Attracting and retaining physicians, especially those in primary care, is an enduring challenge for hospitals. Hospitals have begun deploying a strategy to meet this challenge that, at first glance, might seem surprising: including in the mix of a hospital's employed physicians those using a different practice model than most, namely personalized medicine.
Demand for a primary care physician who focuses on preventive healthcare, like the MDVIP personalized model, among the patient population is growing, and providing physicians who practice it is one way to remain competitive in the marketplace while also retaining physicians.
Under the MDVIP model, patients pay an an annual membership fee; in exchange, members receive preventive medical services not usually offered through commercial health insurance plans or Medicare. As a result of the smaller practice sizes required to be able to provide the services, members receive same-day or next-day appointments for urgent and non-urgent care and the ability to reach their physician 24 hours a day via cell phone or email.
Quentin Pirkle, MD, chief physician recruiting officer with Atlanta-based Piedmont Healthcare — a nonprofit, five-hospital health system with two large physician practices located in greater metropolitan Atlanta and North Georgia — explains why Piedmont first became involved with this practice model: "Most physicians in town embracing this were located north of Piedmont's main hospital, so our patients would have to change hospital systems if they wanted to use this model. We came to the realization that we had a large subset of patients interested in concierge medicine."
In fact, the health system entered this market by purchasing a single-physician practice followed by a five-physician practice that included two physicians practicing personalized medicine and three who were not.
"We wanted these practices to become part of Piedmont because a subset of our patients wanted concierge medicine, and we didn't want to lose them," says Dr. Pirkle.
This model is also helping retain physicians. "The physicians [in the personalized medicine model] are very happy," says Dr. Pirkle. "They tell me they are able to practice medicine like they wanted to practice, at a more personalized, comprehensive, slower pace."
Benefits of being hospital employed
William Brubaker, MD, is a hospital-employed internist at Boulder (Colo.) Community Hospital, a community-owned and operated nonprofit, hospital. In practice since 1977, Dr. Brubaker has been employed at the hospital for the last 15 years and went to the personalized medicine model three years ago.
"There are benefits to being hospital employed," he says. "You are not as hassled so much by the day-to-day operations of the office."
Personnel management, meeting payroll, collections and the general business end of a medical practice are largely taken on by the hospital, he notes.
"Being hospital employed removes a lot of those burdens from you," he says. "You have to work through the organization, but it really added stability to our practice."
And, he says, "There are an increasing number of people who want more personalized care."
Dr. Brubaker is not just an employee of Boulder Community Hospital but is also affiliated with MDVIP, a network of personalized-medicine physicians.
"MDVIP takes care of the billing related to the personalized medicine model, so we don't have these billing expenses," he says. "That's an expense the hospital would be incurring."
Helping retain physicians
Dr. Brubaker also sees the personalized medicine model as benefitting medical care in general because he believes many physicians who would have dropped out of medicine had they been unable to transition to this model.
"This is a model that allows us to practice for longer," he says. "I really do believe this is a way to keep physicians involved."
He admits the personalized medicine model faced some rough patches early on. Five years ago, he says the concern was what the community would think about physicians who did this and whether it was a good thing to do or not. However, times have changed.
"I think [these concerns] have pretty much gone away at this point because more and more doctors are doing the personalized care model and people are used to the idea," he says.
Dr. Pirkle of Piedmont agrees, pointing out that such personalized care is not especially expensive.
"I don't think concierge medicine patients are wealthy," he says. "The cost of MDVIP [to the patient] is less than the cost of fully loaded cable TV."
Keeping patients with the hospital
Dr. Brubaker went to the personalized medicine model about 12 years after becoming a hospital-employed physician. His group is made up of 10 internal medicine physicians; he is the only one with a personalized medicine practice.
"When I transitioned my practice, one of my concerns was that my patients that didn't join would all be able to find appropriate physicians," he says. "Those who did not remain with me went to other physicians in my group. It helped others build their practices."
His role in the group has remained largely constant. "My partners cover for me when I am not able to be available," he says. "In return, I cover for them. I take my usual spot on the call roster just like I always have."
Reginald Fowler, MD, internal medicine, is an MDVIP-affiliated physician employed at Piedmont Healthcare. Like Dr. Brubaker, by being employed he benefits by not having to handle the business side of a practice, which he did for over 20 years. The personalized medicine model affords him the opportunity to practice the way he thinks is best. He sees this as particularly valuable in promoting preventive medicine.
"This modelis all about prevention and health systems are paying more attention to this concept," he says.
Regarding hospitalizations, he says, "I didn't have many before [going to the personalized medicine model], but now I have fewer. The time that can be spent with each patient to assess their individual problems is invaluable in this model. The result is more of a holistic approach to patient care ."
Offering patients a closer relationship with their physician is also a competitive advantage. "This is a tremendous marketing tool for hospitals and health systems. Many patients desire the personalized care model," says Dr. Fowler. "There is a tremendous demand for this kind of service, and this is manifested by the patient waiting lists that many physicians have."
"Students have never seen anything like this"
Not only are Dr. Fowler and his patients benefitting from the personalized medicine model, but medical students are as well. For 25 years, Dr. Fowler has trained medical students, physician assistants and nurse practitioners from Emory University. Now he is a clinical preceptor for first and second year medical students at Morehouse School of Medicine. Students accompany him to patients if the patient is comfortable having a student present.
"The patients enjoy talking with the students, and the students have never seen anything like this in terms of the time spent with the patient," he says.
When hospitals and health systems have employed physicians involved with the personalized medicine model, they address patient demand, physician desires and competitive issues. Experience shows that physicians employed by a hospital or health system work well in a variety of facilities, from community hospitals to major teaching institutions.
"This [personalized medicine] has worked really well for me," Dr. Brubaker says. "I think it's worked very well from the hospital's perspective. It's a win-win."
Alan S. Horowitz is a professional writer with over 30 years experience. Specializing in business, healthcare and technology topics, he has been published in Computerworld, The Wall Street Journal, Information Week, Entrepreneur, Fortune Small Business, Software Advice and Advertising Age, among other publications and websites.