Primary care in transition

Joseph Badolato, DO Vancouver, Washington

"I talk to primary care doctors around the country who see 25 to 30 patients per day and they say, 'I don't know how I'm going to do this for the next 20 years-filling out insurance paperwork, getting approvals for patients, fighting patient noncompliance.' There are just so many things working against what you do to help the patient, you get to the point where it really catches up with you."

Karen Engberg, MD Santa Barbara, California

Sanford Owen, MD Gulfport/Biloxi, Mississippi

"My only fear for the future is that the insurance companies will find some way to squash my business model. I went to a cash-only model 4 years ago. I lost very few patients. My income went up, and I have infinitely less paperwork. I take my own calls and give patients e-mail access. I have pretty broad skills, so I can handle 90% of problems that come in, and I insist that my referring physicians go through me for management of a patient's care. That puts fewer time constraints on me because I'm not having to solve problems someone else created."

Richard Roberts, MD Belleville, Wisconsin

"We're trying to improve value by reconfiguring people's jobs so they're practicing at the top of their license. We want doctors practicing medicine, not spending their time completing forms. Nurses can diagnose and treat uncomplicated infections over the phone, so doctors don't have to do it. Medical assistants can put patients into rooms, freeing up nurses."

Andrew Selinger, MD Bristol, Connecticut

"We'll be forming an accountable care organization as of January. We're trying to figure out how to deliver value and save money on the 5% of patients who use 50% of practice resources. It's a tremendous amount of work, developing clinical leadership and getting the doctors to reorganize their care teams and understand maybe they're going to spend less time seeing patients as we shift from volume to value. So it's going to be a huge shift in the culture and how we operate day to day."

-By Jeffrey Bendix, MA,
Senior Editor