A Letter from Dr. Norcom

A New Medical Model

When I was very young, I learned from my grandfather, that the quality of any action or activity was more important than the quantity.  I have beautiful memories of him and his peach orchard. Shining summer afternoons - beholding in amazement the color, shape, texture, tone of a quality peach, and his detailed description thereof.  He worked the orchard himself, with his own hands and tools, well over two acres of peach trees. “Coppertop, we may not bring as many peaches to market as some growers around here, but I like to sell good peaches” He sold his peaches direct to the consumer.  The transaction made sense to me as a boy.  It still does.

US physicians, beginning as early as the 1950’s, began accepting “middle man” payment for the care they provided their patients.  Without a direct fiscal relationship between doctor and patient the current “system” in the United States is under great economic and quality pressure to take care of more and more people with less and less qualified doctors. Our population is exploding – it has doubled since the 1970’s.  And it is aging rapidly.  Due to widespread physician dissatisfaction the rate of doctors entering practice in general/primary care has been dwindling slowly each year for the past sixteen years.  And doctors are retiring earlier now than ever before. The sum of these changes equals an impending/occurring crisis resulting physician burnout and decreased quality of care.

I practice medicine because I love taking care of patients.  I love medicine. My career has been extremely rewarding and at times very frustrating/disheartening due to lack of autonomy and inadequate time to thoroughly listen and address patients’ needs. I learned in medical school that the patient describes their illness and the doctor listens, and then interviews the patient in detailed way.  In the current system this crucial first step in medical care can’t even fully occur.  Physician economic trade journals are replete with articles on “how to manage the ten-minute visit”, etc.  Ten minutes is an insanely short amount of time for even proper care for a sore throat. Most docs work on a strict 15-minute template (some a 10 minute template or six patients per hour!). The 15-minute orchestration gives them effectively about 10-12 minutes with each patient, with 4-6 for diagnosis/listening/physical exam and 6 or so minutes for education and discussion of treatment – pressuring decisions and squelching thoughtful analysis.

In the late 1990’s I grew a practice from zero to 2700 patients in three years; as this numerically “successful” practice grew the quality of the care I provided - even with longer hours at the office and intense effort – decreased.  I cared deeply for these patients and found it increasingly frustrating to not be able to give them enough care. I subsequently worked in the “urgent care” arena for a few years – the place where patients go when “their” doctor “can’t” see them.  I learned so much during this time about the inadequacies and access issues that people face on a daily basis when trying to obtain care from their “PCP” (Payer Contracted Physician – to coin a new title).  I don’t want to be your PCP, I want to be your doctor, the old-fashioned kind – the kind that listens well, thinks cogently, cares about every single decision, and sees you when you’re ill and well – who focuses on you as a whole person – not an insurance code.

Practicing medicine is a sacred art.  I have dedicated the whole of my adult life to it. I have been told by colleagues and patients that I’m good at it.  But no physician can consistently provide high quality of care at a clip of 30 plus office visits per day, and practice populations from 2,500 to 4,000 patients and rising.  These numbers are astounding but, sadly, real. There’s a great chance that this is how your current doctor practices. I know, because I’ve spent my career working within this “system” (more like a factory).  The practice of medicine in our country, the “great art and noble endeavor”, has been relegated to the business of “marketing efficiency models”, and the cold diagrams of insurance actuarial tables.  Physicians and patients alike have been left paying the real price – decreased quality of the doctor-patient relationship and decreased quality of medical care.  Incidence rates for control and screening for major illnesses is bereft with examples of gross inefficiencies in care.  Doctors are patients as are being burned by a business model focused on quantity, instead of quality.  And the picture is worsening rapidly.

Rates of physicians not accepting new Medicare patients are at an all-time high and rising.  Medicare reimbursement for physician services has dropped yearly over the past many years, for both general and specialty care.  Many Medicare patients are left obtaining care.  Private insurance premiums have risen over 50% in the last decade while primary care physician salaries in some markets, including the Northwest, have not kept pace with inflation.  Primary doctors are strained and stretched more than ever, and it’s showing in the care they provide.  Somewhere along the way we’ve all forgotten that the relationship is between the patient and the doctor, medically and fiscally – that’s the only way it can work well.

Frank Norcom of Bixby, Oklahoma, grew peaches – really good ones.  He grew them because he loved it. He grew fewer than his competitors, and his customers could see and taste the difference. I ate hundreds and hundreds of those peaches. I love good peaches. My grandfather was a giving and charitable man.  He believed in quality.  So do I.  Call me if you feel the same way about your health.