clerk. All of these features combine to greatly minimize the overhead cost of running the practice, which allows me to pass that savings on to patients in terms of keeping the practice small and keeping the practice membership and office visit fees relatively low.

Medical science is not perfect, which I guess is why we “practice” medicine. There is also an art to the practice of medicine, and to the greatest extent possible I work with my patients to make medical care decisions based not only on published guidelines but also on patients' personal preferences. I do my best to avoid unnecessary tests and avoid costly treatments when less expensive ones (i.e. genereic medications) would work just as well. My relationship with patients is highly dependent on mutual trust and respect.