Technology empowered direct pay primary care

by Anar Mikailov

By now it is common knowledge that primary care is an undesirable field for newly graduating medical students.

Additionally, many current primary care physicians are closing shop and either enter early retirement or seek non-clinical professions. According to the American Academy of Family Physicians, the 2010 Residency Match showed that 1,184 U.S. medical grads chose Family Medicine, less than half of the available positions (aafp.org Match 2010). As the down falls of practicing family medicine continue to mount (e.g. low salary, minimum time per patient, significant paperwork and insurance headaches), residencies in this field become less desirable. Given the lack of medical student demand for primary care careers, I would like to discuss a tangible alternative for practicing primary care: a direct-pay practice utilizing web based technology.

About three years ago I learned of a primary care physician who implemented such practice. Dr. Jay Parkinson had just completed his residency, moved to Brooklyn, New York and realized that one – many of his friends did not have health insurance and two – he did not want to start or join yet another typical practice that most of us visit. So he took an innovative approach by creating a direct-pay clinic managed entirely by web-based technology. In doing so, Dr. Parkinson obviated the need for administrator staff and nurses, ended waiting lines and said goodbye to insurance. More importantly, the patients received dedicated doctor face time, web scheduling, email access, video chat access and a PHR – all on a sleek web portal. Since 2007, the HelloHealth based direct-pay model has been adopted by hundreds of doctors across the country.

In June of this year I met with the first doctor in Philadelphia to implement HelloHealth – Bruce Hopper Jr. MD. He was a physician on the hamster wheel, churning through over 40 patients a day while seeing his annual income decline and burn out set in. Instead of abandoning medicine, he adopted the HelloHealth direct-pay model. Since June I have worked closely with Dr. Hopper learning the ins and outs of his practice and I will continue my work as I begin my clinical rotation with him. The following describes just a few aspects of a HelloHealth managed direct-pay practice.

The office staff includes only a doctor; there are no nurses or administrators, as all organizational aspects of the practice are managed via HelloHealth Portal. Additionally, all scheduling, billing, and medical information also resides on the remotely hosted, HIPAA certified HelloHealth servers. Patients sign up for HelloHealth online, and then add Dr. Hopper as their doctor. As an official member, patients can set up in-person appointments, video chat appointments, send email, and instant message with Dr. Hopper. In addition, all patient medical records (labs, medicines, diagnoses, imaging) are easily accessible, printable and syncable with other PHR (Personal Health Record) providers like GoogleHealth. The HelloHealth practice management portal is intuitive, very web 2.0, and the way medical management should be in 2010. With decreased overhead burdens and flexibility of this model, it is not uncommon to find Dr. Hopper making house or office visits and managing follow-ups by video or email. More importantly the new model allows Dr. Hopper to continue his passion for modern medicine and building meaningful patient relationships.

The big question for many medical students is what the expected annual income is for a doctor who adopts such model.  Based on Bureau of Labor 2009 Statistics, the median wage for a Family Physician was $160,530; based on modest cost and revenue figures, income for a direct-pay model will be at least double that amount.

Instead of waiting for medical reform legislation or other top down intervention the direct-pay practice is a grassroots alternative ready for adoption. And to any medical student that brushed off primary care, I suggest to please reconsider. Our country needs a new wave of medical students interested in front-line positions – and I strongly believe the technology empowered direct-pay approach is a major leap in that direction.

Disclaimer – I am not affiliated with or sponsored by any person or company mentioned.

Anar Mikailov is a medical student and blogs at his self-titled site, Anar Mikailov.

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