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Northwest Voices

Seattle Times letters to the editor

January 22, 2009 at 4:00 PM

Health care

Thousands with insurance, but without care

I am writing in response to Carol Ostrom’s Sunday piece [“Curing what ails us,” Pacific Northwest magazine, Jan. 18] about health care and innovative ways to improve it.

I am an internist, meaning I provide primary medical care for adults, and I am concerned that the biggest drawback to the “retainer” or “concierge” or “boutique” model of health care is not even mentioned in this fairly extensive overview of innovations in the delivery of health care. To quote Ostrom, “… a primary-care shortage looms — here and everywhere. A bazillion baby boomers with complex chronic diseases are lumbering into geezerhood …”

In the face of this, Ostrom seems to tout the “retainer or concierge or boutique” model of health-care delivery (for those who can afford it), despite citing (and apparently ignoring) two important figures: The doctors in a Qliance style of “retainer-concierge-boutique” practice will carry about 500 to 800 patients each; a typical primary care provider carries about 2,500 to 3,000 patients.

I find myself wondering where the 1,800 to 2,500 patients who have been effectively abandoned by their boutique doctors — those patients the boutique practice cannot or will not accommodate — will now be receiving health care. Are those of us who are continuing to do our best to provide high-quality, primary care to our current patients now expected to expand our practices by thousands of patients so that patients who have been left behind by their boutique doctors can continue to receive health care?

If so, this is certainly a recipe for worsening the quality of health care, not improving it, as already overextended providers become even more overextended.

If not, the denying of health care to these thousands of patients is certainly another recipe for worsening the quality of health care, not improving it, as these patients are added to the ranks of those who have no access to health care, despite having health insurance.

It is clear to me that the appearance of boutique or retainer practices is adding to the shortage of primary-care physicians and is making it more difficult for patients to receive health care. It is not a model of innovative health-care that should be praised or encouraged.

— Dan Stambor, M.D., Seattle

Sacrifice nothing, everyone benefits

As a family-practice physician for more than 20 years, I have seen both sides. Completing my family-practice residency and working for Group Health for five years, I left in 1995 to go into private practice with another family physician and a nurse practitioner at Woodinville Primary Care. We all wanted to spend more time with our patients and enjoy our practice more. This was our initial mission statement.

I am very pleased to say after 12 years, we are alive and well. Our appointments are half an hour, other than for single problems like colds or ear aches and complete physicals, which are 45 minutes. We have five other providers who work with us; the model of care is very similar to the Group Health Factoria pilot. Our phone calls on weekends are few because we take time to talk to our patients while they are in clinic. We do lots of preventive care and patient education one on one; I like to say we are preventive-care specialists.

We cofounded Puget Sound Family Physicians (PSFP) with three other clinics seven years ago. We benefited from insurance contracting and implementing an electronic medical record (EMR) together three years ago.

In comparison with another clinic of similar size in the PSFP group who sees twice as many patients in a year, our annual income is about the same. Our patient satisfaction scores in PSFP have consistently been high because we take time to talk to our patients. Our employees are stellar and generally stay a long time, considering every practice has some turnover.

We do not have a subscription practice. In other words, we don’t have a surcharge above insurance, in order to provide patient-centered care. Our practice is self-sustaining with no large debt and we all make a living wage.

The bottom line: Primary care can be done in a sustainable way for both patients and physicians without sacrificing quality. We’ve been doing it for 12 years and plan to continue.

So, in answer to the charge that family practice is going to collapse, from my perspective, I don’t think so. We just have to make it work the way it should for all of us.

— Sally Edwards, M.D., Woodinville

Fighting a losing battle

It was refreshing to read in “Curing what ails us” that some physicians are seeing the wisdom of the naturopathic approach to medicine: more patient time, listening and prevention. However, as important as these are for improving health and reducing costs, they are not enough.

As long as the M.D. medical system is joined at the hip bone to the pharmaceutical industry, they will continue to fight the losing battle of, as they phrase it, “managing” symptoms instead of curing patients. The deaths, side effects and astronomical costs prove that chasing symptoms with drugs doesn’t work.

While we in the naturopathic community are flattered to be imitated, real change to the disastrous medical system will not take place until all doctors, not just naturopathic doctors, stop covering up symptoms with drugs and start focusing on treating the underlying causes of disease.

— Thomas Ballard, R.N., N.D., Seattle

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