Another primary care practice bites the dust

Annie responded to a question: "Why are you quitting your primary care practice to become a hospital doctor [hospitalist]?"

Hi Katie,
I am happy to share my experience as it develops.  I am not yet in the new job, but can tell you that it was sort of by accident that I have drifted into the hospitalist role.  I did not set out to find such a job.  Initially I was looking for a hospital or community supported outpatient situation in another state to ease a transition back to IMP-dom [Ideal Medical Practice] in a more favorable economic environment (having finally accepted that Lexington IS a very toxic dead zone).  Alas, when push came to shove, my husband, who initially said he would consider moving, dug in his heels and said he wants to keep his practice as is until he retires (he is 64 and thinking of retirement over the next 3-5 years).

So, off to the marriage counselor....decide to stay married after all.......And look for something workable.  Interviewed with the prison system.  YUCK.  Talked with a house call only company in Cincinnati...sounded OK, but too far to comfortably commute daily.Talked with the health department....realized I'd last a few weeks before the bureaucratic headaches drove me insane.     Then got a call from a recruiter about this hospitalist job.  Seven days on, seven days off....hmm...

As I mulled that over, I continued my constant internal "post mortem" on my practice and why I am finally giving up.  Decided that the final straw has been Medicare part D.  The incredible burden of pharmacy management along with the demands of being a "medical home"  (read "unpaid customer service department for every other part of the healthcare system") has meant that I now do three days of free service for every two days of actual patient care, and "consumer directed" health plans have meant that more and more often I never get paid at all, even for the actual patient visits.    All of this adds up to my loss of faith that primary care will survive at all, at least around here.  And since moving to Oregon is off the table, that tipped me into the "I'm not only quitting being an IMP, I'm quitting primary care.  Period."

So I went to the town with the hospital job.  It's an hour and 20 minutes from Lexington.  The hospital is smallish (94 beds) but in good condition, and even has a cool robot that specialists from Louisville use to "consult" (I can't wait to see how that works).  Everyone I talked to seemed genuinely happy and to like each other.  They have one hospitalist now, and he's been doing it mostly by himself with some help from a locums that the recruiter who called me provides.   The census runs around 8-12 most of the time now, and the most he has ever had was 22 on one Saturday.  (the hospitalist I have covered for in Lexington keeps a census of 18 to 30 most of the time, so I have come on board with 22 patients, all new to me, at one time on several occasions.  Can't say I enjoyed that, but proved I can do it if I have to).  Obviously, if it is going to survive long-term, this hospitalist program will have to grow some, but they seem committed to making it a reasonable growth plan.  They don't want to risk starting it and then having the hospitalist docs quit and leave.  The CEO knows that she has only one shot at satisfying her local primary care community if she is going to get their business, so she is ramping up very slowly.

Then there is the town.  I won't bore you with all the prosaic descriptions of small town characteristics. Suffice to say that the hospital has farm land on two sides, the stock yard is right next door to the Wendy's, and I could buy farmland there for about 20% what I would pay in Lexington.  In short....I love it.  My husband also likes it enough to consider retiring there, and meanwhile it is an easy drive for me to make each week and he can visit midweek if he wants, or not, because I'm taking a horse or two with me each week so I won't be lonesome.

When you consider that I will be making five times what my practice has been paying me, plus all the typical stuff like health insurance, actual PAID VACATION...( I haven't taken a vacation except IMP Camp since 2004)....  Well, I'd have to be pretty stupid not to give this a try.

Stay tuned for how it works out.  My first week on the job starts on May 5th...Cinco de Mayo...hmmm
Annie Skaggs MD
Lexington KY

Comments

[Sandra Barton MD]

Um, hello, as an IM doc in Oregon, I'm shocked to read "...and moving to Oregon isn't an option..." It's the same here, sister!! Are you joking?? I joined an HMO clinic here in Oregon 7 years ago, and at this point, NONE of the doctors who were there (15 doc clinic) are still there!! All have found their escape routes out of primary care. And I am actively looking!! So, not sure where you get the idea that Oregon is a greener pasture, except for maybe Chuck Kilo's group!

[John Brady, MD]

Good luck Annie. Your story is so heart-wrentching and shows pointedly how terrible the current environment is. We all hope the hospitalist position gives you the professional satisfaction and the income needed to heal some of your wounds.
John