I couldn't agree more with the sentiments expressed in “Is ‘Busy’ Good?” [September/October 2008] by Jean Antonucci, MD. I practice in a thriving two-person family medicine practice with my spouse in San Diego, where we are now in our 23rd year of practice. In addition to implementing many of the principles expressed in the article, we also decided 22 years ago to sever all connections to insurance plans, including Medicare. All of our patients are insured, but they have decided to pay our significantly higher fees (and seek reimbursement from their insurers) so that we can take care of their primary care needs, instead of seeing physicians on their health plan. Since there is no shortage of family physicians in San Diego, this tells me that they place great value on the kind of care we are able to provide by not being “busy.”

I encourage other physicians to follow our example, as this not only will make for a much more satisfying career in family medicine but will probably improve the image of our specialty, particularly in the eyes of our patients.

I would like to make it clear that we are not a concierge practice; we do not require our patients to pay a retainer, nor do we limit the number of patients in our practice. We're more like the family doctor that some of us older physicians remember seeing when we were much younger. He was the doctor we saw first, no matter the problem. He was able to take care of the vast majority of our concerns, and we paid his entire fee when we went to see him.

We have come a long way from those days, and I wish I could say that the direction has been forward.