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In the past several years, more and more people have acknowledged that our current health care system is broken. Many doctors feel hurried, and patients don't appreciate being rushed through their visits. Is there a way to step off the hamster treadmill and still continue to deliver medical care? We hear from two doctors who have done so in very different ways.
Guests: Pamela Wible, MD, is a board-certified physician and nationally recognized innovator in patient-centered care. She pioneered the community-designed ideal medical practice in Oregon in which patients design their own clinics. Dr. Wible co-authored Goddess-Shift: Women leading for a Change, with Michelle Obama and Oprah Winfrey. The photo is of Dr. Wible.
Steven Fugaro, MD, is a partner in MD2 in San Francisco, a retainer medical practice.
The podcast of this program will be available the Monday after the broadcast date. Podcasts can be downloaded for free for six weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.
Did you enjoy this radio show? Average rating: 4.1/5 (38 votes)
What do you think? Click the stars to vote!
If you have more to say, post a comment below!
Who deals with Medicare, Insurance etc.????? This service is provided by doctors offices now. Does the pt. have to do it? Thanks P.Knight
Wonderful examples for patient and doc - as patient, have felt as cattle.
Want to move to Eugene Ore or San Fran !
Thank you; let's spread the word to country.
Your doctor guest from San Francisco who operates a "retainer-style" medical practice should be at least a little apologetic that he is only serving the rich, those who can pay a retainer of over $10,000 per person per year (He would not divulge the actual amount because he is obviously embarrassed about it). When he would not divulge the actual amount of the retainer is when I turned off your program this morning.
He is yet another example of the dissolution of American society. The rich get the best of everything and live in an affluent bubble, the middle (I am a school teacher) get squeezed and struggle to pay for health care, college, home mortgages... and the poor have poor services, poor health care and suffer with joblessness, poor health, poor educational opportunities.
We are in another gilded age and I mourn our loss of a strong social contract and the "rewarding feeling" that being a part of something larger can give us. Instead the doctor gets his "rewarding feeling" on an affluent island in a widening ocean of want. He is a hypocrite and you should have called him on it.
I listened intently to this program - this approach to health care is along the lines of what we tried to do at SAS. Where I practice now is a small Pediatric office that is grounded in community relationships. But I lament feeling like I have not earned my keep on the days I see only 11-12 children, regardless of the number or complexity of issues. What the speakers did not address is how they stay focused on the person they are with and also answer the phone.
Perhaps 1/4 of the children I see are on Medicaid. So someone has to be sure we have the documentation to justify a claim, and file the claim, track the receipts. I find that a nurse working with me is invaluable, to gather the vitals, do the in office labs, review administer and document immunizations, handle some of the phone calls.... I heartily agree with the question you asked, that if every provider limits their practice, how will there be enough providers to go around? And who will care for the under-insured and uninsured, who comprise a large group in my community?
Very interesting program, with more questions than answers
What a set of fairy tales! I listen to your program regularly and enjoy it but the two doctors on this program are from another planet. One barters for her services, which is illegal in most places, especially if she does not report it to the IRS. She charges $50 to uninsured patients. I practice in Mississippi where 40% of patients are under-insured or have no insurance. If I get $3.00 I am lucky. We have the fewest number of doctors per capita of any state. A doctor here cannot see 10 patients a day and serve the community.
We have to deal with Medicare rules and regulations and with insurance companies that look for every reason to withhold payment or to delay payment. CMS has withheld payment to us 3 times this year. CMS has even denied payment to us until we prove that what we did was within their guidelines. The last time I read the Constitution this was denial of due process of law.
We have HMOs that have signed up Medicare patients by misinforming them of the coverage. I have seen patients who could not write that were signed up for a Medicare HMO and did not even know they had signed. Their names had been forged and the deductible they were going to have to pay was $10,000.00 before the insurance company paid.
These patients for the most part were living well below the poverty level and many could not understand the contracts if they were able to read in the first place. The particular insurance company that did this was located in Kentucky. The patients were residents of Alabama and Mississippi. I wrote the 6 Senators of these three states and not a single one answered. The federal D.A.'s office would not investigate because the complaint did not come from the patients.
We have 20 employees for 5 doctors because we cannot get the work done otherwise and we certainly would not have time to file all of the insurance, type the records to suit CMS and private insurance, administer meds, schedule follow up visits and run the blood tests. I would like to see how Dr. Wible handled all of this outside of LaLa land.
As for doctor Hicks; he lived in a time when he gave everyone a penicillin shot. Now we have to be aware of far more resistant infections. Tests have become more numerous an complex. We would be sued for malpractice if we practiced like Dr. Hicks nowadays.
In Mississippi, at least, there is not a glut of general practitioners or of any specialty. Dermatologists are limiting their patients because they cannot see all of the ones they already have.
What a luxury it would be to be able to be paid by every patient I see! If I lived in planet Oregon or planet California I guess I could do so, but not here or most of the real world.
You have presented two exceptional situations that cannot possibly work outside of the wealthiest areas of this country.
I am having that kind of trouble, getting a straight answer I feel like I am on a game show with a timer ticking when I go to my 18 doctors, I have to explain what I feel like because of because of a Non-Hodgkins-Lymphoma, Chemo taking certain medicines the fact that I could have ONJ from taking Fosamax while having Chem I feel like I am having to diagnose myself constantly then the doctor suggests I am depressed. They are all doctors in same Medical Group all CAT scans are sent to all of them. Yes I am depressed, I'm poor have fibromyalga, have symptoms and no one hears me.
Still have an access port inside my chest b/c Lymphoma is suppose to return Ahhhh !! Boy I sure would like to have Dr. Marcus Welby to talk to. Boy 777 Community Medicine here in Wisconsin or Minnesota. What a wonderful concept.
Sincerely, Marlene
On that assembly line doctor treatment line... with no answers!!!
For me, Joe's comments about his doctor making house calls brought back childhood memories of when Dr. Adams, our family doctor, made house calls with his little black doctor's bag which always contained just what was needed.
While Dr. Wible's style of practice is not new or unique, as she noted, the way Dr. Wible involved her community of future patients in setting up her practice was interesting to hear about.
Having been involved in the medical/health care field for well over 40 years, including being involved with the inception of Medicare and sophisticated computer software that made complex insurance billing possible, I am afraid that with the coming health care changes, practices such as Dr. Wible's will be limited to only a few, and that the so-called factory approach will be the norm for the masses.
As for Dr. Fugaro's “retainer” practice, it is a good model for some which is enjoying success in some parts of the country. While there always has been concierge medicine, and certainly always will be available to those willing and able to pay, it will be interesting to see how the retainer model fares when upcoming mandates start to take effect.
Also, when looking at these important delivery models, we need to keep in mind the catastrophic component of medicine, but that is for another post.
This was one of the best radio shows you've ever had. And what an idea! Physicians taking care of patients like it should be... like it used to be. Taking an interest in the individual, instead of the physician having to be told what to do and how to do by a certain hospital or the insurance companies.
I am also finding that now that I'm on Medicare the time my doctor spends with me has been cut shorter and my wait for them to see me is much longer. I've waited an hour to see the doctor and he/she is with me maybe five minutes. It's not right!
Keep up the interesting programs. I listen to you every Sunday and receive your newsletters. I love your program!
Pam
I have to say that interviewing the doctor who charged 10k-30k above and behond insurance cost to the patient was disquieting for me. I expected a more people friendly topic from peoplespharmacy.com Do I really need to be reminded that you can buy very custom care with lodes of money? The rich don't need peoplespharmacy.com thought they should listen to it. We who squeak by do need peoplespharmacy.com because its smart and affordable advice.
I listened with interest to Dr. Wible's recent broadcast concerning her practice model that she established in Oregon.While it sounds idilic and there are many good suggestions that are offered, I am at a loss as how some of the practical matters of running a medical office are handled.
As a manager of a group of Family Physicians, I don't understand how Dr Wible can answer phones ,see patients for an average 30-60 minute appointment, co-ordinate care with other physicians, seek drug authorizations from insurance companies, offer same day appointments snd all while being available 24 hours a day seven days a week to answer phone all phone calls. All, while employing no staff.
How many patients can one serve with this type of model? If you are the only physician in town, do you just quit offering appointments after the 10 you have open a day are used up? Do you only serve a patient population in the low hundreds? Do you ever get a vacation or a night on the town without your pager?
With this type of model we better start attracting a lot more physicians to primary care but I can't really see the attraction unless you're Mother Theresa.
One of the most self aggrandizing interview ever.
Your guest was comparing her office to the 'other' place.
She said that in her office she answers the phone & spends 60 mins with each patient. Should you not be asking who mans the phone then? I am skeptical.
I thought it was interesting that none of the physicians gave as a possible way to increase the patient doctor relationship could be that they just make less money. See fewer patients and thus spend more time with them. The reason its a factory system is because its a profit maximizing system driven to make as much money as possible for ALL involved. You cant just blame the insurance companies.
The hurried pace is driven mainly by the doctor's need to make as much money as possible. I noticed the guest you had on talking about a retainer based system certainly makes patients pay absolutely through the nose. I would guess most of his patients aren't simply upper middle class but truly wealthy people.
I am sure this San Fransisco super doctor would not be happy with the income level of the old fashioned country doctor whose virtues you seemed to extol.
That's whats wrong with our medical system.
Your program always starts my Sunday and today’s was priceless. It’s not often that a window to the world of plutocracy is opened to the airways and this time, a window from Eugene and a window from Frisco.
When I wasn’t shouting “BS!” (code) to my coffee cup, I was wondering how these fresh medical practice trials would play in Oakland or Brooklyn. I’ve seen video of free clinic sessions around the Carolinas drawing thousands too poor to get any treatment thru normal channels. (Couldn’t they just skip those trips to Starbucks every day?)
Logging on to read program comments I’m relieved to find others writing better than I about our nation’s health swindle… a near perfect system designed to insure that docs, hospitals, insurers, and yes, pharmacists and drug mfgs get paid. Oh, and then dispense a little health care.
So it’s important to hear what they (them in Eugene and SF), think up there at the top. It shows what a tough climb is ahead if true health care reform is ever to be achieved.
What nonsense and what waste of radio time to try and peddle this!
I bill insurance for my patients through a free online clearinghouse.
I accept most insurance, but no longer accept Medicare though I
continue to care for my Medicare patients. I never turn anyone
away for lack of money. ~ Dr. Pamela Wible
Hi Gale ~
I believe that doctors need to be happy for our health-care system to be sustainable. Currently (depending on the study) 50-60% of docs want to quit. I never suggest all docs have a practice like mine, but I do suggest all docs live their dreams. And some docs need staff to have the type of practice that works for them. I am simply a role model demonstrating what works for me and my community. Doctors deserve to be happy. Happy doctors = happy patients = happy health-care system.
The Physicians Foundation Study (2008) revealed that 65% of physicians lose money every time they see a Medicaid patient. This is unsustainable. If our practices are unsustainable we can't care for anyone. I do not chose to participate with insurance companies that make it impossible for me to function as a physician or stay in business though I never turn patients away for lack of money.
I will not see higher volume than is safe. Empathy burnout occurs in primary care after 10-12 patients which means that many docs are "tuning out" 2/3 of their patients. This is not health care.
Currently only 2% of graduating med students will pursue general internal medicine. I believe many do not chose to pursue primary care because of unsustainable workloads, lack of positive role models, dysfunctional health-care system. If physicians all worked humane schedules in practices that were in alignment with their values, the values of their community, we would start to build the type of health-care system that would attract more physicians into primary care (3 of my patients in my first year of practice told me they plan to pursue family medicine as a career after being exposed to my practice). We could keep the 60% of docs who want to quit. Retired docs would return and young docs raising kids could continue to practice with humane working conditions that allow them to have a life.
Gale, please email me as I know I've only touched the surface. I am happy to answer all your questions.
idealmedicalpractice.org
Pamela Wible MD
I am happy to answer all your concerns by email. There is a map on my website of hundreds of physicians across the country running similar practices. I have previously been accused of practicing "Alice-in-Wonderland" medicine by docs who are in disbelief about community-designed ideal practices. These practices are highly functional and have been replicated in large cities and small towns across America. It is my hope to inspire other physicians to think out of the box and liberate themselves, live their dreams.
Pamela Wible, MD
I often refer to our practice as "VIP without the fee." I offer boutique
or concierge care to everyone regardless of ability to pay.
Regarding doctors and money I would like to point out that many
primary care docs make less than plumbers. I know several who
would earn more, and work less hours if they went into waitressing.
But these docs continue to devote themselves to their patients often
at their own expense.
I am happy to answer any other questions. Contact me through my
website. Thank you.
Pamela Wible MD
I've streamlined my practice in several ways so that my admin burden is low and my patients take on more responsibility than in standard practices. For example 30% of calls/faxes to standard office are for refill requests. I only fill Rxs during visits and I give up to 1 year supply whenever possible. BIG decrease in workload with this one office policy. I do not contract with abusive insurance companies. BIG relief. I train patients to be self-reliant. I treat them like adults as find they are more capable in self-management than we would have expected. Appointments may be made online or by email. Huge timesaver and requires less staff. I work very part time and have 500 patients. This model works well for me and were I working full-tile with 1000-1500 patients I would likely have a staff person. My admin office is at home so I never have faxes and phones ringing during office visits with patients whom I see in a small office space I rent at a wellness center 2 miles away from my home. Main message: Think creatively, be happy, access ones dreams. Medicine is a wonderful profession. Please email me and I'm happy to answer any other questions through my website. Thank you. Pamela Wible MD