WHY FAMILY PRACTICE?

 

This week, I read an article written by a D.O. Family Physician, published in the Pennsylvania Osteopathic Medical Association newsletter.   The doctor had written about the disparity of income between Family Practice and other specialties as well as her viewpoint that too many are seeking mid levels instead of family physicians.  The doctor made some good points in her letter, but it seemed to me that she may be suffering from the problem many Osteopathic Family Physicians have.    They have either forgotten or they do not recognize what Osteopathic Family Physicians have to offer that no one else does.    The fact that I’ve been working primarily with Osteopathic physicians for 24 years gives me a little insight.  I believe the fact that I’ve probably attended more state Osteopathic conventions than any one other one person in this country gives me the right to address this to some degree.   I have been blessed to speak at more than 57 state D.O. conventions in the past 24 years, as well as several national conventions.  I do not speak at any Allopathic conventions any longer, simply because the majority of allopathic physicians do not practice what I call GOOD medicine.  Yes – I firmly believe we have the best medical care in the world – but that doesn’t mean that all of our physicians are giving the best care they can.   The differences between the two approaches to medicine may give you an idea of what I mean. 

 

Most (not all) allopathic Family Physicians seem to follow the old belief that clinical lab tests will only confirm what the exam and history reveal.   Most Osteopathic primary care physicians that we’ve had the pleasure to deal with seem to use clinical lab tests to not only confirm what they suspect – but also to detect asymptomatic problems.  In other words, it seems that more Osteopathic Family Physicians are following PQRI and AHRQ to detect problems before symptoms are seen, instead of waiting until the problem reveals itself.  This is part of the Osteopathic creed treating the WHOLE BODY rather than addressing only the symptoms that present itself during the examination.   That has been my approach to working with primary care physicians for more than 20 years.  Instead of giving palliative solutions, it is better to address what is causing the problem, and that is one of the main reasons why we’ve chosen to speak at only osteopathic conventions instead of Allopathic conventions.

The Osteopathic doctor writing the article revealed that she believes a physician can make more money in any other specialty other than Family Practice and that also reveals a belief shared by most Allopathic physicians.  Let’s consider why the FP (Family Practitioner) is the lowest paid of all M.D.s.   A patient presents with intermittent chest pain and most of the M.D.s that I have been a patient of would automatically send the patient to a cardiologist, in spite of the report from the American College of Cardiologists that says that 33% of referrals from primary care to cardiologists turn out to be non cardiology problems.   A wise physician will run diagnostic tests in their own office to identify if the problem is cardio, pulmonary or gastro in nature, before sending the patient for new consults, additional co-pays and additional waiting time before they’ll be seen.   The test may be a holter, 30 day cardiac event monitor, pulmonary function test, breath hydrogen testing, autonomic testing using heart rate variability or others.   Now, not only does the wise D.O. make $300 more on the visit than the allopathic physician anxious to refer the patient out – but they also are treating the whole body to determine the cause of the problem.  This would make Dr. Still proud.  

 

So – the allopathic physician referring the patient out – maybe to the wrong specialist – gets a $90 office visit, while the doctor truly intending to find the cause deposits $300.    Most physicians missed the memo when PQRI came out that the carriers have gotten smart enough to realize it’s better to pay $200 today for the right diagnostic test than have to pay $18,000 a day in catastrophic care because the problem was missed.    Similarly, the diagnostician is also ordering clinical lab tests (most of which are performed in their own office, allowing them to make a very nice profit) as they know the clinical lab may help them determine the origin of the problem.   In spite of the fact that many office managers tell their physician that they are not allowed to do testing in the office, very few contracts prohibit this.   More than 90% of the contracts we have reviewed only limit where the physician may send out the blood IF they are sending it out.   Less than 10% do not allow the physician to run the tests in their own office.  This myth, believed by too many office managers, usually costs the typical Osteopathic family physician more than $200,000 a year in missed net profits.    By the way, $200,000 a year in missed profits is only about $16,000 a month and that is very easy to make when you’re doing the clinical lab tests that PQRI and AHRQ are encouraging you to do at the point of care.   So far, every practice we have shown this to and have followed up with our suggestions have increased their income far in excess of this $200,000 a year – so it’s really easy to do.

 

Now you see how the Allopathic Family physicians actually have kept their average annual income at the $190,000 (per the 2008 data from The Medical Group Management Association) level while Endocrinologists are above $205K, Dermatologists are $340K and some surgeons are making $370K.     Is it possible for Family Practitioners to be making $350K a year?  Of course it is, and I can name more than a half dozen client Family Practitioners doing exactly that – but they are not practicing like typical Allopathic physicians.  They are giving GOOD medical care to their patients instead of what I classify as mediocre care.   I have many MD and DO clients actually working smarter instead of harder and they may be seeing less patients a day than others do – but they are practicing good medicine.    They are the practices where I would feel very comfortable sending my wife, father, sons, daughter-in-laws or grandchildren to, for care.  What kind of practice are you willing to send your loved ones to?    Do you want the kind that do minimal diagnostic or clinical testing so that they are guessing at the cause of the problems or do you want one astute enough to capture the problems early enough to make positive changes in the care your loved one gets?  

 

Don Self is a reimbursement consultant out of Whitehouse, Texas.    His email is donself@donself.com and his website is www.donself.com   His cell is 903 372-7529.