The business of family medicine

Every day that I walk into the family medicine office that I'm currently assigned to, I'm smashed over the head by the realities of why I could never go into primary care: the business side of medicine.

On the surface, family medicine conjures up warm-fuzzy images of the iconic practice model of a strong doctor-patient relationship that creates a forum for the patient to address all of their concerns and for the doctor to manage the patient's medical problems and prevent future illnesses from coming up. In reality, the whole enterprise is a bit like speed dating: get the patient/date to talk about themselves for a few minutes, drop some one-liners and patient's/date's , give them your number, tell them to call you soon and move on to the next one. Maybe they call, maybe they don't...who cares because I'm gonna see 30 others today.

To continue my god-aweful dating metaphor, the entire venture of family medicine is a bit like the 20-something bachelor's dating scene. You make your game (practice) as attractive as possible by adding on as many bright-shiny things as possible: the bachelor pad (a pimp office with lots of room), the interesting friends (in house cardiologists and endocrinologists), the stylin' wardrobe (custom embroidered white coat) and the reputation ("You should go see Dr. Bostonian, I hear that his 'practice' is enormous. All of his 'patients' that I've talked to have been extremely 'satisfied', but I hear that he his 'visits' are usually less than 5 minutes.") In the background you've got several other things going on...the cougar (the nursing home gig), the druggie (methadone clinic), the groupies (drug reps/speaking engagements) all vying for your time and energy.

Ok, I'm done with the crappy metaphor.

In reality, I've been studying medicine for the past 2 years and I don't have a lick of business sense. There is little-to-no appeal in spending a decade building a practice after all of the hassle of medical training and residency. A lot of people heading into primary care assume that they'll be able to find some doctor that is on the verge of retiring and will just take over their practice...I'm not willing to gamble my well-being on a capital-venture project or some dude deciding to hang it up. I really don't see myself becoming a savvy business person who battles day in and day out to keep his practice in the black by working 3 other jobs so that I can use that money to cover the practice overhead while I wait for insurance reimbursements. It's simply not what I came to medical school to do. I came to learn to practice medicine, not to run a business.


Albinoblackbear said...


I see what you're getting at but yes, the patient/dating analogy is a bit sketch...hahahah.

If you're bored (does that ever happen anymore?) check out www.cbc/whitecoat and listen to the podcast from Aug.11th 2008.

His show is very well done and he speaks to exactly what you are talking about in that episode.

Highlights include how many family docs go bankrupt or are now subsidizing their practices with cosmetic features like Botox etc.

Bostonian in NY said...

Trust me, I still get bored...but now I have Netflix (TM) so I can stare at DVDs of all the movies/TV that I've missed for hours on end instead of actually thinking about things to write about in my world.

Your link is missing the .ca so it kicked me over to some strange Japanese version of youtube (TM). Thanks for the hours of japanese humor as well as for the link to public broadcasting...hopefully CBC will have less pledge drive programing than my usual NPR selections.

Bostonian in NY said...

Now you've gotten me in trouble...I sent Dr. Goldman an idea for a segment and he emailed me back within about 20 minutes of me sending it...

M said...
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M said...

Oh, I had to laugh at this. General practice weirds me out on so many levels. I wonder how they'd react to the dating allegory? It's quite clever and unsettlingly close to the truth.

Australia is funny in that the metropolitan areas are inundated with GPs whereas the rural areas can have a really appalling doctor to patient ratio.

The suburb that I live in is about a 20 minute drive from the central business district but it's some sort of massive doctor's hangout. There's a large private hospital, four general practices and private ob-gyns, peds and orthopods dotted around the area. (There are probably a lot more, I'm just listing the ones I know of.) It's like a cheap and dirty version of Harley Street. With kangaroos.

As a child, I always thought that a GP's job as to wear a stethoscope and write down names of medicine. Yeah, impression hasn't changed much. /lynched

Albinoblackbear said...

HA! That is rad! Dr.G is awesome. His show is one of the many CBC podcasts I subscribe to and have yet to hear a boring/irrelevant show.

Sorry about the Japanese site--I've gone there by accident before myself!

And CBC is pledge-drive free so...g'head and enjoy an excellent product from the land of milk and honey. "Ideas" and "Quirks and Quarks" are two other wicked programs.

Okay, I have officially outed myself as a complete nerd on the www. Sigh. No shame.

Dragonfly said...

I have ZERO interest in setting up a business.
You forgot to mention that the GP business is ALWAYS running behind (though it is a possibility for me).

The Lone Coyote said...

The business side of things is what led me away from FP in the end. But the reality of medicine is that no matter what you pick, there is no escaping it. If you are a consultant you are essentially doing a customer service pitch for other physicians to get them to refer their patients/business to you. It never ends.