The Value of Independence
Every July has me reflecting upon independence, as the regular readers of my blog probably recall. I would rather call the recent holiday Independence Day than the 4th of July, even though both are technically right. I think of what cost and also what joy the founders must have experienced as they celebrated the end of monarchical tyranny. When I think back to what motivated me to start Green Spring Internal Medicine all those many years ago, freedom from tyranny in healthcare was definitely part of it. It was that and also wanting to push back against mediocracy of practice management which I had experienced in prior settings. Doctors and hospitals seemed not to care enough about patient care, and healthcare workers were disengaged. I also worried about joining another practice who might, like my first practice, go the direction of concierge medicine. As it turned out, those worries were justified.
Earlier this year, I raised the question at a staff meeting, "What makes independent practice worth it?" After all, with such a trend of practices being bought up by health systems as well as venture capital firms, I had already contemplated this question for some time myself. I had reflected on the previous practice models and settings and considered the potential impact going forward. Always certain truths would come back to me. As it happens, what members of the team expressed were the same kind of sentiments. We are able to offer a certain kind of care to our patients. The services we offer are always aligned with what we understand to be good for patients and good in the healthcare system. We can design and implement better workflows without having to go through a committee, and we are free to adjust to be sure that everyone on our team is in the right position and engaged with the work.
Of course, too much independence isn't exactly what we're after, and we don't have control over many of the forces at work in the healthcare system around us. At our healthiest as a team, we are not a bunch of rugged individualists sharing real estate; rather there is a measure of healthy interdependence. We are not only interdependent within the walls of our practice with one another and with our patients but also within the larger healthcare ecosystem.
For too long, primary care specialties like internal medicine, have been under-valued in healthcare to the point that we are seeing Amazon-ization or Walmart-izing of outpatient care. Make no mistake, however, there is great value not only in monetary terms but also in terms of vital connection for everyone to be under the care of a primary care physician. The only way non-concierge independent practices like ours have survived is to build teams around us to share in the effort to provide the wholistic care people need. We marvel at those who think that primary care practice could be taken over by nurse practitioner-only or PA-driven groups. Certainly, there has been movement in that direction. The pandemic also saw pharmacies proclaimed as the main mass vaccination sites in 2021, with pharmacies supplied with COVID vaccines long before they arrived within our walls.
Notwithstanding, Green Spring Internal Medicine drove hard once we had COVID vaccines in hand and committed ourselves to market the availability of these vaccines to our patients and to set up vaccine campaigns until the majority of our patients received them. In fact, our practice recently won a statewide award in the MDPCP (all Medicare) program for the highest percentage of our patients up-to-date on their COVID vaccines! This program spans over 6000 primary care providers and over 300,000 patients across the State of Maryland.
Reflecting a bit more, I do believe that independence has contributed to our excellence. We are not steeped in bureaucracy. Staff members who formerly worked in more regulated settings have shared with us that a new workflow would take weeks-to-months to implement if it was approved at all. At our practice, we were able to launch our vaccine campaign within 3 days of the notification that they would finally be sent to us! We have the ability to build a healthy workplace culture, as my brother-in-law Michael Stallard has phrased it in his writings, because we have both relationship excellence and task excellence.
Though we have had to continuously adapt to survive, our aim is thriving together. We have sought to grow and cultivate both a team and the kind of relationships with our patients which are characterized by trust, excellence, accountability and meaning. Because of the very human need for connection, we do not regard automations like ChatGPT as a business threat but rather as an opportunity. At once, we are able to be old-fashioned and modern.
We are interdependent on our software company, eClinicalWorks, to modernize a few things on our behalf; thus, we and our patients do have to be patient while waiting for a more bidirectional patient portal and for online bill payment. At the same time, having adopted EMR (or EHR) technology long before others back in 2006 when we opened the doors, we are quite far along at being able to interact securely online with our patients through the patient portal and are at work modernizing scheduling features and updating our website this summer. Stay tuned!
