Family Medicine + Sports Medicine / OMM potential practice options

[KeikoTanaka]

I feel like for a long time now I've always deep down wanted to have my own practice where I can do full-spectrum Family Medicine along with Sports medicine and OMM for patients. But, I talk myself out of it because everyone says the future of primary care is so "Bleak" for physicians and will be over run with NPs and PAs yada-yada-yada.

However, given this new-wave culture of people wanting holistic healthcare, someone who will "listen" to them, and everyone seeking a Chiropractor for every little pain and tweak here and there, I just feel like I am sitting on a Gold Mine of potential where I can be that holistic provider who also offers all those same modalities (and way more) that the Chiropractor or NP down the street can't offer - But because not enough DOs actually do full-spectrum Primary Care in this light, for a variety of reasons - Patient's aren't even aware this is an option. Or, if they know it's an option, there's absolutely no one around that actually does it.

So let's say I go into this full-throttle and I want to follow this path after medical school and offer all these services to patients - I unfortunately don't think this is a model I could feasibly practice and do while being a pawn in a healthcare system where admin are breathing down my neck to see more and more patients in less than 12 minutes.

To do a full medical intake for acute and chronic problems, reconcile medications, and still offer OMM and Sports Medicine modalities during a single session, I would need 20-30 minutes with a patient.

So finally my question is: Is the only way to have a model like work to own my own practice? Would any healthcare system hire a primary care physician and be totally okay with saying okay we'll buy you an X-ray... provide all this overhead for these injections, and OMM tables, etc etc. Obviously even if I opened my own practice these things would take time to get, so how would all this work?

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[VA Hopeful Dr]

So there's a lot to unpack here.

Primary Care isn't bleak by any stretch. Our incomes and the demand for our services have pretty consistently gone up year by year.

What exactly do you mean by "full-spectrum"? Traditionally that means clinic, hospital, OB. Those jobs are out there but very hard to find and almost always very rural.

To find a hospital willing to support this you'll have to prove its financially viable. Basically the OMM part is the harder sell since everything else is done all the time and known to be profitable.

 

[KeikoTanaka]

So there's a lot to unpack here.

Primary Care isn't bleak by any stretch. Our incomes and the demand for our services have pretty consistently gone up year by year.

What exactly do you mean by "full-spectrum"? Traditionally that means clinic, hospital, OB. Those jobs are out there but very hard to find and almost always very rural.

To find a hospital willing to support this you'll have to prove its financially viable. Basically the OMM part is the harder sell since everything else is done all the time and known to be profitable.

Sorry for the wall of text, I didn't mean to give so much to unpack. But here's more wall of text lol:

When I say full-spectrum I don't mean hospital and OB, but, I have spoken to a few Family Physicians who basically are upset that they did all this training for Peds and when they go and work for a healthcare system with an Urgent Care and Pediatrician down the road, you basically become an Internist. So, for me, full-spectrum would imply the whole gambit of offering the things I want: Adult medicine, Pediatrics, Urgent Care style visits for my patients, and Sports med/OMM.

I spoke with a faculty member at my school the other day who just opened up a DPC practice 4 months ago and said she feels like more of a doctor now because she can see Pediatric patients as an actual family unit, while also doubling as an urgent care for her patients. She also offers home visits and unlimited telemedicine visits for her patients who are members. I'm not so interested in the home-visit part, but I do appreciate that this model offers her the choice to do so if that's what she wants to do.

I guess my question really comes down to: If I were to go work for a healthcare system, how can I sway them to allow me to practice in the way I want? Or is this an unrealistic expectation with consolidation and the only way to truly spend 30 minutes with a patient would be to own my own practice.

Because at the end of the day I could spend 30 minutes probably with patients in a healthcare system but because I'm seeing so few patients, theyre gonna be like "Nah we're gonna pay you very little" - Whereas in a private practice this is actually something people will pay me more to do? But even with traditional insurance, I still feel like it's a numbers game whereas in DPC you're gonna actually make more by spending more time with patients because that's what they're spending their money to get, that personal connection with the physician.

And of course there could be varying levels of membership depending on who wants to receive more or less or no OMM at all. Or simply make OMM treatments cost $ per session rather than being part of the membership.

I suppose I'd like to hear from Osteopathic physicians who practice like this and see what kind of set ups they have and what freedoms they have with their set ups and what they wish they did differently/or what they like about their practice environment. It feels to me that the majority of OMM Faculty at my school ONLY do OMM. Which obviously makes for a good OMM faculty/professor, but, for patients, having someone to do all the above just seems like the true vision of what an Osteopathic physician should be.

And BTW the "bleak" statement is more just from out of fear. Yesterday Medscape was full of articles about NP and PA independence and how with the reimbursement parity executive order that Trump passed, I'm weary about what reimbursement will be in the future. I feel like DPC takes that problem out of the equation.

 

[septoplasty]

Sorry for the wall of text, I didn't mean to give so much to unpack. But here's more wall of text lol:

When I say full-spectrum I don't mean hospital and OB, but, I have spoken to a few Family Physicians who basically are upset that they did all this training for Peds and when they go and work for a healthcare system with an Urgent Care and Pediatrician down the road, you basically become an Internist. So, for me, full-spectrum would imply the whole gambit of offering the things I want: Adult medicine, Pediatrics, Urgent Care style visits for my patients, and Sports med/OMM.

I spoke with a faculty member at my school the other day who just opened up a DPC practice 4 months ago and said she feels like more of a doctor now because she can see Pediatric patients as an actual family unit, while also doubling as an urgent care for her patients. She also offers home visits and unlimited telemedicine visits for her patients who are members. I'm not so interested in the home-visit part, but I do appreciate that this model offers her the choice to do so if that's what she wants to do.

I guess my question really comes down to: If I were to go work for a healthcare system, how can I sway them to allow me to practice in the way I want? Or is this an unrealistic expectation with consolidation and the only way to truly spend 30 minutes with a patient would be to own my own practice.

Because at the end of the day I could spend 30 minutes probably with patients in a healthcare system but because I'm seeing so few patients, theyre gonna be like "Nah we're gonna pay you very little" - Whereas in a private practice this is actually something people will pay me more to do? But even with traditional insurance, I still feel like it's a numbers game whereas in DPC you're gonna actually make more by spending more time with patients because that's what they're spending their money to get, that personal connection with the physician.

And of course there could be varying levels of membership depending on who wants to receive more or less or no OMM at all. Or simply make OMM treatments cost $ per session rather than being part of the membership.

I suppose I'd like to hear from Osteopathic physicians who practice like this and see what kind of set ups they have and what freedoms they have with their set ups and what they wish they did differently/or what they like about their practice environment. It feels to me that the majority of OMM Faculty at my school ONLY do OMM. Which obviously makes for a good OMM faculty/professor, but, for patients, having someone to do all the above just seems like the true vision of what an Osteopathic physician should be.

And BTW the "bleak" statement is more just from out of fear. Yesterday Medscape was full of articles about NP and PA independence and how with the reimbursement parity executive order that Trump passed, I'm weary about what reimbursement will be in the future. I feel like DPC takes that problem out of the equation.

1. Swaying a healthcare system is dependent on your potential to generate RVUs. Plain and simple. It might be a harder sell at some places, and as such you'll likely have to transition to where you want to get to. I would see this as the more "difficult" route. In contrast, DPC or private practice. Obvious benefit of the healthcare system is, you have a guaranteed salary, and if you're into debt, this is important.

2. Yes, people will pay you for hollistic care. There's market for it, and its booming, IF you market yourself well. There will always been room for alternative medicine.

3. Go DPC.

4. Why sports medicine? Why not something else like Integrative Medicine? (The reason I ask is, I'm SM trained, service models aren't usually what you would describe).

 

[VA Hopeful Dr]

4. Why sports medicine? Why not something else like Integrative Medicine? (The reason I ask is, I'm SM trained, service models aren't usually what you would describe).

Because most of the doctors I know who go that route end up deep in quackery?

The rest of your post is spot on and I agree

 

[KeikoTanaka]

4. Why sports medicine? Why not something else like Integrative Medicine? (The reason I ask is, I'm SM trained, service models aren't usually what you would describe).

Thank you both for your responses on this.

I think that in terms of Sports Medicine, it is a great fellowship to increase my competency in procedures that are easily done in an outpatient setting. Furthermore, if I were to do a SM fellowship at a DO-friendly residency, that is increased time to work on OMM while simultaneously learning and getting more proficient in sports medicine modalities. And, of course, it's an easy marketing tool to flash that "board certification". I think in a world of evermore present independent NP practice as well, having an additional niche in something is a good way to sway someone to come to my office, even over another physician in the area. Why not go to the person who can do both?

To be honest I'd have to really look more into integrative medicine to even know what that's about.

 

[septoplasty]

Because most of the doctors I know who go that route end up deep in quackery?

The rest of your post is spot on and I agree

I think this is open to interpretation, there is certainly a role for this modality, however I can see your point about going too deep in.
If the OP is attempting to develop a holistic practice, certainly, IMO being knowledgeable about integrative medicine > sports medicine.

 

[Sushirolls]

Keiko,
As a Psychiatrist I routinely advise my patients on first visit/consult to get a PCP if they don't have one. If they express certain aspects of what they are looking for I might be able to guide them on the list of local websites I provide them. The list includes the Big Box shops to the solo to the DPC to the small groups. The dissatisfaction I might hear from patients is the Big Box shop who isn't listening, rushing, difficult phone tree access, or not a good fit, etc. Or I hear that their smaller practice doc is 'odd.' But by far there is greater dissatisfaction amongst those with the Big Box shop wanting a better relationship, less rushed.

Hold off on assuming you'll do SM, and wait until later in your residency before making such a leap. Continue to talk with staff docs, shadow, and pick the experiences of the docs you do rotate with to help shape your desire for what your private practice goals are. Start keeping a journal, write down your ideas, start up costs, cool websites, etc, etc and collect these concept ideas over the next few years. I wouldn't be too worried about the OMM skills, once you open up your own place it'll come back quick like riding a bicycle and you'll start to improve upon your skills - even if they atrophy during residency.

An FM who offers and routinely does OMM in private practice is a niche in itself and can lead to very loyal patients.

Be aware that even if you plan for a practice with XYZ approach, you'll tweak it a year or two in. Might be that you decide to drop medicare and lower paying insurance. Or perhaps drop all insurance and go DPC. You'll learn things once you are underway. Have fun with it.

But with your current stage of training, don't let the dream die, keep adding to your journal of ideas and notes.

 

[Sardonix]

So there's a lot to unpack here.

Primary Care isn't bleak by any stretch. Our incomes and the demand for our services have pretty consistently gone up year by year.

What exactly do you mean by "full-spectrum"? Traditionally that means clinic, hospital, OB. Those jobs are out there but very hard to find and almost always very rural.

To find a hospital willing to support this you'll have to prove its financially viable. Basically the OMM part is the harder sell since everything else is done all the time and known to be profitable.

Look, I dunno how to tell you this, but you might wanna sit down. The surgery gunner bro M2 who spent an afternoon shadowing a notoriously self-absorbed local ENT just told me primary care and any other aspect of medicine that doesn't directly deal with surgery is overrun and dead with midlevels. Sorry to tell you like this. I suppose we should both thank him for his generous insight.

 

[KeikoTanaka]

Keiko,
As a Psychiatrist I routinely advise my patients on first visit/consult to get a PCP if they don't have one. If they express certain aspects of what they are looking for I might be able to guide them on the list of local websites I provide them. The list includes the Big Box shops to the solo to the DPC to the small groups. The dissatisfaction I might hear from patients is the Big Box shop who isn't listening, rushing, difficult phone tree access, or not a good fit, etc. Or I hear that their smaller practice doc is 'odd.' But by far there is greater dissatisfaction amongst those with the Big Box shop wanting a better relationship, less rushed.

Hold off on assuming you'll do SM, and wait until later in your residency before making such a leap. Continue to talk with staff docs, shadow, and pick the experiences of the docs you do rotate with to help shape your desire for what your private practice goals are. Start keeping a journal, write down your ideas, start up costs, cool websites, etc, etc and collect these concept ideas over the next few years. I wouldn't be too worried about the OMM skills, once you open up your own place it'll come back quick like riding a bicycle and you'll start to improve upon your skills - even if they atrophy during residency.

An FM who offers and routinely does OMM in private practice is a niche in itself and can lead to very loyal patients.

Be aware that even if you plan for a practice with XYZ approach, you'll tweak it a year or two in. Might be that you decide to drop medicare and lower paying insurance. Or perhaps drop all insurance and go DPC. You'll learn things once you are underway. Have fun with it.

But with your current stage of training, don't let the dream die, keep adding to your journal of ideas and notes.

Thank you! this was oddly positive for what I've heard on SDN haha. Thank you for your advice, I actually already have a blank journal that could be perfect for such a collage of ideas.

 

[VA Hopeful Dr]

Look, I dunno how to tell you this, but you might wanna sit down. The surgery gunner bro M2 who spent an afternoon shadowing a notoriously self-absorbed local ENT just told me primary care and any other aspect of medicine that doesn't directly deal with surgery is overrun and dead with midlevels. Sorry to tell you like this. I suppose we should both thank him for his generous insight.

His opinion only counts if he can bench 350