I am a solo, independent family physician and my practice is not a silo. It is not a cold, stagnant, immobile, potentially dangerous storage facility where data to be used by insurance companies and statisticians is held until it is finally purged. No, my office is a visually and emotionally comforting, innovative, healing environment where information is shared and confidence is enhanced. It is an oasis.
My practice is embedded in my community and many of my patients are also my neighbors. I offer 24/7 access, home visits, same day appointments, little to no waiting time, a patient portal with secure e-mail, and unlimited free education sessions with an RN to enhance the patient’s confidence in their health management. My patient appointments are 20-minutes long (40-60 minutes for new patients), which gives me the time I need to go through the entire list of patient concerns without feeling rushed. I take most insurances and do not charge any added fees. Measurements of my practice show twice as many of my patients say they get “perfect care” compared to national average. To them, my practice is an oasis.
When I started my practice over 10 years ago, I figured it would last about 4 years. The truth is that instead of burning out, I am more energized and engaged about practicing medicine than ever before. The autonomy of being in a small practice means it is a continuous experiment done on my timeline with the resources I have available. I can quickly change policies, try new concepts out, and cast aside ideas which do not seem to work. Given the small size, there is little chaos and the flow through the day is smooth. Most days I go home for lunch and most evenings I have time for a run. The practice is integrated into my life and lifestyle, and although sometimes frustrating and always challenging, it is indeed an oasis for me.
But climate change in the medical system threatens to destroy my oasis. Significant numbers of experts believe practices like mine should not exist. Instead of looking at the oasis, they see a silo. Many believe coordination is the most important pillar of primary care, but they mistake structure (lines of communication) for behavior (actual communication). Others believe expensive technology with disease-based registries is the cornerstone to higher quality, but they mistakenly equate disease with ill-health and ignore the fact that family medicine is fundamentally relationship-based. Still others feel that cost containment can only be achieved by thrusting onerous administrative burdens onto primary care practices, but they mistake cost containment for cost shifting.
And all of this matters. It matters because without comprehensive family medicine costs soar and quality drops. It matters because the incessant push to follow the latest metric distracts us from what is really important and prevents us from finding a metric which accurately measures what we do. It matters because joy is found through a sense of autonomy and the more we sacrifice our autonomy for job security, the less happiness we will have. It matters because small practices have the freedom to innovate and change and can and should lead the way into the future. And it matters because at a time when we need more family physicians than ever, independent practices are shutting their doors at an alarming rate.
So now is the time to discard talk of silos and how to dismantle them. Let’s begin instead to discuss oases and how to create and nurture them. Let’s recognize failed policies which lead to dead zones and work to reverse them. Let’s unite our oases locally and nationally in an exciting network of innovation and quality. Let’s understand what is truly important in family medicine and change reimbursement policies to reflect this. And let’s eliminate unnecessary administrative burdens which constantly distract us from the important job we have to do everyday.
The life of my oasis, and thousands more like it across the nation, can no longer afford to wait.
John Brady is president, Ideal Medical Practices.
