Young doctors are often progressive thinkers who like to support small businesses, buy locally grown produce from food shares, shop from individual merchants on Etsy, and never be seen in any chain store larger than Trader Joe’s. It seems every industry is recognizing the benefits of the personal service of a small business.
Decades ago, the majority of physicians owned their own small practice, and had patient satisfaction and personal satisfaction much higher than what is found in today’s large systems. Numerous studies have shown the benefit of the personalized care realized in a small practice. The large systems are pushing the “team” and “care coordination” concepts, as a means to achieve the “medical home” feel that naturally exists in small practices. Yet today, physicians take jobs with the big boys; in Denver this means Kaiser, Denver Health, MCPN, Salud, and Clinica. Hardly anyone is opening their own practice anymore. Why?
Some say they didn’t go to med school to be a bill collector, others say they enjoy the freedom of being an employee (ironic). Overall, it is a culture shift, from times when most doctors hung their own shingle, to a time when most go work for the man. Dentists aren’t the same: It seems a fair number of dental students graduate with intent to buy their own practice, or buy into a closing one.
I am not sure of the reason, but I think this is a tragedy. I have worked in the large systems, and I have run my own practice for a couple years, and I can confirm that it is much more fulfilling, financially rewarding, and flexible to run your own business. No Tuesday afternoon committee meeting just to move a stapler; if I want to create a yoga or nutrition program, I find the pieces and make it happen. And the patients love it, when they can call, text, or email and get a quick response from their provider; when they can walk in and not have to overcome multiple lines of staff defense (receptionist, vitals, MA, check out); or when they know that they can count on us to go well beyond what might happen in a crammed 8 minute appointment elsewhere.
I once saw a picture of a stack of Russian VHS tapes, on top of a fire extinguisher case, in the hallway of an apartment block on Denver’s southeast side. Those few blocks are Denver’s little Soviet Union, full of early 1990s refugees from all corners of the USSR. I found myself waiting there last Thursday at 7 a.m. while doing a home visit before heading to my office. The elderly patient’s grown son had requested that I visit, and while I don’t think I did too much while there — listened to lungs, watched her walk — I know the patient and family appreciated it tremendously.
Is this type of service lost in medicine? I know that if I was an employee at MCPN, I would never feel emotionally attached enough to make such a trip. Instead, I would rush through return calls at the end of the day, and maybe get to this phone call within the week if lucky.
I have met with a number of policymakers in Colorado’s health care scene recently, and I am getting tired of hearing “well maybe you are different than the others, and all doctors can’t be like you.”
But they can. They used to be. The art has been lost. I challenge other providers working in large systems to take the step. I was inspired by the IMP movement, a group of practices that vary widely in format, except that all keep the small practice concept, and the better outcomes that come with it. I offer to any provider, anywhere, to come take a look at my methods if curious, and I think most IMPs out there would make the same offer.
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