Career Path

Hello all.  Recently, I've been thinking about a new career path.  I'd love to give my patients the time and attention they require without having to worry about a hectic schedule.  Doctors, as you know, in general, are in a funny situation these days.  Much of our reimbursement have been drastically cut.  Many of the tests we order are denied by insurance companies.  We need to see more and more patients in any given day in order to cover the overhead and make a decent salary.  You see - I'm a cardiologist and that's what I've always wanted to be.  When I was in medical school (Georgetown, Class of '94), I learned to be a doctor who really cared for his patients.  Listened.  Thoroughly examined.  Listened more.  Thought about.  Explained everything.  Followed closely.  I graduated from med school in 1994 and, you know, that really wasn't that long ago - and it's close to impossible to be that doctor in today's healthcare environment.  I see some doctors - they are rushing, and still falling behind - so they need to rush even more.  A patient waits an hour to see the doctor for three minutes.  I've heard it being compared to waiting on line at Disney for Space Mountain for an hour and then once you finally go, it's over in a two minutes.  That's not what the patients want and it's not what the doctors want either.

So, how do I get around it?  When I first heard of concierge medicine, it sounded too "elitist".  However, the more I think about it, the more i am starting to really love the idea.  As you may know, concierge medicine is medicine by way of retainer.  For an annual fee, you have priority access to your doctor 24/7.  Appointments whenever you want - essentially no waiting in the waiting room - and, get this, you have your doctor's full and undivided attention for as long as necessary.  The patient gets the doctor he/she deserves and the doctor gets to be the doctor he/she always wanted to be.  No rushing through patients like they're on an assembly line.  Imagine - I can give my patients my full and undivided attention and really think their situation through without being rushed and interrupted.  How can that not lead to better care?

Can I make this work as a cardiologist?  I think I can.  I know it will work - the only difficult part will be getting patients to agree to pay extra money for something that they are already getting with their health insurance, right?  Well - the thing is - they will be getting a level of care that their insurance coverage cannot even approach.  For example - I get a phone call from a patient - let's call him Mr. Smith. Let's say it's at 9 pm and Mr. Smith tells me he is having a little trouble breathing.  While I'm on the phone with him, I quickly look up the details of his history on my iPad and we have a conversation, but I soon realize that this phone coversation will not be good enough.  I need to see him.  Regularly, this is when the doctor says, "Go to the Emergency Room and I will see you there."  So - after waiting in the ER for two hours, the patient will be seen, admitted and I would be called and go in and see the patient - approximately 3 hours after the call.  However, now I would say, "Mr. Smith, I can be at your house in 30 minutes."  I take my stethoscope, my blood pressure cuff, pulse ox, my portable EKG and echo machine and Mr. Smith, no matter what the  problem is, is already getting a much higher level of care.  This lost art of the house call may have just either prevented an unnecessary hospital admission or facilitated a much needed one.  Better care.

I'm going to spend some time thinking about this in much more detail and I'll check back soon.  I'd love for you to drop me a message with your thoughts.  Thanks.