The Thrill of a Solo Community Practice
Pamela L. Wible, MD
Lane County Medical Society Journal, August, 2005
Six weeks ago I opened a solo family & community medical practice in Eugene, Oregon. To assess the medical needs of my community, forums were held in neighborhoods and community centers throughout the region in which I facilitated discussions on the “Ideal Medical Clinic.” People were encouraged to share their wildest dreams and most creative visions in round table discussions which were incredibly lively providing fertile material for the co-creation of a true community-based medical practice. Within one month, ninety percent of the community input was incorporated into a fully functioning solo “Family & Community Medicine Clinic.”
So what does this “ideal” clinic look like?
The clinic is housed in a wellness center tucked in a wooded residential area just one mile from my home. The center features yoga, massage therapy, counselors, and a full size solar-heated, wheelchair-accessible indoor pool and hot tub. A covered walkway connects the pool to the cozy medical office space complete with overstuffed chairs, pillows, and fun flannel gowns.
Patients enjoy 24/7 access to their very own family doctor including hospital care if needed. Appointments are thirty to sixty minutes scheduled on weekday afternoon/evenings with same day and weekend options. I enjoy a leisurely bicycle ride to the office on days with scheduled patients and reward patients if they walk, bicycle, or use public transit to their visit with a selection of gifts (local handmade soaps, lotions). Other gifts (massage or body work) honor major behavior or lifestyle changes. Generic antibiotics are dispensed on-site so ill patients do not have to wait afterwards at a pharmacy. Novel voluntary programs include healing circles, a quality improvement team made up of patients, chronic disease support groups, and a variety of volunteer opportunities for skilled patients to serve other patients with special needs.
The community medical practice operates with no grants or outside financing beyond the small amount I contribute to buy furniture and supplies. I rent an office space for $280/month and with no staff I have extremely low overhead. My home business office is where I handle my phone calls, billing, and charting on my laptop computer. Malpractice insurance is inexpensive (discounted fifty percent) as I work part time. Insurance is accepted and uninsured patients are given at least forty percent discount with barter options available. Financially, I will likely exceed my prior full time salary.
Some of my colleagues want to know what it is like in a “spa” practice. There is a concern that I will serve the “worried well” rather than real medical patients. My very first “spa” patient was an uninsured, whimsical, twenty-five year old, thin male with a blood pressure of 220/120. Within one week, I diagnosed him with a renal artery stenosis due to fibromuscular dysplasia, a rare condition neither myself nor any of my colleagues have ever seen. I accompanied him to angioplasty which was curative. His blood pressure normalized to 118/80 without medication. It was academically and personally thrilling to be there beside my patient through every facet of his treatment. Late that evening, I brought the family and patient into the radiology department to recreate the amazing scene showing the catheters, wires, and film images which they kept as souvenirs. We all stood there silently in awe. I now have the luxury to stand silently in awe with my patients marveling at life itself.
What was this experience worth?
I waived my portion of the hospital bill as I was simply having too much fun! My patient did give me ninety dollars and his parents, local artisans, made me a beautiful hat.
Pamela L. Wible, MD is a board-certified family physician in Eugene, Oregon.
She opened the Family & Community Medical Clinic on April 1, 2005.