Hello,
My dream has been to be a rural family doctor. I am from northern Michigan and would like to live and work up here. The past year I have been shadowing with 5 diff. FP docs and what I've seen is not what I'd expected. Each patient visit is so short there seems to only be time to deal with symptoms and that means adjusting and dishing out meds 90+ percent of the time. There seems to be no time to really look at the patients problems and hardly a chance to discover the CAUSE of the illness.
One of the doctors had been practicing for over 30 years and told me that with the short 15 minute visits the 'art' of healing has been lost.
I would still like to go to D.O. school and be a FP, but are there any ways around this trend or will we lose more and more of the personal side of medicine? Are there doctors forming clinics which address the needs of patients interested in in healing and not just suppressing symptoms? I've heard the Naturopathic doctors are favored in parts of Canada for this reason alone. What is the future of the doctor/patient relationship?

-Sorry for so many questions!!!

-Dan Cote'

unfortunately it's not just FP - it's all fields of medicine. With the industrialization of medicine (which is not going to disappear) art is no longer necessary. communication is necessary inasmuch as a way to prevent lawsuits, but medicine right now is ultimately it about coming down to the bottom line. chances are the FPs are seeing that many patients because they are enrolled in multiple plans that give them crappy reimbursement so in order to 'break even' or even net positive, they have to do more work. it sucks.

there is a way you can do what you want to do - but it may involve you living a life of poverty. you don't HAVE to sign up with HMOs, medicaid and medicare and can be a cash only fee for service. then you can charge what you want (within reason) and spend as much or as little time as you want with a patient. you have to be willing to be the best doctor you want to be, and sometimes that doesn't parallel making money.

maybe i'm just being cynical.

do you think he regreted that at first? i mean i was thinking maybe start out taking many hmo's and slowly wean out the ones with the lowest reimbursement and then eventually maybe all hmos. any thoughts? i mean you would be building up your practice and when you reached the numbers quit taking hmo's. but, this also seems very unfair to your pts too! ???

so let me get this straight. he takes ppo's but its up to the patient to file and do the paperwork. so essentially he doesnt take a copay..he takes the entire amount and the pt gets the money from his/her ins co. ??

thanks for the info...its nice to hear that that kind of practice does make it!

if you start your own practice for the ground up, it's not atypical to not make any money the first few years -- you have to establish a patient base, and most doctors aren't trained well in practice management coming out of residency so you have to learn the coding, billing forms, etc. making 50k (if that's net) is possibly not bad depending on how much overhead there is. it's nice to hear how well your friend has done since then.

in terms of dr. smurf's question regarding PPOs - it's not uncommon to have the patient submit their own claims. they'll get reimbursed according to the terms of the PPO - for example, if it's an in network person, they'll get reimbursed full. if it's out of network, then they'll likely get reimbursed 70 or 80% until they meet their deductible.

in terms of building your practice and then dropping plans -- it actually puts everyone in an awkward predicament. on the one hand, they may wish to continue with you as their physician, however, if they are paying for insurance (employer) and can't afford your rates then you lose that patient and everyone else under their plan. I knew one physician that was taking HMOs for a while, got tired of it all, and then dropped every single one of them. a few patients stayed because they could afford him, but he ended up losing a lot of business and almost had to start from the ground up again and this was a practice that had been around for 10 or 15 years. it's almost better not to make bedfellow's with the plans since it really doesn't seem to help you much. building up a successful practice is a matter of providing niche services and great advertising.