Why You Should Choose an Independent Doctor

Find out how choosing an independent practice can save you up to 50% on medical costs.

Recent changes to medical plans have made high deductible plans almost ubiquitous. With Obamacare rollbacks, we are also seeing a lot of people opting to forgo medical insurance and not have any at all. These situations have found many people in a place where they need to seek the most cost effective care they can receive. Independent doctors are uniquely positioned to provide this. There are a few reasons why this is so.

Why Independent Practices offer Low-Priced Quality Care

First, independent practices have decreased overhead. Compared to a large multi-physician foundation that employs a larger staff, an independent practice can keep its personnel to a minimum to support fewer doctors. This savings can be passed on to the patient.

Second, small private practices have decreased bargaining power. This is unfortunate for us, but you, the consumer, can benefit from it. Even with the discounted rates from insurance, services are going be cheaper through an independent practice. Unfortunately, small private practices do not have much negotiating power when dealing with insurance companies and often will be reimbursed less for similar services and therefore have a much greater discount for patients. Larger foundations and corporations can negotiate high rates and this translates to higher patient shares on high deductible plans and for cash payers. I have seen the EOBs (explanation of benefits) of large medical groups versus smaller independent practices and the difference can be staggering.

Third, supportive care can be more personal. When you call a private practice, you will often have a live person pick up the phone, as is the case at our practice. Bigger foundation practices often route you through a phone tree. When calling a large medical group, I had to dial 3 numbers to get where I wanted and then was on hold for 4 minutes. Unfortunately when I did talk to a person, he was unable to help me because he only knew scheduling and knew nothing about billing. He pointed me to a website where I could look up prices.

Some Examples

To prove my point I decided to do my own cost comparison. For the large medical foundation, I used their online cost estimation tool for a typical office visit for a cash pay patient and was quoted $138 discounted from the billed amount of $197 (cash pay is often given a discount to bring down the price closer to the negotiated rate from insurances). At our independent office, a similar visit will cost a person without insurance $66.50 discounted from the billed amount of $105. That is less than half the cost!

This cost savings also extends to ancillary services such as physical therapy and x-rays. For the large medical group I researched, a basic physical therapy initial evaluation will cost you $192 (discounted from $274) out the door. American River Rehab (a local independent PT) is cheaper at $100 for the initial evaluation if you are cash pay (and $75 for follow up). Again, almost half the price!

For radiology, I looked up the large medical foundation radiology services and inquired how much a screening mammogram would cost. I was quoted $337 discounted from the billed amount of $482. I compared this to Insight Imaging (a private radiology office in Grass Valley, a nearby town) where it is $192.50 discounted from the billed $293. This savings is significant. Here I only mention PT and radiology but this extends to skilled nursing facilities, labs, hospitals, home health and all other medical services.

Obviously I’m a little biased as I work at an independent practice. However, it is hard to argue with the numbers I present above. This is nothing against the doctors at these bigger groups. They are all very capable and comparable to independent doctors, but when it comes to value for services rendered, independent physicians come out on top. If you are happy with your doctor and the cost you pay, please stay with your current physician. But, if you are looking for a better value, do your own cost comparison and call around to your local big groups and small independent physicians. I believe your findings will be similar to mine.

This has huge implications in today’s medical field where spending continues to rise and doctors are being blamed. A recent study shows that by 2026, health spending in the US will rise to $5.7 trillion! To be good stewards of money flowing through the medical community it is our duty to take cost into consideration while still providing excellent care. ACOs (Affordable Care Organizations) have this as their primary goal and are where medicine is migrating. These organizations band practices together with the goal of providing superb care while keeping costs low and referring to low cost entities to save Medicare money. We recently joined National ACO with this in mind.

So, when you are looking for a new doctor or any ancillary services, take into consideration the cost. If you are outraged about the rising cost of healthcare, do some research. An independent practice will most likely offer you more value in your medical care. You can also choose a doctor affiliated with an ACO. As an independent doctor, I join with other independent practices and make the commitment to you and the community to provide excellent medical care while keeping the costs down.

My Residency Personal Statement

Raw an unedited, I reveal my Residency Personal Statement.

Like the personal statement for medical school, the one for residency is vital in securing a spot at the residency of your choice. The emphasis of the personal statement shifts from why you want to be a doctor, to why a particular specialty fits you best. I chose Family Medicine as my specialty and had to craft a personal statement to let residency directors know why. Below, you’ll find that statement, unedited. Enjoy!

My Personal Statement

“Only two more miles until we reach our campsite.” I looked up at him, sweat stinging my eyes. Two miles?! We had already ascended to 6000 ft. over the past three hours. At our current pace, we would make it to camp in another hour. My friend and I were the last two in a group of four hiking the Tahoe National Forest on a four day excursion: one day hiking in, two days relaxing at the lake, one day hiking out. I grumbled to myself about over-packing only to be cheerfully reminded by my friend about the wonders of getting away from the city. Thirty minutes later found us one mile away and my determination was not going to be trampled like the dirt under our feet. Pain was taking over my left gut and my sweat-soaked t-shirt was evidence of the hot sun and rigorous battle I was fighting. I had the resolve to overcome and I was glad I was fighting it with a friend. We had endured much together over the last five years.

I had many other friends along the way, but four years after this encounter with the mountain I first met and began developing a friendship with my wife. We opened our souls to each other, allowing the other in to see beneath the surface. We probed deep into each other’s lives to determine why the other was the way they were, what had shaped them and what made them tick. Today we are still inquisitive of the deeper meanings behind each other’s actions. This search will never end; I am glad it won’t. This expands beyond my wife, family and friends to my patients. When I have had continuity of care with patients, I have enjoyed developing deeper bonds beyond the doctor-patient relationship.

Ever since deciding to become a doctor, I knew that primary care was my destiny. Developing long-lasting relationships has always appealed to me. The idea of being somebody’s “doctor” gives me a joy that is humbling and carries a great responsibility. As their doctor, I am accountable to look out for their best interests, treat them with respect and be their gateway to the medical field. This can only be accomplished effectively through personal relationships with patients.

Family Practice is the best amalgamation of all that I want in a career. Family Medicine combines the procedural tasks of orthopedics and minor surgery with the care of mental health in psychiatry and vast knowledge of internal medicine, all of which I enjoyed throughout my third year rotations. I am excited to treat men and women, young and old and to span all cultures, social status and income levels. This specialty champions honesty, reliability, compassion through altruism and a strong work ethic with lifelong learning. Through the teachings of my parents and my own personal commitment, these characteristics have become a pattern in my life.

Growing up I wanted to do something that would positively affect people and give meaning to their lives. This desire led me to becoming a doctor and manifested itself outside of my medical pursuits. Throughout high school and college I engaged in acts of service that were beneficial to friends, family and strangers. In Medical School I immediately became involved in church and looked for opportunities to serve. Perhaps the most rewarding experience is my involvement in my church’s youth group. As a leader of a junior high boys’ Bible Study, I have been a role model and am able to talk with young men on a deeper level about virtues that I cherish and my experiences when I was their age. Many of them have grown spiritually and emotionally thanking me for my influence in their lives. This experience reflects my deeper dedication to compassion and altruism. Through this act of service and others I have found that serving in itself is a reward because it provides a context for what I do in the medical field.

We turned left and started our descent into a valley. I could see the lake from here. Ross, my high school buddy, slowed down and I caught up to him. “All downhill from here,” he said. A bit cliché, but I let him have the remark. It was all downhill from here and I was excited. I thought about the mountain I was climbing on my journey to becoming a doctor. At that time I was just beginning my ascent. There would be rest stops along the way: high school graduation, college graduation and medical school graduation, but I would continue up the mountain until I reached my destination. Now as I reflect back on my journey thus far, I am excited. I have endured the side aches and the sweat and look forward to the next milestone of graduation. But from where I am on the mountain I can see ahead of that stop to the next leg in my journey, residency. My life experiences and medical education have adequately prepared me for this new path where I will finish my residency training but only begin my continued learning. I am confident that my commitment to honesty, kindness and lifelong education will give me the strength and resolve to realize my dreams and overcome the next leg of my expedition.

What do you think? Personally, I like this much more than my medical school personal statement. Four years in medical school must have had more effect than I thought in my development. If you enjoyed this and need to write a personal statement or know someone who does, I’d love to read it. Feel free to pass this on.

My Medical School Personal Statement

Raw and unedited, I reveal my personal statement for Medical School.

Getting into medical school is a long and arduous process.  I wrote an earlier post on my experience here.  Part of this experience includes completing a long application which includes a personal statement.  I’m sure most are acquainted with a personal statement as many colleges require them.  When writing one for medical school, it seemed different however. All of my dreams seemed to be hinging on this succinct statement of intention to become a doctor.  Here it is, unedited.  Enjoy!

My Personal Statement

It slipped away too easily to be love. It was a typical day and my mom stopped at Chevron to fill up on gas. I, being the big toddler that I was, accompanied her into the mini mart. I was left to roam the endless aisles of candy while she paid the bill. Then I spotted her; there she was beckoning me. The snickers bar was all I wanted on this afternoon and more. I went and asked my mom if I could have it. “I don’t have money to spend on things like that,” was her reply. Distraught, I walked back to the aisle to bid my newfound love goodbye. Then an idea popped into my head: I could still pursue this love affair, only undercover. When I got in the car I thought we could get acquainted, so I took it out and started to unwrap it. Before I could, my mom turned around, seeing me in the rearview mirror, and demanded to know where my new love interest had been abducted from. She knew the answer and turned the car around. I slowly walked back into the mini mart to my impending doom, following my mother’s orders. I gave the candy bar back to the attendant and told him I was sorry. Early in my life my mom taught me the value of honesty. Being honest doesn’t only apply to what I say, but to what I do and how I live.

My parents educated me while I was young about the importance of being a man of integrity and living up to a standard in life. I have always set my standards high and have dedicated my life to loving others and working hard. At times it’s hard to be motivated, but I find my strength in my faith as a Christian and my dedication to family. Both serve as my basis for loving others. My parents support has allowed me to realize my dreams thus far and will continue to do so in the future. They taught me to live a life worthy of my potential. The moral qualities taught to me by my parents have prepared me to be an honest, trustworthy doctor.

Similar to my moral education, my desire to become a doctor came at a relatively young age. I was a tall uncoordinated young man, having my fair share of accidents, and found myself visiting the doctor repeatedly. Seeing my family doctor work with empathy for his patients and later having an uncle who went through medical school served to spark and build my interest in the field of medicine. I later did my senior project in high school on shadowing an emergency room physician. My qualities as a sincere, compassionate man have affirmed my desire to become a doctor.

Here at Point Loma Nazarene University I joined a local group of aspiring students with career interests in medicine and went on several trips where we were able to help out with children. Perhaps the most memorable and rewarding experience from this group called Healer’s Hands was when we went to a children’s convalescent hospital to spend time with debilitated kids. While I was unable to do anything to physically help these children, developing relationships with them and seeing the smiles and joy that it brought them was gratifying and served to show me that love for others is probably the best medicine there is. Compassion for patients and looking out for their wellbeing is a quality that every doctor should have and exhibit behind their practice. My experiences with friends as well as strangers have bolstered my compassion for others.

While in college I was selected to do research with one of my professors, Dr. Shellhamer. This was an esteemed honor because only two people a year are asked to do this with him. He saw my hard work and determination and wanted me to be on his research team. While researching, I have experienced elation through my success and have had to learn to overcome the adversity of failure. Determination to figure out the correct solvent system or concentrations of reactants was the impetus that drove me to continue. I learned that persisting through struggles and having the strength of mind to overcome reap rewards over time.

I now turn to pursue a different love affair in my life – a love affair that accompanies my journey in becoming a doctor. This one is full of compassion for other people. I believe that my life experiences have educated me and made me better both emotionally and morally guiding me to this point. The determination I have learned has prepared me to succeed in any endeavor, and the values of honesty and love will allow me to do well in the future. My commitment to my faith and to delivering the well being of others through compassion will give me the strength to realize my childhood aspirations of becoming a doctor.

So, would you have extended an admission to medical school based on that statement? Reading it definitely brought back memories and even some of the stress associated with the medical school application process. Check back next week for my residency personal statement.

Can Google Predict if You Have Cancer?

If Google can predict cancer, should they?

I was listening to a podcast the other day and was introduced to the idea that google search trends are a very powerful tool in predicting many different things.  Some of these have real life implications in medicine.  I looked it up and sure enough research has been done to see if specific search terms can predict if a user is developing certain medical conditions.  I thought it would be interesting to explore this topic.

In the Journal of Oncology Practicean article was published looking at the ability of google searches to predict pancreatic cancer.  The researchers looked for people who queried the internet for precursor symptoms to pancreatic cancer such as jaundice or itchy skin, light stool, dark urine, sudden weight loss, and abdominal swelling or pressure among other symptoms. They then cross referenced this with users who were eventually diagnosed with pancreatic cancer. Their final results showed “that we can identify 5% to 15% of cases, while preserving extremely low false-positive rates (0.00001 to 0.0001).” In the case of pancreatic cancer this is important because early detection can translate to longer survival rates.

Another study done in the JAMA Dermatology journal sought to determine if internet searches correlate with incidence and mortality rates of common cancers.  They came to the conclusion that “population-level internet search behavior may be a valuable real-time tool to estimate cancer incidence and mortality rates” in colon cancer, lung cancer, lymphoma, melanoma and thyroid cancer. This positive correlation is groundbreaking and can have real-world utility.  While this study was population based, if we were able to identify these patients through searches and inform them to seek care and screening tests, cancers could be found early and there would be decreased illness burden and death.

Lest we think that data mining can yield only positive results, let’s look at one more article where the findings were not as compelling.  In Nature in 2013, an article was published showing google’s flu trend drastically overestimated peak flu levels when compared with the CDC’s real world data.  It is a sobering reminder that as “flu-tracking techniques based on mining of web data and on social media proliferate… they will complement, but not substitute for, traditional epidemiological surveillance networks.”  While this is an example of where data mining failed, this was in a more public health related capacity and not on the individual level to predict cancer.  

So based on the studies above, it does appear that Google has the data and ability to predict if at least some individuals were at an increased risk for cancer.  What may be the downside of this though?  First, arguments against the practice of data mining should be put aside considering this is already done.  We’ll forgo that discussion.  There is the worry of false positives and alarming those who may not have cancer, even though this may be rare.  In my opinion this would be worth it to save a few lives (and the symptoms those without cancer are googling should probably be seen by a doctor anyway).  

What if something was missed? Obviously if people are relying on being told if they cancer or not, there may be repercussions if they are not told.  Then there is the worry that people may rely more on google than their doctors.  As the Nature  study above states, googling should compliment but not substitute the evaluation of a doctor.  I think all of these are legitimate concerns.

In conclusion, I think the possibility of having Google predict cancer is an exciting frontier to explore.  There are some downsides that need to be considered though. Google and other big name tech companies are already mining our data and using it to make our web experiences more tailored to us an individuals.  Should this data be used to improve our health?  Do these companies have an ethical duty to warn a person if their search histories are in line with a possible cancer? Are there other downsides? I’d like to know your thoughts.  Comment below and add to the conversation.

Sacrificing Customer Service for Quality Metrics?

A greater emphasis is being placed on meeting quality metrics than customer service for physicians. Is this a good thing?

A few weeks ago I received an email from the Independent Physicians Association (IPA) I am a part of.  It was announcing there would be a change in their payment model with a bigger emphasis on “quality.”  Quality refers to meeting certain evidence-based measurable categories (also called metrics) to assure doctors are practicing medicine well.  Examples include getting a majority of blood pressures under 140/90, getting diabetes under control with an a1c under 8 and getting patients over 50 screened for colon cancer.  Essentially, through chart reviews, the IPA is able to see how well I do in these and other categories and adjust my payment based on results.

Within this email was further information on how this payment was going to be disbursed.  Money that used to be given based on patient satisfaction was being moved into the quality category.  Essentially a greater emphasis was being placed on quality metrics than patient satisfaction. This initially irked me because I do very well in the patient satisfaction department.  I take time and care for my patients with a genuine attention and this is reflected on my patient satisfaction scores.

I also do my best with the quality department but sometimes find it difficult to get all patients within the metrics set. Part of this is because some of these quality metrics are outside of my control.  For example, I can refer a person for a colonoscopy but I cannot make them get it done.  I can adjust medications for diabetes and blood pressure but if the medication is not taken or the person is not adhering to a proper diet and exercising, their numbers may not improve.  I feel like patient satisfaction is under my control whereas metrics may not be.

So, why the shift?

It is extremely important to provide a quality product that improves and lengthens lives.  This is what the world looks at when judging how well doctors are doing.  Customer service is secondary.  Both are important and ideally, a doctor provides both, but when it comes down to it, our job is in health and the best way to judge this is through these quality metrics.

My Take

In the long run, this will be a good thing. If we meet the mark set for each of these metrics, patients will benefit with less death and disability from disease processes. I hope that doctors will not throw their customer service skills by the wayside and solely focus on achieving the quality metrics.  My biggest concern with this shift is that doctors may start sacrificing customer service for quality metrics.

Personally, I will continue to provide excellent customer service.  This shift has motivated me to make a more concerted effort to make sure I meet the measures.  I will likely be a little more assertive in convincing my patients to get tests done and make medication changes to improve control of their disease.  I need to be aware of doing this in a gentle and non-coercive manner to maintain patient satisfaction. So for me, this will be a good thing and there will be an improvement.

So don’t be surprised if your doctor starts to work harder to control your blood pressure, get your A1c down for your diabetes or get certain tests done.  Hopefully, this is still done in a respectful manner that shows superb customer service as well. This will translate to a more healthy life for you. With all this, I’m curious what you think. Comment below and let me know.