X-eGroups-Msg-Info: 1:12:0:0

From: lawrence lyon <llyonmd@yahoo.com>
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Wed, 5 Oct 2005 09:49:23 -0700 (PDT)
Subject: [Practiceimprovement1] recruiting new doctors to our model
Reply-To: Practiceimprovement1@yahoogroups.com

one thing i found and which supremely disappointed me upon graduation from residency and beyond, was that there are plenty of established doctors and health provision organizations who and which are perfectly happy to take advantage of graduating residents. i have heard, but don't where it comes from, that many graduates leave their first position after residency within one year. This "chickenhawk" attitude, in combination with the lack of resident preparedness due to poor practice management teaching, exacerbated by high medical school debt load, sets up graduates to be taken advantage of, and then perpetuates the scramble to see as many patients as possible, ultimately placing the pursuit of money over caring for patients.

quite frankly, i was shocked when told by the ceo of an ipa for which i worked after residency, that i would learn a lot from their methods "if i could stomach" how they do business. if i had done what and how this organization had wanted, and had been specifically told to do by their medical director, i would have not taken the time and care to do a thorough history and physical examination on a new patient in that office who presented with fatigue, and would not have discovered his active gi bleed. he probably would have died.

i mention this because, as we know, the economic pressures of current practice and the "standard of care" don't just affect routine and preventive care, but can make the difference between life and death.

in our model, where the emphasis is on providing care rather than on seeing some imaginary number of patients per day determined by some bean counter, we think we do several things:

we encourage our patient's trust in us;

patients are more likely to tell us their symptoms, concerns and fears;

we have the opportunity to significantly improve patient health through education;

we can get to the cause of the patient's symptoms faster (occam's razor);

patients are more likely to do what we recommend, including taking medications we prescribe.

although we don't yet have the hard data which statistically supports what we think, that's one place we have to go since the insurance companies are already there, and trust me, they wouldn't be going there if there were no data to support their move (i'm sure they do have other, and ulterior motives). anecdotal evidence certainly points in that direction, but is not enough.

doing a good job depends on our being happy in doing our job. a primary focus of our mission must be to educate residents and to encourage a path upon graduation which promotes our standard of care: good patient care as well as physician health and well-being, including relief from financial pressures to the degree that they do not drive patient care; and, as many of us can demonstrate, that our form of care can still be financially rewarding.

how shall we do this?