Thursday, June 12, 2014
Creative Destruction Or Internal Combustion?
Below the surface bubbles a provocative and troubling question. Many of these entrepreneurial "experts" have little previous experience actually running a primary care practice or taking care of the average outpatient. Although no one has directly said it (except Khosla), the underlying assumption is that change is too big or too important to come from within. They argue that those immersed in the bubble of inefficient and expensive day to day care must be blinded by their own involvement. These "leaders" espouse creative destruction and spurn internal combustion.
But I wonder if "good" primary care is something that can be totally grasped from the outside. My understanding is radically different from what it was before medical school or even in residency. With experience, my viewpoints have changed, my techniques have evolved, and my awareness has grown. I couldn't imagine approaching disruptive change without the knowledge I now hold.
So I looked with great enthusiasm to plot the path of Iora Health and internist Rushika Fernandopulle. What I found, however, was an unsustainable model (Iora health I believe has still never made a profit) heavily dependent on venture capital. The Atul Gawande New Yorker article talks of a team of two physicians, two nurse practitioners, one social worker, and eight health care coaches taking care of 1200 patients. Certainly this model is not cost efficient. In my previous practice, I was overseeing 2000 patients on my own (and yes, my average hospital census was not much higher than theirs). It seems there was a lot of hype and Internet buzz, but many questions still remain. Is Iora health still running the Atlantic City clinic? I couldn't seem to find any information about that on the web. I would like to know more.
I am an internal medicine physician. I have been practicing primary care, hospital medicine, and palliative care since 2002. In January of this year, I started a new and innovative practice in which I visit patients in their homes and in the nursing home. I schedule a full hour for each outpatient visit and answer my phone personally.
And by the way, so far I can pay my own bills and my admission rate is low.
No venture capital investors, no yoga classes, no health care coaches, no fancy videos or selection of expensive teas in my waiting room.
Instead, I do something much more simple.
I spend a lot of time with each patient.
Posted by Jordan Grumet at 4:42 AM