P
premedie
Physician, heal thyself
Frustrated by bureaucracy, Carmel Valley doctor runs his office without help
By Nicole Reino
August 15, 2004
CARMEL VALLEY ? Dr. Jim Ochi doesn't have a receptionist.
When patients arrive at his Carmel Valley office, they flip a light switch in the waiting area to tell him they're there.
Medical assistants or nurses? Ochi says he doesn't need them, either. He gets the patients from the waiting room himself and brings them into his small examination room.
"My colleagues think I'm nuts," Ochi said.
In most respects, he's a conventional pediatric ear, nose and throat specialist. He just runs his practice in an unconventional way.
Increasingly restrictive insurance regulations, the push to see more patients and the rising cost of practicing medicine are issues that prompted Ochi to adopt a philosophy he explains this way: "To crank down the volume and make costs go through the floor."
Ochi accomplishes it by doing everything himself. "I change the paper, I put the Etch A Sketch and the Magna Doodle back in the corner and I empty the trash," he said.
Because he has no employees, Ochi uses computer technology to assist him. Parents book their childrens' appointments on the Internet, and Ochi stores all of his medical records on his laptop.
His main office is in Carmel Valley, where he rents a room in a suite, but he spends three half-days a week at an Escondido office that he subleases from Children's Hospital and shares with other doctors. A receptionist who works for Children's Hospital activates a walkie-talkie-like device that vibrates to alert Ochi when patients arrive.
Ochi, who went to medical school at the Mayo Clinic College of Medicine in Minnesota, said when he first went into practice 12 years ago, his was conventional one, with a receptionist and a nurse.
In the early '90s, he said, health care began to change significantly. The onset of managed care took control of pricing away from doctors. Now, Ochi said, the only way doctors can make a profit is to either control costs or to coalesce into large medical groups.
Ochi doesn't want to be part of a medical group. He's convinced, he said, that when doctors get together in large groups, too often they start serving the needs of the group rather than the needs of their patients.
A medical missions trip to Mexico, Ochi said, gave him the idea to simplify his practice.
"When you do a medical missions trip, you are basically boiling down the health-care encounter to its absolute bare minimum, which is what it used to be in this country ? one person talking to another, one person under the care of another," Ochi said.
"I was sitting there during a break thinking, 'This is amazing. Here we are in a room that is not even as nice as my garage, seeing patients who have the same problems as they do back home, seeing patients who have the exact same problems as they do back home, getting the same results.' "
Ochi said the biggest difference was that he got to spend more time with those patients, and they seemed happier. It inspired him to replicate the experience in his own practice.
With the help of technology, Ochi gradually made the changes. He began by using a computer voice-recognition system for all of his transcriptions. Then he began to keep all of his medical records on the computer. About 2 1/2 years ago, he began offering online appointment scheduling.
Because patients fill out their forms before coming into his office, Ochi said, he is able to spend more time with them.
Judy Berlfein brought her 12-year-old son, Misha, to see Ochi recently. Berlfein said she was a little nervous booking the appointment because she had never done that online before. She said she consulted three doctors to make sure Ochi was legitimate.
Not only was she calmed by Ochi's conclusion that her son's lymph node didn't need to be removed, she was impressed with how personal his practice was. "My husband and I came out of there and went, 'Did we just go into some other time zone?' " Berlfein said.
Ochi sees between 45 and 50 patients a week, no more than two patients an hour. He said most doctors see about eight patients an hour.
Doctors typically generate most of their revenue by doing surgery, Ochi said. Doctors who are part of medical groups or who have high operating costs sometimes feel pressure to do more surgery, he said.
Ochi, who does about 10 surgeries a week, said he feels relieved to be free from that pressure.
"Admittedly I'm not bringing in as much, I'm not seeing as many patients, I'm not generating as much revenue," Ochi said. "But then if you look at my output, it's a tiny fraction."
He also is grateful to be free the confinement of a rigid schedule, which leaves him more time to do other things.
Ochi, who did his residency at UCSD Medical Center, is an assistant professor of surgery at UCSD. He gives lectures on how physicians can simplify their practices.
"He's the reason I decided to go into private practice," said Dr. Sherry Franklin, a pediatric endocrinologist in Kearney Mesa. Franklin describes Ochi as "a pioneer for physicians."
Ochi is modest, however.
"I don't think for a moment that I have any special medical expertise that makes me stand out," he said. "But I would say by running my practice this way, it makes people feel ? I think at the very least ? that they've gotten a fair shake."
http://www.signonsandiego.com/uniontrib/20040815/news_m1m15ochi.html
Frustrated by bureaucracy, Carmel Valley doctor runs his office without help
By Nicole Reino
August 15, 2004
CARMEL VALLEY ? Dr. Jim Ochi doesn't have a receptionist.
When patients arrive at his Carmel Valley office, they flip a light switch in the waiting area to tell him they're there.
Medical assistants or nurses? Ochi says he doesn't need them, either. He gets the patients from the waiting room himself and brings them into his small examination room.
"My colleagues think I'm nuts," Ochi said.
In most respects, he's a conventional pediatric ear, nose and throat specialist. He just runs his practice in an unconventional way.
Increasingly restrictive insurance regulations, the push to see more patients and the rising cost of practicing medicine are issues that prompted Ochi to adopt a philosophy he explains this way: "To crank down the volume and make costs go through the floor."
Ochi accomplishes it by doing everything himself. "I change the paper, I put the Etch A Sketch and the Magna Doodle back in the corner and I empty the trash," he said.
Because he has no employees, Ochi uses computer technology to assist him. Parents book their childrens' appointments on the Internet, and Ochi stores all of his medical records on his laptop.
His main office is in Carmel Valley, where he rents a room in a suite, but he spends three half-days a week at an Escondido office that he subleases from Children's Hospital and shares with other doctors. A receptionist who works for Children's Hospital activates a walkie-talkie-like device that vibrates to alert Ochi when patients arrive.
Ochi, who went to medical school at the Mayo Clinic College of Medicine in Minnesota, said when he first went into practice 12 years ago, his was conventional one, with a receptionist and a nurse.
In the early '90s, he said, health care began to change significantly. The onset of managed care took control of pricing away from doctors. Now, Ochi said, the only way doctors can make a profit is to either control costs or to coalesce into large medical groups.
Ochi doesn't want to be part of a medical group. He's convinced, he said, that when doctors get together in large groups, too often they start serving the needs of the group rather than the needs of their patients.
A medical missions trip to Mexico, Ochi said, gave him the idea to simplify his practice.
"When you do a medical missions trip, you are basically boiling down the health-care encounter to its absolute bare minimum, which is what it used to be in this country ? one person talking to another, one person under the care of another," Ochi said.
"I was sitting there during a break thinking, 'This is amazing. Here we are in a room that is not even as nice as my garage, seeing patients who have the same problems as they do back home, seeing patients who have the exact same problems as they do back home, getting the same results.' "
Ochi said the biggest difference was that he got to spend more time with those patients, and they seemed happier. It inspired him to replicate the experience in his own practice.
With the help of technology, Ochi gradually made the changes. He began by using a computer voice-recognition system for all of his transcriptions. Then he began to keep all of his medical records on the computer. About 2 1/2 years ago, he began offering online appointment scheduling.
Because patients fill out their forms before coming into his office, Ochi said, he is able to spend more time with them.
Judy Berlfein brought her 12-year-old son, Misha, to see Ochi recently. Berlfein said she was a little nervous booking the appointment because she had never done that online before. She said she consulted three doctors to make sure Ochi was legitimate.
Not only was she calmed by Ochi's conclusion that her son's lymph node didn't need to be removed, she was impressed with how personal his practice was. "My husband and I came out of there and went, 'Did we just go into some other time zone?' " Berlfein said.
Ochi sees between 45 and 50 patients a week, no more than two patients an hour. He said most doctors see about eight patients an hour.
Doctors typically generate most of their revenue by doing surgery, Ochi said. Doctors who are part of medical groups or who have high operating costs sometimes feel pressure to do more surgery, he said.
Ochi, who does about 10 surgeries a week, said he feels relieved to be free from that pressure.
"Admittedly I'm not bringing in as much, I'm not seeing as many patients, I'm not generating as much revenue," Ochi said. "But then if you look at my output, it's a tiny fraction."
He also is grateful to be free the confinement of a rigid schedule, which leaves him more time to do other things.
Ochi, who did his residency at UCSD Medical Center, is an assistant professor of surgery at UCSD. He gives lectures on how physicians can simplify their practices.
"He's the reason I decided to go into private practice," said Dr. Sherry Franklin, a pediatric endocrinologist in Kearney Mesa. Franklin describes Ochi as "a pioneer for physicians."
Ochi is modest, however.
"I don't think for a moment that I have any special medical expertise that makes me stand out," he said. "But I would say by running my practice this way, it makes people feel ? I think at the very least ? that they've gotten a fair shake."
http://www.signonsandiego.com/uniontrib/20040815/news_m1m15ochi.html
