Dr. Albert Fuchs is an ethical purist. That much is clear from our podcast interview today in which the Beverly Hills internist shares his views on his transition from an overworked less-than-satisfied traditional medical practitioner to a streamlined, calm, happy doctor with no immediate plans to quit his concierge practice.

At a patient's urging, he explored the concierge or retainer practice model, discovering its many variations. And realizing that, by cutting back dramatically on his patient load, he could once again become the real physician he had dreamt of being in his medical school days.

Seeking the mentorship of a family member with business experience, he began the transition several years ago by severing ties with the healthcare insurance industry, first with the PPOs and a year later with Medicare.

Paradoxically, he argues that, instead of contributing to the creation of primary care shortages with this model of care, he sees that students considering medicine as a future career are more likely to consider primary care when exposed to the role models of contented physicians providing the care they most enjoy giving to their patients! As opposed to the image many are witnessing today of harrassed, irritable doctors rushing from patient to patient, handling 5 phone calls between rooms, in order to make their "quota".

His advice:

• decide on whose behalf you are truly willing to work and who your customers really are - insurers or patients?
• take the high road and offer only those services and that care that is evidence-based. Keep it ethical - only offer what you would have done unto you!

Listen to The Entrepreneurial MD Podcast with Dr Fuchs's refreshing account of how he chose to re-align with his deepest professional values, in his quest for his vision of an ideal practice.

And then rejoin us here for your comments and opinion!

What does it take to liberate one unhappy urologist from a bleak unending future as a physician group associate?

Answer: A powerful guiding vision.

Dr. Richard Schoor is a Smithtown NY urologist who, relatively early in his practicing career, has already accomplished three great things as an entrepreneurial physician:

1. He has built a solo specialty practice, with the guidance of his own Grand Vision, and is en route to the much bigger dream
2. He has carved out a niche for himself as a male infertility sub-specialist, in a crowded field, thereby turning his potential competitors into a source of referrals
3. He has begun building a web presence and "platform" for his name and practice using 21st century marketing tools, and has already reaped the benefits. He is the author of an acclaimed blog -- The Independent Urologist.

Since I teach and encourage each of these principles, in my eyes that makes him an up-and-coming star entrepreneurial physician business owner!

Listen to Rich Schoor MD tell his story of how he escaped the "safe" trap of group practice, and opted instead for the elation of independent solo practice (it's less than 20 minutes).

And then please rejoin us here to share your thoughts and questions.

Andy Oakes-Lottridge MD is an intrepid family physician entrepreneur who is now having as much fun building his practice, Personalized Health Care, as he is delivering medical care -- right in the homes of his patients.

As one of the growing number of physicians with concierge or membership-style medical practices (known to some as "boutique practices"), he opened his doors (actually the doors of his Honda Accord car) almost three years ago after recognizing some significant limitations to traditional group practice.

However, instead of opting for an office-based practice, he has chosen a practice in which 100% of his patient visit are home visits. Talk about keeping overhead down!

At The Entrepreneurial MD Podcast, you can enjoy his refreshing story and appealingly candid insights about life as a concierge home-visiting doctor in Fort Myers in the Southwestern part of Florida, and then rejoin us at here to add your comments or questions!

Joshua Schwimmer MD over at The Efficient MD has put together a comprehensive overview of the appropriate use of patient-physician email. He speculates as to why medical practices and healthcare organizations are late adopters of email as an efficient means of communication, and then suggests some ways that email may be used:

 over at has put together a comprehensive overview of the appropriate use of . He speculates as to why medical practices and healthcare organizations are late adopters of email as an efficient means of communication, and then suggests some ways that email may be used: has put together a comprehensive overview of the appropriate use of . He speculates as to why medical practices and healthcare organizations are late adopters of email as an efficient means of communication, and then suggests some ways that email may be used:

 

• Asking about lab results
• Reporting potential side effects of medications
• Clarifying whether it's safe to take a certain medication
• Reporting home blood pressure readings
• Reporting blood sugar readings
• Giving positive feedback
• Giving negative feedback
• Asking for prescription renewals
• Reporting new minor (but important) symptoms
• Communication new medical issues when out of the country
• And many others

I enjoy being able to communicate with my own physician using the RelayHealth platform, and am usually delighted to get a quick response. It certainly saves playing phone tag.

Dr. Howard Stark, in a recent Entrepreneurial MD podcast, sang the praises of his tranquil office. His receptionist's phone seldom rings, as most of the communication with patients is handled via his "invention" - a web-based encrypted, HIPAA-compliant virtual office now available to other practices from DoctorsOnTheWeb.net.

Check out the brief MSNBC video with Matt Lauer and Dr. Nancy Schneiderman on Dr Stark's site! They discuss the future of email in medical practices.

What are your thoughts?

There appears to be a flurry of development of web-based applications to facilitate doctor-patient communication, as well as practice management.

Until now, insurers have been slow to reimburse for e-communication, making its adoption much less attractive to even the most tech-savvy physicians. Unless they've figured out a Return on Investment (ROI) elsewhere in terms of reduced staffing needs etc.

From an article at philly.com today, "Insurers look at virtual visits to doctor" ,

"Aetna Inc., one of Philadelphia's dominant insurers, and Cigna Corp., which is based here, have announced that they will pay for doctors' visits on the Web. Aetna expanded a pilot program in California, Florida and Washington to the rest of the country on Jan 1. Cigna will start paying in January."

The physicians interviewed for the article held mixed opinions as to the value of the proposed coverage. Some were all in favor of communicating via the web and  getting paid to do so, while others were obviously leery of the trend, citing quality concerns. Patient opinions are also obviously all over the board.

I've interviewed one physician whose life in practice has been dramatically improved by the use of email (without reimbursement) instead of the phone -- Dr. Stark is all smiles about life on the job these days, and I bet he'd smile even more if he were being paid for his email communications.

It is also possible that once patients are accustomed to paying a co-pay for the convenience of an Internet visit, they may be willing to pay for that same visit in a practice that offers the service and doesn't take insurance (like many of the concierge or micro-practices). 

Of course, the million dollar question most practicing physicians are asking, as they look enviously over at their lawyer buddies, is: Can charges for phone calls be far behind?

If you were reimbursed for your time writing emails or using web communication, what difference would that make to the way you practice?