A confluence of events has occurred in the United States that could help to save the lives of many patients as well as the lives and careers of many physicians. The solution is to apply the use of micropractices to address the current opioid addiction crisis. A micropractice is a small medical practice that is run efficiently to keep overhead low and put the patient first. The patient is given more time and attention than is traditionally given in a big box, assembly line clinic. Barriers between doctor and patient are removed. A micropractice may simply be one doctor working in a single room. The size of the patient panel is kept small so that each patient has access to the doctor and is treated like a human being, not a number. Micropractices also address the needs of doctors to have healthy, non-abusive workplaces. Micropractices also happen to be ideal settings for patients who need treatment for opioid dependence and addiction.
In 2001, CNN published an article documenting that doctors were being sued and disciplined for under-treating pain. Around the same time, certain pharmaceutical companies were heavily marketing the use of powerful opioid analgesics for treating pain. We, as physicians, were afraid of getting in trouble for ignoring patients in pain. We believed that we had an obligation to prescribe opioids to patients in pain to stop their suffering and improve their quality of life. Over the next decade, we learned that liberal prescribing of opioids for non-malignant chronic pain contributed to an increase in opioid dependence, addiction, and overdose death.
New guidelines have recently come from the CDC on how to address pain and how to responsibly prescribe opioids. Unfortunately, there has been some fallout, causing a new crisis among opioid dependent and addicted patients. As doctors and pharmacies have become increasingly reluctant to prescribe and dispense opioids, patients who are dependent and especially those who have become addicted have found themselves unable to obtain their drug of choice. Many have turned to the streets. They soon discover that the prescription pills are very expensive on the black market. Many addicts turn to heroin. As a result, overdose deaths continue to increase.
The Surgeon General has urged physicians to do their part in fighting the opioid epidemic. First, we can prescribe fewer opioids. We can do everything possible before prescribing opioids for pain. When we find that we need to prescribe opioids, we can observe new guidelines and recommended limits. Second, we can take an eight-hour course required to apply for a waiver to prescribe buprenorphine under the Drug Addiction Treatment Act of 2000. This waiver allows us to prescribe medications such as Suboxone to opioid dependent patients to minimize withdrawal discomfort and prevent cravings and relapse. Preventing relapse is most important because relapsing on opioids compared to other drugs has a high risk of overdose death.
During the past 10 to 15 years, as the opioid crisis appeared and spiraled out of control, our nation’s doctors were having a crisis of their own. Increasing government regulation, Poorly designed EMRs, insurance industry intrusion into health care and abusive workplaces have all contributed to poor physical and emotional health of our health care providers. Doctors are committing suicide. Doctors are crashing their cars due to lack of sleep. Talented, compassionate and caring doctors are leaving the medical field. We are now facing a physician shortage that will only get worse.
One answer to the health care crisis is to encourage doctors to “drop out of the system.” Doctors can be educated to leave abusive hospitals, big box clinics, and insurance companies behind and open micropractices. A micropractice takes away the barriers placed between physician and patient. It allows for better patient care and better physician career satisfaction. It keeps doctors healthy, alive and happy.
What business model can help a doctor to make this transition to a micropractice? How do they pay the bills and keep the doors open? Here is where the opportunity comes in to save lives and make a difference in the current opioid crisis. Accepting patients for the treatment of opioid dependence and addiction in a micropractice makes perfect sense. The big box clinic doctors do not have the time and flexibility to care for patients who are fighting addiction. These patients need more time and attention. A micropractice doctor is ideally suited to help patients addicted to opioids recover from addiction. These patients need a doctor who will spend time with them and answer their phone calls. The last thing they need is the bureaucracy of an assembly line clinic. An army of gatekeepers is not going to help an addict get clean.
If you are an unhappy doctor working in an abusive workplace, consider dropping out and saving yourself. We need you. Please don’t leave the profession. Please take care of your health and sanity. There are many areas of the U.S. that do not have enough physicians to treat opioid-addicted patients. You do not need to work for an employer. All you need is the basic medical equipment you can fit in a house call bag and a room to work in.
This is the answer to the question asked by many doctors when they first learn about the concept of a micropractice. How is it possible to walk away from employment and go into business in a macro practice? You can start by taking the eight hour course to learn about how to treat patients who are dependent and addicted to opioids. I recommend a live course where you can ask questions and have discussions with the instructors. I hope that more doctors will follow this path. Together, we can save lives and save our own lives.
Mark Leeds is a family physician and can be reached at his self-titled site, DrLeeds.com.
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