September 2002 • Volume 8 • Number 9 |
Back in the "glory days" of family medicine -- the 1970s -- Michael Worzniak, M.D., of Ann Arbor, Mich., often worked 18-hour days and was on call most weekends in his solo family practice. The schedule was grueling, but the payoff was great: He came to regard his patients as friends and vice versa, he told a lecture audience Aug. 2 at the National Conference of Family Practice Residents and Medical Students in Kansas City, Mo.
FP Susan Jurasek, M.D., of Lincoln Park, Mich., presented herself as the next generation of FPs to attendees at the lecture, titled "Family Physicians in the New Millennium."
In an effort to regain balance in their lives, an increasing number of physicians of Jurasek's generation are refusing to work extended days, carry a pager every weekend, visit inpatients or make house calls, she said. However, the result is an interruption in continuity of care and a breakdown in the doctor-patient relationship, said Jurasek.
Some of these physicians may have self-imposed limits on the scope of their practices during their child-bearing years, intending to resume services such as maternity care later in their careers. The problem with that, said Jurasek, is that skills not used regularly are soon lost.
| The idea is to take advantage of the low overhead afforded by practicing outside an office. |
Margit Chadwell, M.D., of Grosse Pointe Park, Mich., stood by nodding knowingly. She then took the podium to represent the generation of the future and presented a new model for practice, dubbed the "circle of care" model, that makes it easier for physicians to attain the hoped-for balance in their lives. Practices incorporating this design make use of job sharing and mixing part-time and full-time physicians.
The lecture was aimed at students and residents who may be coming to grips with what their careers will look like. However, it had significance for practicing physicians as well. It also offered a sneak preview of Worzniak's and Chadwell's article on the circle of care model in the September Family Practice Management at http://www.aafp.org/fpm/20020900/ .
The idea is to take advantage of the low overhead afforded by practicing outside an office, said Chadwell. A physician has no overhead at all when he or she walks into a hospital or nursing home. A practice that sees patients only in the office spends 60 percent of its income on overhead, while a circle of care practice can reduce its overhead because it won't need as many exam rooms or support staff, Jurasek contended.
In fact, practices that successfully embrace the circle of care model are more profitable than office-limited practices, the lecturers told their audience.
Those in attendance were receptive to the idea. "It's really exciting to hear this. We've struggled with these issues in my practice," said FP Erik Gundersen, M.D., who has a practice in Onalaska, Wis. While he saw potential for the model, he also saw one drawback: "Doctors want that 9-to-5 (schedule)."
Chadwell presented three practice versions that incorporate the circle of care model. They use varying numbers of part- and full-time physicians, but the concept remains the same: While one or more physicians are staffing the office, another physician is in the field visiting that practice's patients in nursing homes, at hospitals or on home visits. The physician in the field rotates regularly to practice in the office. Ideally, more than half of the income is generated outside of the office, said Jurasek.
"This model is more profitable because office-based visits generate the least income," said Chadwell. "Fixed overhead (costs) shift to 47 percent for the low-range model and 40 percent for the high-range model."
"I sound like an economist, not a doctor," she then quipped.
"But it's important," Worzniak replied.
"There is a misunderstanding about how to generate revenue," he said. "Physicians don't always understand the economics of it."
FP Report is published by the
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Copyright © 2002 by
American Academy of Family Physicians.