Comments on: A doctor without an office http://www.kevinmd.com/blog/2007/09/doctor-without-office.html Tue, 14 Feb 2012 11:46:00 +0000 hourly 1 By: Jayhttp://www.kevinmd.com/blog/2007/09/doctor-without-office.html#comment-80356 Jay Mon, 24 Sep 2007 03:01:00 +0000 http://clients.emmense.com/kevinmd/2007/09/a-doctor-without-an-office.html#comment-80356 Thanks for the post Kevin. Always nice to read interesting discussion. It's a bit like getting free consultations from those who have been in the trenches much longer than me. I'll keep everyone posted about the progress of this practice on my blog:<br/><br/>http://www.jayparkinsonmd.com/blog<br/><br/>Thanks again. Thanks for the post Kevin. Always nice to read interesting discussion. It’s a bit like getting free consultations from those who have been in the trenches much longer than me. I’ll keep everyone posted about the progress of this practice on my blog:

http://www.jayparkinsonmd.com/blog

Thanks again.

]]> By: Juleshttp://www.kevinmd.com/blog/2007/09/doctor-without-office.html#comment-80347 Jules Mon, 24 Sep 2007 00:05:00 +0000 http://clients.emmense.com/kevinmd/2007/09/a-doctor-without-an-office.html#comment-80347 This is a pretty interesting idea. I'm curious if it would be good for someone with chronic issues. This is a pretty interesting idea. I’m curious if it would be good for someone with chronic issues.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/09/doctor-without-office.html#comment-80345 Anonymous Sun, 23 Sep 2007 23:19:00 +0000 http://clients.emmense.com/kevinmd/2007/09/a-doctor-without-an-office.html#comment-80345 It is something we do to each other. Some medical boards require it. A local physician complained to my board when I stoped taking call. I was ahead of him. I had already checked and found that they considered it a contractural issue for outpatient practices. If you tell people it is office hours only then that is fine by them. Obviously with patients in a hospital, you would have abandonment (and staff rules) issues preventing that. Also, the fact that they don't require it doesn't mean you wouldn't have an obligation under common law when treating an acute illness. I therefore, even though I "don't take call", still check on or give my number to patients who are having an acute episode of illness. It is the right thing to do and makes me feel better. Only one person abused that access in several years. It is something we do to each other. Some medical boards require it. A local physician complained to my board when I stoped taking call. I was ahead of him. I had already checked and found that they considered it a contractural issue for outpatient practices. If you tell people it is office hours only then that is fine by them. Obviously with patients in a hospital, you would have abandonment (and staff rules) issues preventing that. Also, the fact that they don’t require it doesn’t mean you wouldn’t have an obligation under common law when treating an acute illness. I therefore, even though I “don’t take call”, still check on or give my number to patients who are having an acute episode of illness. It is the right thing to do and makes me feel better. Only one person abused that access in several years.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/09/doctor-without-office.html#comment-80334 Anonymous Sun, 23 Sep 2007 18:45:00 +0000 http://clients.emmense.com/kevinmd/2007/09/a-doctor-without-an-office.html#comment-80334 The old 24/7 thing is an insurnace scam that docs have fallen for. <br/>Some guy gets a wart removed once and your're on the hook for his every need at every hour regardless of whether you ever see a single dime from him or his insurer again. Has any other profession fallen for this con job? The old 24/7 thing is an insurnace scam that docs have fallen for.
Some guy gets a wart removed once and your’re on the hook for his every need at every hour regardless of whether you ever see a single dime from him or his insurer again. Has any other profession fallen for this con job?

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/09/doctor-without-office.html#comment-80309 Anonymous Sat, 22 Sep 2007 21:49:00 +0000 http://clients.emmense.com/kevinmd/2007/09/a-doctor-without-an-office.html#comment-80309 The 24/7 coverage is an insurance issue. If he's not taking insurance, there's no reason why he can't leave a message to go the the nearest ER.<br/><br/>There are independent nurse practitioner clinics in my town. That's what they do. Free-standing urgent care clinics. That's what they do. The retail clinics you hear so much about these days. That's what they do. Why are the rules different for a private physician in independent practice? The 24/7 coverage is an insurance issue. If he’s not taking insurance, there’s no reason why he can’t leave a message to go the the nearest ER.

There are independent nurse practitioner clinics in my town. That’s what they do. Free-standing urgent care clinics. That’s what they do. The retail clinics you hear so much about these days. That’s what they do. Why are the rules different for a private physician in independent practice?

]]> By: Happymanhttp://www.kevinmd.com/blog/2007/09/doctor-without-office.html#comment-80305 Happyman Sat, 22 Sep 2007 21:18:00 +0000 http://clients.emmense.com/kevinmd/2007/09/a-doctor-without-an-office.html#comment-80305 In my experience those who pay out of pocket (as opposed to those with medicare) are going to be much higher maintenance, calling in the middle of the night for the sniffles, etc.<br/><br/>However, since medicare pays much better for housecalls than office visits, a housecall practice focusing on the elderly is a good business model (I do this part-time). This is still stressful at times, dealing with concerned families & aides, and as with an office practice, there is lots of unreimbursed work, although the overhead is potentially very low compared to office practice. In my experience those who pay out of pocket (as opposed to those with medicare) are going to be much higher maintenance, calling in the middle of the night for the sniffles, etc.

However, since medicare pays much better for housecalls than office visits, a housecall practice focusing on the elderly is a good business model (I do this part-time). This is still stressful at times, dealing with concerned families & aides, and as with an office practice, there is lots of unreimbursed work, although the overhead is potentially very low compared to office practice.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/09/doctor-without-office.html#comment-80303 Anonymous Sat, 22 Sep 2007 19:58:00 +0000 http://clients.emmense.com/kevinmd/2007/09/a-doctor-without-an-office.html#comment-80303 In my state, he can just tell them that he will not be available at the that time and to call someone else or go to the ER. (I just heard a collective sigh from ER docs everywhere). He doesn't have to be a slave to it. And the low overhead will allow him to take off without shelling out a fortune. <br/><br/>If he chooses to cover the practice 24/7, I imagine that he would have no trouble getting a regular office based doc to cover--especially if he refers the patients over 40 that call him to them. They would be getting overflow from his practice for very little work. In my state, he can just tell them that he will not be available at the that time and to call someone else or go to the ER. (I just heard a collective sigh from ER docs everywhere). He doesn’t have to be a slave to it. And the low overhead will allow him to take off without shelling out a fortune.

If he chooses to cover the practice 24/7, I imagine that he would have no trouble getting a regular office based doc to cover–especially if he refers the patients over 40 that call him to them. They would be getting overflow from his practice for very little work.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/09/doctor-without-office.html#comment-80302 Anonymous Sat, 22 Sep 2007 19:54:00 +0000 http://clients.emmense.com/kevinmd/2007/09/a-doctor-without-an-office.html#comment-80302 US Congressman Paul Broun, MD of Georgia had a housecalls only practice. US Congressman Paul Broun, MD of Georgia had a housecalls only practice.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/09/doctor-without-office.html#comment-80296 Anonymous Sat, 22 Sep 2007 18:22:00 +0000 http://clients.emmense.com/kevinmd/2007/09/a-doctor-without-an-office.html#comment-80296 He needs to have a partner to take call for vacations, cme's,or family activity. If there are more patients applying, then get rid of the hypochondriacs and those who require high maintenance. He needs to have a partner to take call for vacations, cme’s,or family activity. If there are more patients applying, then get rid of the hypochondriacs and those who require high maintenance.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/09/doctor-without-office.html#comment-80289 Anonymous Sat, 22 Sep 2007 16:59:00 +0000 http://clients.emmense.com/kevinmd/2007/09/a-doctor-without-an-office.html#comment-80289 It would be interesting to see what he's up to in a year.<br/><br/>It's a not bad idea, but I suspect his business won't end up as originally envisioned. Hopefully the e-consults can include digital images . It would be interesting to see what he’s up to in a year.

It’s a not bad idea, but I suspect his business won’t end up as originally envisioned. Hopefully the e-consults can include digital images .

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