11 July 2013

Doctors Leaving the System for Contract Medicine

These three doctors are thinking much alike and yet making themselves very different as they have moved to much the same degree out of the system. These are the doctors: Dr. Jordan Grumet, an Internal Medicine physician practicing in Highland Park, Illinois who has blogged since before 2008; Dr. Leslie Kernisan, practicing geriatrician in San Francisco and blogger since September 2012; and Dr. Rob Lamberts, a primary care physician in Augusta, Georgia who has blogged since March 2007 with a year off during 2011.

All three doctors have left the normal practice system and are using contract medicine as their norm. Dr. Grumet is the only one still with Medicare and insurance and the other two have left Medicare and insurance for fees only. Dr. Grumet uses the term concierge and Drs. Kernisan and Lamberts do not. I have listed the blogs by each doctor that I am using for my blog. These are what makes me enjoy reading them.

Dr. Kernisan can take criticism and the NY Times article did bring it on her. I can often disagree with any of the three doctors, but I still respect what they are doing and their objectives for what they wish to accomplish. We need more doctors like this. They may be providing a way out of our broken health care system.

Dr. Lamberts is the one blogger I have read the longest and I will continue to follow his blogs. I am quoting this because it explains Dr. Lamberts, “My experience with the system shows that nobody pays you without expecting more in return. Then I’d just end up compromising to keep the money flowing, and that is a kind of relationship I just got out of. Instead, I am trying to do it the right way, keeping my focus on what is important: giving my patients the best care possible. It’s not been real exciting – there hasn’t been much to write about, spending my creative energy on a building system that will actually improve care, not hinder it. I’ve also had to pay much more attention to the little details: tracking where the money comes from and where it goes. I’m not real good at that, so it’s been a steep learning curve, but it’s given me a sense of control I’ve not had for a very long time.”

Dr. Kernisan is concerned about the elderly and about their caregivers and this is not something many doctors are willing to take on. I will quote a little from her blog, “This morning, I gave a talk to a group of family caregivers, at a retreat sponsored by Family Caregiver Alliance. We talked about what caregivers should know about the geriatric approach to care, and how they can learn more about medical care that is tailored to the needs of aging adults. We talked about delirium, and how caregivers can recognize it and get better help from clinicians.

We talked about participatory medicine -- they were all savvy, experienced caregivers but none had heard of the e-patient movement -- and the Beer's criteria, and then we got into how tech tools might help caregiving feel more manageable. (More on those in future posts!)

I loved every minute of it, doing this session with family caregivers. I can't wait to participate in more events with caregivers.”

Dr. Grumet has just recently started his conversion and while he takes responsibility for what he is doing, he is cautious at the same time. I will not quote as much from him, but what he says is powerful, “There is a certain feeling of disenfranchisement among those of us who were present during the infancy of healthcare social media. Before the days of twitter, the players were few, the interactions meaningful, and the main mechanism of change was a quaint self publishing tool called a weblog.”

It has been interesting that the three doctors are spread out from Georgia, to Illinois, and California. They have spread their wings and are now working to improve health care for their patients.

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