Welcome to the official web site of an Independent Personal Physician, me. I am a primary care physician dedicated to providing the finest, most comprehensive and convenient medical care in the manner of decades past when your family’s doctor was a trusted personal consultant not an insurance bureaucrat.

History

For those of you not old enough to remember what primary medical care used to be like, it was substantially different than what we have today.  As a rule, Doctors did not keep people waiting for hours, did not rush appointments, took care of acutely ill patients at home and generally had much better relationships with their patients. They were truly respected friends of the family. Today doctors have to have relatively large staffs to handle insurance bureaucracy, along with computers, programming, licensing fees and malpractice insurance. The cost of practicing medicine has skyrocketed. The end result is doctors have to see 15 to 20 people daily just to pay the bills, never mind making a living. They are forced into practicing impersonal clinic style medicine. This is what generates most of the complaints people have with modern medical care and the lack of confidence many have in their own physician who was, more than likely, assigned by an insurance company! Why do many prefer to go to the internet for medical advice instead of their own physician?

There are two major compartments to the medical system, primary care and secondary care. They function in entirely different manners. Secondary care is episodic and inherently expensive. As an example, you break your leg. You are referred to an excellent orthopedic surgeon who takes you into a multimillion dollar operating room and performs surgery to repair the break. Eventually your leg heals and you never see that surgeon again. The bill will be in the thousands of dollars. Whether or not that surgeon was a sociable individual or a jerk was probably never an issue.  His or her skill as a surgeon was most definitely the issue. Primary care is longitudinal. We take care of patients over an expanse of time for multiple often unrelated issues. The bill for any individual problem is usually under $100. Our personalities and bedside manner become very significant issues as to the degree of confidence the patient has in our motives and judgment. Under current circumstances a physician can not develop the kind of relationship it takes to manage patients effectively even if he or she is the smartest, nicest person in town. For a $50 office visit he or she has to tolerate the same amount bureaucracy if not more than the surgeon of a $2000 surgery. In my last year of standard practice we spent $300,000 on insurance bureaucracy alone. For every dollar I spent the insurance companies spent a very conservative $2 on their end. That is $900,000 dollars to control one practice that did not gross over $600,000 dollars.  What this means is that we are spending $200 for a $50 office visit, $50 for inferior medical care and $150 for the paperwork.  The concept behind insurance is to protect our financial welfare. Primary care medicine never gets that expensive. So why do we involve insurance companies? All they are doing is making it more expensive at the cost of quality.

How did we get here?

In the early 1960’s, if you had insurance at all, it was of the Major Medical type where the insurer paid up after a given deductible, $250 to $500 being typical. Most of these plans paid for inpatient care only. So, for minor workups and testing that could have easily been done as an outpatient, patients were admitted for lengthy hospital stays so their insurance would foot the bill. This created a false and very expensive economy. In an attempt to control costs and improve access to preventive care the concept of the HMO was developed and over the next 40 years grew to what it is today with multiple variations and subtleties like PPO and POS plans.  The end result is that now we are saddled with the expense of a huge insurance bureaucracy and the overall productivity or efficiency of the system has deteriorated further at the cost of quality. Back in the 1960s the appropriate move would have been to allow outpatient testing and increase deductibles to discourage over hospitalization.  Finally, we are now getting back to a more reasonable approach to health insurance with the growth of high deductible plans and the newly enacted Health Savings Accounts or HSAs.

The Solution: Independent Personal Medical Care

I went to medical school with a vision of being your family’s trusted advisor- the physician who listened to your concerns and treated them appropriately, who showed up at your bedside when you were sick, who gave our children their shots and patched up their cuts and bruises, who personally cared for your terminally-ill loved ones, and who helped guide you through the medical system when the going got tough. Under the Independent Personal Medical Care (IMPC) model, I can once again be that physician.

The IMPC model not only improves quality of care, it dramatically reduces its cost. How you ask, by taking the insurance companies entirely out of the primary care loop. If I don’t have to waste my time meeting their requirements, I can spend it treating you like a person, instead of a number. I can limit my practice to 600 patients, instead of the 3000 I used to care for to cover my overhead. Because I don’t have to support a staff dedicated to complying with insurance rules and regulation, I can offer my services at reasonable rates. I do not charge fee-for-service. I work only on a fixed annual fee. ALL of our services are covered.  Medical decisions will not have monetary considerations. You are NEVER billed for anything other than the annual fee. Expensive comprehensive medical insurance is now unnecessary. You can switch to a cheaper high deductible major medical insurance and take advantage of the newly enacted Health Savings Account to cover the deductible, shelter money from taxation, and build a significant retirement account similar to an IRA. Additional benefits include no co-payments or hidden charges and with most plans you can use any facility or provider without any limitations or insurance headaches.

Dr Stein’s Memos is a place for me to ruminate on current topics in health care. You may be surprised to find my opinions frequently do not jive with current popular thought which is more likely to be based on marketing and myth. In medicine things are not always as they seem.   

Sincerely,

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