I can’t speak for other physicians but I did not go to medical school to become a businessman. Business is a battle between economic forces. While it is true that doctor’s battle disease they should not be battling patients, insurance companies, the government, and the legal system ad nauseum. Quality medical care, primary care in particular, should ideally be devoid of all business considerations. Fee for service care is an unfortunate evil in secondary medicine but primary medicine can be practiced entirely by a fixed annual fee to the advantage of all parties.

From the primary care physician’s point of view the annual fee system simplifies billing to the point that it can be handled by a PC with any standard commercial billing program. Arrangements can be made with banks and credit card companies for automatic transfers which are becoming increasingly popular with consumers. The physician’s overhead drops dramatically allowing him to keep the cost of care reasonable. Most importantly when the physician is dealing with medical issues his own financial considerations are entirely out of the picture as money is no longer tied to individual services. This dramatically improves the relationship between patient and doctor.  My motives are no longer questioned and I can perform at a level that previously would not have been possible.  As an example, I recently got a young couple with four children to stop smoking. The father smoked 2 packs per day for 20 years. His wife smoked one pack per day. Together they were spending over $3000 per year on cigarettes not to mention the health risks and the effect on their children. The father having an underling anxiety disorder was particularly difficult to get away from the cigs and the mother could not hang on with the father continuing to smoke. I saw them every two weeks and spent hours counseling them until the job was done. Regular insurance would never have paid for this.  Fee for service would have been very expensive, indeed more so than my annual fee for this family and my motives may have been questioned. But these people knew that the only reason I was seeing them so frequently was because I truly cared and in the end that may have been the single most important factor in getting them to stop.

From the patient’s perspective this type of practice offers a stunning improvement in convenience and quality at a very reasonable price.  In a recent survey a marketing firm did for my practice my patients were asked if they felt the annual fee was a “good value.” 98.7% answered “definitely.” As the physician is not under economic pressure to maintain large panels and overbook, practice size is strictly limited. Waiting room time is usually just a few minutes. Appointments are never hurried. Same day appointments for urgencies are always practical and special services such as house calls become feasible. I don’t even have an answering service anymore. My patients have my cell phone number! When they have a problem they get me directly! No delays, and no covering physicians unless I’m out of town on vacation. Consequently, my patients are far less likely to wind up in emergency rooms with relatively trivial problems that could have been managed at my office. If they injure themselves on a weekend I meet them at the office and take care of it. No sitting in an ER waiting room for hours not to mention the cost savings!  For my patients their primary care becomes a very reasonable FIXED expense. I get to be a real doc again instead of the insurance bureaucrat businessman our current healthcare system demands.

8/21/06

Dr Mike

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