'Holding onto the primary care dream'

Melissa Lucarelli, M.D. Photo by Narayan Mahon

As part of our 100th anniversary issue, we wanted to compare medical practice in 1923 with practice today.

The first doctor we thought of was Melissa Lucarelli, M.D., one of our editorial advisers.

Lucarelli is a board-certified family physician and medical director and owner of Randolph Community Clinic in Randolph, Wisconsin. She is an independent physician who has to navigate all the challenges of practicing today, but her enthusiasm for primary care and her patients made her an easy choice for this project. We spoke with Lucarelli so our readers can learn more about her.

The following transcript was edited for content, length and clarity.

How long have you been at Randolph?

Lucarelli: I started in 1997. I was originally recruited by the University of Wisconsin on behalf of a retiring solo family practice doctor whose practice they had purchased. They hired me straight out of residency. I worked as a university employee from 1997 to January 1, 2001 when we purchased the practice back from the university. I’ve been independent since then.

Can you tell me about your practice?

Lucarelli: We have approximately 6,000 patients in a town of under 2,000 people, so we draw from the surrounding area, which is mostly rural. We’re about 20 miles from three little hospitals. I have privileges at two of them. I don’t do inpatient medicine anymore, but I still do stress tests at them.

At our clinic we have a clinic manager, a billing clerk, and a full-time receptionist who also tracks all our referrals. She also does most of the prior authorization tasks for imaging. I have one registered nurse. She’s also our chronic care coordinator and does most of the help with prior auths for medications. I have three medical assistants, a nurse practitioner and a physician’s assistant, and a cleaning person.

How many hours per week do you work?

Lucarelli: I’m at the clinic four days a week and I’m always there by 7:30 a.m. and usually out by 6 or 6:30 p.m. On Thursdays I mostly do administrative stuff. Honestly, I don’t know the total. Some weeks it’s probably 50 and some it’s 80-90. It just depends. I’m on call 24/7.

Did you always intend to practice in a small town?

Lucarelli: My original intention was to be an engineer. I attended MIT, but my heart wasn’t in it. Then I volunteered at Mass General hospital and I found I loved medicine. So I shifted gears my senior year and specifically went to medical school to become a small-town primary care physician. I’m from a small town so I went through medical school trying to see everything through the lens of a small-town family physician. I focused on getting the tools and knowledge I needed to do what I’m doing now.

At Mass General I liked the experience of dealing with the whole person, of being able to say they came in with a backache, but what’s the differential diagnosis and what are the things we need to consider? What have they been doing lately, what do they do for a living? I also liked rounds, and having different parts of the medical team communicating and trying to help each other to figure out how to help
a patient.

What do you most enjoy about what you do?

Lucarelli: I have the luxury of being able to sit with a patient and be present with them, figure out what’s going on with their health and help them navigate the health care system. That’s very fulfilling for me. I’m not totally unfettered because we still have to navigate insurance and prior auths and the whole thing everyone else does. But as long as we can still swing it, I’m still holding on to the primary care dream here.

I’m blessed with my staff. Patients tell me every day, “You have such nice staff.” And they are nice, but they’re also focused on the mission. We’re all on the same team and we all get along. My oldest staff member is 72 and the youngest is 19, but we all get along and people are respectful and understand that everyone has different ways of doing things. I think that makes a big difference.

Can you spend as much time in the exam room with patients as you’d like?

Lucarelli: Yeah, most days. If somebody needs more time then I bring them back.

But you don’t feel like you have a daily quota of patients you have to see?

Lucarelli: I don’t feel that in the moment, but we need to keep the lights on. And most patients understand that. They know we’re not a nonprofit. We try to avail ourselves of any kind of (financial) programs we’re eligible for. We’re in some value-based care programs where we get some extra money from Medicare. And we’re doing transitional care management, chronic care management, home health care supervision. We try to do as many of the little pieces as possible.

Do you feel any special challenges from being a female physician?

Lucarelli: Not in the way I thought I would. When I took over I was afraid all the male patients would leave. A couple did, but for the most part I haven’t had a problem because I’m a woman.

I’d be silly to say it’s never an issue, but I went to an engineering school where only 32% of the students were women. And I was an Army kid so I guess I’m used to the dynamic of being an assertive woman in a room full of men. And it’s still that way. When I go to physician leadership meetings and things like that often it’s still majority men. And a lot of that is because women docs are still assuming traditional home/mother gender roles and don’t have the time or bandwidth to be able to do as much of the leadership stuff because you want to make sure you’re there for your family.

Recently I went out to dinner with two other female doctors. We try to get together periodically and just share our experiences. It’s kind of a mental health dinner. “We always talk about stress in the midst of talking about what we’re doing with our lives and our families.”

What do you like to do when you’re not working?

Lucarelli: I usually will pick a project and really focus on it. One thing I started in the pandemic is plan a vacation to Italy. I’m learning Italian using Duo Lingo and YouTube. We’re staying at all off-the-beaten path places which is why I’m learning Italian.

I teach at the University of Wisconsin School of Medicine and Public Health and I am a regional admissions interviewer for my college. My college also has an alumni club where we go to events together and have picnics and go kayaking.

Any regrets about choosing family medicine as a specialty?

Lucarelli: No. It’s my thing. It’s what I do.

Do you have any advice for medical students considering family medicine?

Lucarelli: I think family medicine is amazing. My advice would be if you like helping the whole person and like continuity of care and if you get frustrated when you can’t finish something, if you’re that kind of personality family medicine’s awesome. I think we’re the only specialty that can follow someone through the continuum of life. You can take a little baby and care for them all the way into the nursing home. I have multigenerational families I’ve taken care of. I have people who come to me from really far away because they see value in that relationship.

A century of primary care transformation: Table of contents

• Introduction
• Chapter 1: 1923 vs. 2023: A doctor's daily life
• Chapter 2: Rise of the specialists
• Chapter 3: How insurance changed everything
• Chapter 4: The malpractice threat
• Chapter 5: The vanishing independent physician
• Conclusion: What the future holds
• 'Holding onto the primary care dream:' An interview with Melissa Lucarelli, M.D.