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FROM “THE DOCTOR WILL (BARELY) SEE YOU NOW” TO:
Ample appointment times // freedom from group-practice bureaucracy // a promise to deliver better care //
But for harried physicians, is it a sustainable solution?

Practicing Small

By Betsy Wiesendanger and Charles Slack // Photographs by Mark Mahaney // Winter 2009
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For primary care physicians, the treadmill turns ever faster: Increasing overhead and decreasing reimbursement rates leave them little choice but to see more patients in a day—as many as 3,000 in a year—with hardly any time to treat them.

In response, some physicians are entering what’s called concierge medicine (24-hour access in exchange for a hefty retainer), hoping to make up in higher fees what they lose in patient volume. Another group is taking a different tack, opening small, independent practices but keeping care affordable by trimming overhead and harnessing technology. While a simplified professional and domestic life—seeing a patient in a home office one moment and making lunch for the children the next—is alluring, these doctors say the real attraction is being able to provide what they regard as better care.

Gordon Moore, who coined the term micropractices as a family physician in upstate New York, estimates there are about 425 such offices in the United States. Physicians needn’t be in solo practice to qualify as micropractitioners, he explains: It’s a matter of access (patients can contact their doctor after hours or get a same-day appointment if needed), continuity (patients always see the same doctor) and efficiency (office management tasks that do not affect patient care are outsourced or automated).

The experiences of patients in these practices, Moore says, are encouraging. In a 2007 paper he co-wrote in the journal Family Practice Management, Moore reported patient responses from 50 practices, including 12 micropractices. The alternative practices scored high in patient satisfaction across a broad range of criteria. For instance, in micropractices 60% of patients with chronic illnesses said they had been helped significantly in living with their condition, compared with 35% in standard practices.

Yet some critics question whether such an approach is a realistic solution for a strained national health care system—or simply a refuge for a few burned-out physicians. David U. Himmelstein, a Harvard Medical School associate professor and chief of social and community medicine at Cambridge Hospital in Massachusetts, says micropractices could ultimately add to the burden of other primary care physicians because “lower volume for some means higher volume for others.”

Moore, on the other hand, says the real problem is that too many doctors are shunning primary care and won’t return unless such movements as micropractices make the field more attractive. Yet Himmelstein questions whether physicians will ultimately feel pressured to raise their rates for a smaller number of patients who are willing and able to pay.

Moore concedes that the economic challenges are real but insists that the micropractice represents a fundamentally new approach to primary care. “If my goals are the number of patients I see per day and the number of claims I can submit, I’m spending less energy on patient care,” he says. “When you can spend more time improving the human condition, that’s when your work becomes about dignity and respect.”

Here’s how three micropractitioners are having a go at it.

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