Whenever I meet a new patient and get their history one of my first questions is “Who was your previous doctor?” and in the 25+ years that I’ve been practicing Family Medicine there’s been a disturbing trend in that answer. Before 2010 the answers were usually “Dr. Smith” or “Dr Goldberg” but over the past 10 years what I started hearing and now hear all the time is “Well Care Family Practice” or “University Primary Care” because patients don’t really have one Family Doctor anymore – they have a practice entity that takes care of them.
Even primary care practices with 2 or 3 physicians now need to hire “mid-level doctor extenders” (Nurse Practitioners or Physician Assistants) to help with their patient loads so your own doctor is not someone you see all the time. Nurse Practitioners and Physician Assistants are highly educated and capable medical providers but they are not your doctor. They are often utilized to see you for a non-urgent medical issue when your usual doctor is not available. Many times patients end up seeing that mid-level provider on a regular basis because they like them and it’s easier to get an appointment with them.
Every physician that I know has the upmost concern about their patients and wants to provide the best medical care possible. Unfortunately, our hands are tied because of the amount of
patients we need to see in a day. New Medicare and insurance company regulations have created an enormous amount of computer data entry that physicians must do and that takes away quality face-to-face time with patients and their doctors. University employed physicians are beholden to their corporation’s expectations and usually don’t have much input into the daily office management. Independent physicians are responsible for their own office management but that only adds work to their already busy days. Many independent doctors decide to join a hospital-based practice simply because they don’t want this added responsibility of running a small business along with doing patient care.
I grew-up seeing my family practitioner until I got married. He was also my mother’s Ob-Gyn, made house calls if needed, delivered me and my brother and was our pediatrician. I kid around with my patients saying that I became a doctor because of him and watching Marcus Welby MD (a sitcom in the ‘70’s). However, I definitely knew his name when asked and he knew me, my family, my medical history, our crazy quirks and any important issues we experienced that weren’t medical but still impacted our lives and therefore our general health.
I’ve been fortunate in my medical practice because I’ve been able to remain independent. I was a longtime partner in a solid independent family practice that over the years fell victim to the need for a larger patient population while at the same time having to reduce the time spent with each patient. Physician extenders were hired and were a blessing, but I wasn’t used to someone else seeing my patients in my own practice on a regular basis. Insurance company demands for documentation that had nothing to do with why a patient was seeing me that day always slowed us down and made patients irritable. “Why do you care about when I had a colonoscopy when I’m here because I just found out my husband has cancer and I’m not sleeping?” Waiting room times increased, busy signals on our phones became the new normal and our staff tried to do their jobs but suddenly needed extra hands for tasks that used to be straightforward and suddenly became complex and multiplied exponentially. I never felt that there was an issue with our quality of care because our physicians and nurse practitioners are smart and we always cared about our patients. In fact, there are many doctors that thrive when they’re moving quickly but I was just not happy with the way my practice of medicine had changed.
Last year I made a bold move, left my former office and set-up a new medical office. My new practice involves an affordable membership fee on top of the cost of health insurance. I was understandably nervous because the idea of paying even more for healthcare is a very sore point but the reality is my program is the same price as one SoulCycle or Flywheel spin class a week or one Starbucks Frappacino a day. Those high-end spin classes are loaded with clients that don’t bat an eye at the $30 fee. Also, patients interested in their health should be giving up the daily sugared drinks anyway.
My patients and I have never been happier with their medical care. The membership fee includes an extensive yearly executive physical, testing and bloodwork sent to the Cleveland Heart Lab for markers determining your risk for heart disease. Because of this physical, my program is medically tax-deductible and can be paid for with an HSA or FSA account at work.
My patients contact me exclusively through my cell phone with texts, emails and calls. Their appointments are 30-60 minutes long, there’s zero waiting time, I follow them in the hospital and they are always able to see me same or next day. They are also saving money because now that I have the time to educate them about diabetes, weight loss, healthy lifestyles, cardiac disease and individualized preventative care according to their own risk factors, they are seeing less specialists and requiring less expensive medication. They are also happier and healthier. We are partners in their healthcare, they drive the car and I’m along for the ride helping with directions.
Unfortunately, healthcare is broken right now and instead of Democrats vs Republicans we’re in the middle of a huge battle involving insurance companies vs hospitals vs physicians vs patients. It will not be fixed any time soon. I am thrilled to be able to now spend my days delivering medical care and education to my patients without just being a triage point for specialists during a ten minute office visit. My patients are lucky because they benefit from attentive medical care delivered in a pleasant, unhurried environment without a wait plus they always see their own doctor and they know my name.
If you’re in the Philadelphia area and interested in our program, please call for a meet and greet – you won’t be disappointed. If you live elsewhere, check out mdvip.com for a physician in your area.
Vicki Bralow DO
Bralow Medical Group