Many years ago, three doctors formed an internal medicine practice and were proud of the thousands of patients they accumulated.
They were fine physicians and very dedicated to the masses who walked through their clinic doors. They saw patients in the office, rounded at two hospitals, and visited a number of nursing homes. This was truly a full-service practice.
Around 2005, Dr. A was starting to fatigue. He was well into his sixties and did not like the direction medicine was going. The hours were too strenuous, the documentation requirements were getting increasingly complicated, and he saw the writing on the wall. Regulation was coming, and the results would be devastating. So he decided to retire.
Luckily, Dr. A’s patients (around 5,000 at the time) could be seen by the two younger physicians in the practice (Dr. B and Dr. C) after he left. They both, by now, had thousands of patients of their own, but were happy for the extra work. A final retirement date was set, and Dr. A officially left the practice in 2006.
Unfortunately, without Dr. A’s influence, Dr. B and Dr. C had a series of disagreements and decided to break off the relationship. Half the practices ten thousand patients stayed with Dr. B, while the other half moved locations to join with Dr. C.
Dr. B needed extra help handling all those patients and hired Dr. D. Dr. C needed extra help handling all those patients and in 2007 hired Dr. E. Both practices thrived. Their client rosters swelled even as they faced the continuing assault of governmental regulation. Thousands of dollars were spent acquiring and utilizing electronic medical records. Countless hours were wasted filling out forms and on administrative phone calls.
Around 2013 Dr. E realized that he was spending more and more time on paperwork, and less and less time on patient care. His patients were upset, his personal life was suffering, and most importantly, he was no longer proud of the quality of medicine he was practicing.
So in 2013, Dr. E made a momentous decision. He left his 2,500 patient practice and started a home-based concierge model consisting of only 100 of his former patients. The rest stayed with Dr. C. Dr. E also continued to do nursing home work taking care of other physicians patients, as well as started an administrative role with a local hospice. And he thrived.
Dr. C continued to manage his own patients as well as all those extra that were no longer under Dr. E. But by 2015 he was having trouble maintaining a reasonable lifestyle, and his economic fortunes had worsened. Feeling forced, Dr. C also converted his practice to a concierge model and his patient panel shrunk from over 5000 to less than 500. And he thrived.
Now we must not forget Dr. B and D. They made a successful run at private practice and hired various other physicians and nurse practitioners over the years. The ranks of their patient population swelled. By 2015, however, they began to feel the futility of the current medical system. Thus Dr. B and Dr. D also eventually went concierge, and limited their practices to 500 patients each. And they thrived.
So if we do the math:
Dr. A had 5,000 patients and retired. He no longer is involved with patient care.
Dr. B moved to a concierge practice and narrowed his patient population from 5,000 to 500.
Dr. C moved to a concierge practice and narrowed his patient population from 5,000 to 500.
Dr. D moved to a concierge practice and narrowed his patient population from 2,500 to 500.
Dr. E moved to a home-based concierge practice and narrowed his patient population from 2,500 to 100.
Now before you get in a huff, of course, there is some overlap here.
Most of the abandoned patients joined the prominent medical group in the area and still have doctors, though often have to wait months for simple appointments. Many of them barely know their physicians and are seen by nurse practitioners. None of them have the benefit of having their own doctors in the hospital or nursing home.
You might think I am being hyperbolic.
You might think this story is an exaggeration or fairy tale.
But I’m here to tell you it’s not. I know.
Because I am Dr. E.
Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of Five Moments: Short Works of Fiction and I Am Your Doctor: and This Is My Humble Opinion.
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