A no-insurance practice works for one internist

I attended a dinner "CME"talk a month or so ago. Across the table was a physician who I knew as an oncologist with whom I had patients in common 10-12 years ago. He was a partner in a local clinic at the time but now he had changed to a solo private practice.

"I ain't gonna work on Maggie's farm no more"

He still sees some oncology patients, some left over from his old practice which he had left 3 years ago but basically he does general internal medicine which he said he enjoys a great deal. He said he accepts no insurance at all including Medicare.He spends as much time as he needs/wants with each patient.Typically one one hour plus with a new patient and typically 30-45 minutes with an old patient but often an hour if he hasn't seen them for a while. He tells me he gets almost no calls at night or on the weekend. He has a receptionist and a nurse and the receptionist collects most of the fees at the time of the appointment and for the rest he has a contract with a local accounting company to do the followup billing.There is no back room of three clerks calling insurance companies which my dermatologist needs to run his practice.Almost all of of his new patients are referred by former patients or their families.

The clinic where he had formerly worked had progressively restricted the time he could spend with a patient.It was down to fifteen minutes but right before he left the administrator and the executive committee agreed to require three additional patients per 9 hour day.

There are no insurance company clerks to call to approve a test, he feels no pressure to report to Medicare his quality indicators and he does not worry that one day he will be told by one of his patients that he has been delisted by their insurance company because of quality issues.

He tells me that every day for the last five or six years in his old practice he went to work mad and came home madder as third party payers demanded more and paid less and as his partners tried to adapt to it all by making more demands on everyone. Now he goes to work and looks forward to the day much as he did fifteen or more years ago.

His practice is not the concierge practice in which patients may pay a yearly fee to have ready access to their physician rather his is all pay per encounter.

His practice may not be for everyone but he seems to have made it work.More power to him.

"Well, he hands you a nickle
he hands you a dime
he asks you with a grin
if you're having a good time" ....

"No I ain't gonna work on Maggie's farm no more."

Quoted Lyrics are ,of course, from Bob Dylan ( copyright 1965)