I built an empire nobody wants

Building an atypical empire in family medicine: ©Jackf - stock.adobe.com

As I approach my 66th birthday, I contemplate this vocation I love and wonder if there is anyone left out there that wants to have it. Family medicine has been particularly good for me. Career earnings over $15 million, annual income over $600,000 for at least the past decade and now, the ever-popular three-day workweek. I am not sure why my empire is not in demand; I suppose because my career was built so atypically.

I came to this wonderful Iowa town 31 years ago. A typical Iowa county seat community of 5,000 residents and a county population of 25,000. The Eastern Iowa airport is 30 minutes away and I have used it to fly to places across the globe. Upon my arrival the community hospital had been “integrated” into the Iowa Health System, which had decided it really was not of value to the system, and they recommended closure.

The integrated system did not see value in family medicine either, offering everyone the same “statewide contract” based on RVUs that they could not explain. That is when I decided to take an atypical and unique approach. I did not take the statewide contract, and we did not close the hospital. Instead, we built an empire. We now have a new and paid for critical access hospital surrounded by four rural health clinics. We make it run with four physicians and about 20 PA/ARNP providers.

Recruitment is now impossible. The system has changed family medicine from a calling to a 9 to 5 job. “You need to remove the word ‘call’ from the ad, or nobody will respond,” the recruiters tell us. “But we pay for the call, and it is exceedingly rare to actually need to come in!”“It doesn’t matter, that isn’t the market anymore.”

I do not have to answer the system bosses, I do not have to have an RVU contract. I can set my own hours. I can live as freely as possible in this new paradigm, and I can economically thrive, but the new medical residents flock to the statewide contract and the narrowest of definitions of family medicine.I can take home a known and easy-to-calculate straight percentage of my “net revenue” without RVU obfuscation.

Consistent with this independence, the scope of practice I have enjoyed is no longer allowed in the system. My patients are not added to six-month wait lists for colonoscopies at GI monopolies in the city, as I choose to do them myself. Many thousands of them. Yes, I had to endure the disdain of specialty colleagues, but it did not hurt too much. They do not have the county in Iowa with the lowest morbidity and mortality rates of colon cancer, because that county is where I live and practice.

I also do my own vasectomies, skin surgery, upper endoscopy, stress tests, pulmonary functions, thoracentesis, paracentesis, joint injections, and essentially anything else family physicians used to do quite frequently, before the residencies left the hospital and promoted the profession as a 9 to 5 job specializing in referrals. I do not really practice similar to what is now taught and expected, but I can click the boxes and game the metrics with the best of them. My services seem to be in high demand, I would like to go a few more years and find a rare atypical young doctor who also may want to take the atypical path. Is there one out there?

Practice revenue source key:

50% "cognitive" (CPT 99024-99459) $1,146,907 gross revenue
27% "procedures hospital" (CPT 43239-69210) $534,008 gross revenue
13% "G codes" preventive $155,273 gross revenue
4% "office skin procedures" (CPT 10060-17280) $89776 gross revenue
2% "joint and tissue injections" (CPT 20526-20612). $74894 gross revenue
2% "other procedures" ( CPT 90460-98927) $84051 gross revenue
2% "fracture care" ( CPT 25600-29580) $9,999 gross revenue

I have had my share of the typical accolades. Lifetime Achievement Awards from my teaching of PA students from the university, and the same from the State Osteopathic society which I have served as president of. I also served a term on the Board of the American Association for Primary Care Endoscopy, a similar group of like-minded physicians also lamenting what has become of our profession. I have served on numerous boards: emergency, trauma councils and the lists are long.

Medical directorships of usually four nursing homes at a time, an occasional hospice if needed, and the County Medical Examiner for thirty years. Done a lot and seen a lot is one way to look at it. Managed to stay married and raised a family of four and now four grandchildren. Why does no one want to do this anymore?

Now I have moved from quiet Vinton to bustling Waukee, the fastest growing town in Iowa, a western suburb of Des Moines. I found all the young doctors, they are in groups of twenty or more here, working 9 to 5 and not taking any calls. I am confident they are not making $600K+ and I am sure they will not have $15 million careers. They do not want that. What they want is work-life balance. I have a little secret: I had excellent work-life balance.

They will never see the things I have seen or will do the things I have done and still do. I now do half time in Vinton, Monday until Thursday noon, then I come back to my “semi-retirement” house in busy Waukee. It makes me wonder what will become of this little empire that has served the community well. I have also taken the time to be an expert witness to successfully defend a family physician I did not know who had a rare colonoscopy complication.

I do not teach residents anymore. The same executives that tried to shove the statewide contract and their narrow definition of family medicine down my throat went on television to announce that they were closing the residency “because family physicians do not offer anything more than ARNPs”.Because they made it that way!I teach
PA and ARNPs now because they are eager to learn, and might actually use it.

I now have a net worth over $4 million. Not bad coming from nothing. Helped my kids and grandchildren probably more than I should have, but still enough to comfortably retire, yet I hang on for the hope that someone else will come along wanting to still be a doctor after 5 o’clock when a PA might need some phone advice. It is an added bonus that I still love what I do.

Brian Meeker, D.O., FAAFP, practices in Vinton, Iowa.