More on the Career

Hey there.  So I've been thinking about this concierge medicine - cardiology idea and I think I like the idea.  I've been doing some research and putting together my tentative plan.  Still, I will need to do extensive market research and write up a business plan.  I believe my two biggest hurdles will be to set the correct annual fee and figure out how I will get my first 40 or 50 patients.

You see, I need a price that will cover my expenses and make me a decent salary, but not one that will scare everyone off.  The patients will need to know that they are getting their money's worth.  So what is it worth, really?  Why would somebody give me their money for something their insurance already covers?  Well - I will have to give them service far above and beyond what their insurance company  - and their current cardiologist could ever cover.  This is pretty big because I will have to get people to first, switch doctors and then pay extra money for me.  People get pretty comfortable and attached to their doctors, so this alone will be no easy task - and then getting them to give me extra money out of their pocket on top of that.  Not easy.  So I realize I will have to provide something that is pretty special.

Once I am able to get my first 40 or 50 patients, then I believe word-of-mouth will go into effect and it to the growth of the practice.  I'm going to need to figure out exactly what my start up costs will be and my monthly nut will be so that will give me a better idea of what I need to start and when I will become profitable.

So what will I provide that is so special?  Well, I have tons of ideas - some practical, some way outside the box, some may not be possible.  I'd love to hear what you think.  Obviously, these patients would be getting ultra-VIP care and attention.  They can be seen within 24 hours of calling me - no matter what the complaint or concern.  They will have access to my cell phone and e-mail so that I am reachable at all times 24/7.  I will not bill through their insurance - no pre-authorization, no referrals, or anything like that.  I was actually thinking it would work against me to have an office.  If I have an office, these people will need to get to my office and it could be very inconvenient.  Instead, I go to them - work, house, whatever, wherever.  That would allow me to  see patients almost anywhere on Long Island - instead of being limited to one area.  Obviously, this would also greatly reduce my start-up expenses and monthly bills.  I also think getting hospital privileges would also work against me for the same reason.  If they are admitted, I go visit (as a visitor) and be in close contact with the doctors taking care of them.  What else would I provide that's so special?  Well, their visits will not be at all rushed.  I can certainly be much more thorough than whoever they are seeing now.  I can educate and focus on prevention as well.  Diet and exercise and smoking cessation and diabetes care and weight loss - all these things that doctors should be spending a lot of time on and just can't.  What else?  How about a chef to the house to teach you how to cook a very easy, very healthy meal?  How about a wine tasting of very heart-healthy wines?  How about books and literature and handouts proving continuous education on all relevant information.  I will need a portable EKG and echo machine with me at all times in my car.  I will need a scale, a pulse ox, fingersticks for INR, glucose and potassium.

All that stuff - but most of all, it's the personal attention that the patients will be paying for and expecting.  I really need an honest and realistic evaluation and expectation of the feasibility of this venture - before I start getting a line of credit form a bank and start leasing equipment, etc.  What number of patients will I cap at?  What will happen if I want to take a family vacation?  Basically, at this point, this is me thinking out loud - I'd love to hear your opinion.

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.