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After 40 years of Practicing, I Leave You With This

by Reavis T. Eubanks, MD

After more than 40 years as a solo family physician, I closed my practice on November 30, 2014. As I prepared for that last day, I couldn’t help but reflect on how medicine and the health care industry have changed since I started in late ‘70’s. Some moments have stuck with me more than others – I think they’re worth emphasizing here, sharing the wisdom of a retired physician with those early in their career. 

The physician is no longer the captain

The most radical change I’ve observed is that the physician is no longer the ‘captain of the ship.’ At every turn, the practice of medicine is being determined and affected by other forces – insurance companies, government, hospitals – and it is little wonder that many physicians are discouraged. 

Consider the endless barrage of regulatory hurdles that must be negotiated to order labs and x-rays, to prescribe medications we deem appropriate, to meet Meaningful Use requirements and pay-for-performance programs. With these pressures comes a tendency to abandon our position as the patient advocate because it is far easier to accept an adverse decision than to appeal it. But we must continue to act on our patients’ behalf: if an insurance company balks at a breast MRI that is needed for very specific reasons, the patient is certainly in no position to make her own appeal.

Advice: It is very important that a physician who is just starting out understand and embrace that the physician is the patient advocate. Though there is much we cannot control, we must never abandon this fundamental ideal.

Patient expectations are changing

When I began practice, the only way to treat hypertension was with a salt restricted diet and the herb Rauvolfia serpentina – I kid you not! No diuretics, ACE inhibitors, beta blockers, and the like. Because of the plethora of medications now available to treat all sorts of diseases, the patient is conditioned ‘to take a pill,’ and thus, is quite reticent to follow our advice concerning the benefits of exercise, diet, or other measures to promote good health. 

Advice: Make a concerted effort to change these misplaced expectations. Each patient must be involved in his or her own care, and this is one of the underlying thrusts of Meaningful Use. athenaCommunicator certainly provided my practice with an exceptional patient portal with which to engage patients, and physicians should learn to use this excellent tool to its fullest.

Solo practitioners are becoming extinct

Another major change is that it’s become increasingly difficult for a small practice to survive – the solo practitioner is a virtual dinosaur. Although the patient longs for a physician who knows and treats them as a person, and not merely an object on the assembly line of patient care, it is almost impossible for a large multispecialty clinic to fulfill this desire. The smaller office has a significant advantage in this regard, one that should be marketed to help increase patient volume.       

Advice: For those beginning on this wonderful journey we call Medicine, I urge you to consider the benefits to your patients if you adopt the smaller practice model. Yes, you may be “on call’ more often, but the security your patients feel knowing they are talking to their own doctor cannot be overestimated.

Technology isn’t all that bad

When I began practicing, communication between providers was by letter and phone. When fax machines became readily available, communication speed significantly improved. With the advent of the personal computer, the typewriter became extinct. And with electronic health records, the ability to organize, analyze, and communicate has made a quantum leap. 

My ability to build customized reports in the Reports section athenaNet provides gave me an incredible ability to ‘data mine’ the patient population, as we sought ways to improve patient care. In addition, we had the ability to improve efficiency and productivity as we studied documentation time, patient flow, schedule density, and the myriad of other data captured by athenahealth. 

Before I Go…

I could keep on listing changes to the health care industry, all the pressing challenges and demands. The point is that because of these changes, the right health IT vendor is indispensable in today’s practice.  It provides vastly improved documentation, and the data required by insurance companies and governmental agencies. But it also gives us the tools to closely monitor the financial health of the practice and to make better financial decisions regarding participation in various insurance programs or the ever-changing new models of reimbursement, be they Accountable Care Organizations, affiliation with a local hospital, or other ‘clinic without walls’ concepts. 

So, what is a retired doctor to do? I have leveraged my decades of clinical experience, and enthusiasm for and expertise in using athenahealth services, to form a consulting company aimed at improving physician efficiency and increasing EHR productivity. 

Yes, I am a retired physician. But I am also part of the leading wave of Baby Boomers, not settling into a rocking chair on the porch. “Retirement” didn’t last long!

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Submitted by Carol Alexander Estill - Monday, April 4, 2016

Your comments are both very insightful and impactful.

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