BY DENNIS CONNAUGHTON
 Jane Murray, M.D., center, of Mission, Kan., practices "Western family medicine with an open mind" alongside clinical hypnotherapist Valorie Wells, Ph.D., left; naturopathic physician Mehdi Khosh, N.D.; and others. "I was losing the joy of being a physician," Murray said of her previous academic position. |
Have you ever thought about changing your practice, striking out in a new direction? Three family physicians who not only thought about it but actually did it took part in the Oct. 3 panel discussion "New and Innovative Practice Models for Family Physicians" at the Assembly.
Hospitalist model
Michael McMillan, M.D., a physician at Porter Adventist Hospital in Littleton, Colo., is a hospitalist -- exclusively. McMillan is board-certified in family medicine and was in a traditional office practice for about 12 years before making the switch to hospital-based care. "I decided I'd better find something that met my need to do more inpatient care," he said.
Hospitalists provide continuity of care in partnership with family physicians and other health professionals who are not able to provide inpatient care for their patients. In addition, they often care for unassigned patients admitted to the hospital. They regularly consult with attending physicians, office-based family physicians and other specialists, and social workers. They also deal with representatives of insurance companies.
Managed care was the impetus that drove creation of the hospitalist practice model, McMillan said, in an effort to reduce hospital stays and health care costs. He cited statistics that hospitalist practice has reduced the cost of inpatient care and lengths of stay by 15 percent to 20 percent.
The major benefit of hospitalist practice over office-based practice? Fewer time constraints, McMillan said. "What makes it wonderful is the flexibility of hours. I can't overestimate that part of it, after being in the office for 12 years and constantly behind in appointments. Now I can give patients the time they need."
Cash for care
Jane Murray, M.D., is medical director of an integrative health care center that bills patients directly and does not deal with managed care organizations, Medicare or other insurers.
"I was chair of a family medicine department in a medical school for many years, and I was getting tired of the way medicine is typically practiced -- trying to see more and more patients; having fewer and fewer resources; and following other people's rules, such as those from managed care companies," Murray said. "I was losing the joy of being a physician."
So she decided to start a practice with providers who offer complementary and integrative medical care, such as Chinese or Oriental medicine, massage therapy, hypnotherapy, craniosacral therapy and naturopathic medicine. Murray now practices what she calls "Western family medicine with an open mind" at the Sastun Center of Integrative Health Care in Mission, Kan.
Although the center accepts no health insurance plans, it provides patients with forms they can fill out and submit to their own insurance companies for reimbursement for the care they receive.
Murray said she thinks physicians should be open-minded about alternative forms of health care. "I get patients who are fleeing the same system I fled," she said. "I have learned that patients really want their doctor to be open-minded. Patients want to be heard and taken seriously, and they want us to offer hope. They want us to take enough time to consider what options might be open to them."
'Residentialist' practice
Norman Vinn, D.O., M.B.A., is part of a growing trend toward physicians in "residentialist" practice -- that is, physicians who provide care for homebound patients, including the frail elderly, disabled patients and terminally ill patients. Vinn is chief medical officer for Housecall Doctors Medical Group Inc. in San Clemente, Calif.
In light of the aging U.S. population and the availability of new technology, house calls have become a booming industry, he said. "Half of my practice consists of end-of-life, hospice-eligible patients. The fact is we give these people huge amounts of hope with palliative care through emotional and physical pain relief. As residentialists, we specialize in providing comprehensive primary care services in the home."
In 1998, Medicare established nine new CPT codes designed to reimburse physicians who provide home care to certified homebound patients. Thanks to technological advances, residentialists can provide routine lab testing and X-ray services in people's homes. Vinn said he spends 30 minutes or more with each patient.
Vinn appreciates the flexible hours, being out of an office, the potential for growth in the market, the relatively low overhead and his own personal satisfaction in doing this work.
"People are unbelievably grateful that somebody cares about them and somebody showed up," he said. "The average survival time in our practice is 10 months, so these people don't have a big window to their life. You can make pretty good money doing this if you work hard, but money isn't everything. There's a lot of career satisfaction."
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