“I’m as mad as hell and I’m not gonna take this anymore!!!” (Peter Finch’s character Howard Beale in the movie Network)

Many years ago I became very discouraged by practicing medicine in the era of managed healthcare. Because of this I made a transition in October, 2005 from an academic medical practice with the UCSD Medical Group, where I was for the previous 15 years, to a solo private practice in Family Medicine in the beautiful north coastal San Diego County town of Encinitas. I did this in a personal attempt to provide quality service to my patients and to develop better relationships with them in a way that was done before the drastic changes brought on by managed healthcare. I put a great deal of time, energy, and thought into this endeavor, and this website is intended to explain the how and why behind my medical practice design. The website is very wordy, and it's certainly not flashy, but the content is sincere and necessary for potential patients to understand my medical practice.

In a typical family practice a physician is responsible for 2000-2500 patients (sometimes more) and needs to see 20-25 patients each day (also sometimes more). That makes it difficult to see patients when they want to be seen, to do so on time, and to spend the necessary time to maximize the benefit from an office visit. Little time is left for other necessary office activities such as phone calls with patients and specialists, medication refills, and review of test results. My goal is to have a much smaller number of patients so that I can provide care that is much more responsive, thorough, and personalized. Also toward this end I am on-call for my patients 24 hours per day almost every day of the year

I designed an idealized medical practice that meets many of the goals of the Institute for Healthcare Improvement, the Ideal Medical Practice (IMP) project, and the American Academy of Family Physicians’ “Future of Family Medicine” project. Features include office visits that are same day or next day, on time, and not rushed so as to maximize the care of the patient and deal with more than the surface of a medical or psychosocial problem.

The "direct practice" financial model that I worked out combines 2 different practice styles that are gaining increasing popularity. One is based on a practice membership fee model that goes by various names such as boutique or concierge medicine. The other is to be a cash-only practice, also known as being insurance-free. This refers to having no insurance contracts and collecting full payment at the time of service for an office visit (no billing clerk is needed). Patients will leave my office with a form that can be submitted to request reimbursement from fee-for-service insurance plans. Office visit fees will also be reimbursable by health savings accounts (HSAs), many of which now provide debit cards for easy access to account funds. My practice works best for those who want to be active participants in the nationwide movement toward consumer-directed healthcae.

My medical records are electronic (no file clerk is needed). My phone is answered by me or my daughter Chelsea when she is in the office helping out. I take vital signs, give shots, and run EKGs (no medical assistant is needed). My office is small but comfortable in space (I don’t need a large reception area or many exam rooms) and small in volume (no practice manager is needed). All of these features combine to greatly minimize the overhead cost of running the practice and allow me to pass that savings on to patients in terms of keeping the practice small (around 500 - 600 patients) and keeping the practice membership and office visit fees relatively low. The fees that I charge for procedures will be 20-25% less than Medicare rates, which are already discounted compared to what is typically paid by private insurance or cash-paying patients.

Some medical practices charge patients for itemized services that are not typically reimbursed by insurance companies. These services include telephone consultations, email consultations, prescription refills, and completion of medical forms. These services are covered by my practice membership fee, which fits my practice into the model of medical practices that charge a flat fee for non-covered services (these are known as FNCS practices, with FNCS standing for fee for non-covered services).

Medical science is not perfect, which I guess is why we “practice” medicine. There is also an art to the practice of medicine, and to the greatest extent possible I work with my patients to make medical care decisions based not only on published guidelines, best practice performance, etc, but also on patients' personal preferences. I do my best to avoid unnecessary tests and avoid costly treatments when less expensive ones would work just as well.  When cost is a factor in medication choices I look up prices on line.  My relationship with patients is highly dependent on mutual trust and respect.