Re: Out of the Frying Pan into the Fire!

[Guest guest]

Run away as quickly as you can.

From: [ ] On Behalf Of drmachata [drmachata@...]

Sent: Tuesday, February 22, 2011 9:03 AM

To:

Subject: Out of the Frying Pan into the Fire!

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.

My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing

power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively

with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared

in making seeing more patients possible, helped with boost staff morale. I worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel

of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to

7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over

our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out.

Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes

for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps

was " too inefficient and messy " . Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff " did not have time " to perform a

full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule. Patients routinely wait

interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager.

I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients.

Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers

burn out.

Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six weeks to prompt conservative me to contemplate so radical a move.

Hope everyone has a productive and happy day.

Machata MD

[Guest guest]

Run away as quickly as you can.

From: [ ] On Behalf Of drmachata [drmachata@...]

Sent: Tuesday, February 22, 2011 9:03 AM

To:

Subject: Out of the Frying Pan into the Fire!

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.

My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing

power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively

with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared

in making seeing more patients possible, helped with boost staff morale. I worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel

of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to

7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over

our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out.

Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes

for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps

was " too inefficient and messy " . Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff " did not have time " to perform a

full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule. Patients routinely wait

interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager.

I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients.

Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers

burn out.

Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six weeks to prompt conservative me to contemplate so radical a move.

Hope everyone has a productive and happy day.

Machata MD

[Guest guest]

Welcome !Thank you for your post. It is good and bad to hear all the stuff going on out there in the non-IMP world. Obviously, you will be needing to make a lot of decisions regarding where your future lies (ex. can you change the mentality of your current practice or do you need to move on?). This group is outspoken and a wonderful resource for answering any questions you might have.Lynn is a superstar. Learn as much as you can from her (without getting too clingy—nobody likes that). B From: [mailto: ] On Behalf Of drmachataSent: Tuesday, February 22, 2011 11:03 AMTo: Subject: Out of the Frying Pan into the Fire! Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out. Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was " too inefficient and messy " . Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff " did not have time " to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule. Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager. I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients. Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six weeks to prompt conservative me to contemplate so radical a move.Hope everyone has a productive and happy day. Machata MD

[Guest guest]

Welcome !Thank you for your post. It is good and bad to hear all the stuff going on out there in the non-IMP world. Obviously, you will be needing to make a lot of decisions regarding where your future lies (ex. can you change the mentality of your current practice or do you need to move on?). This group is outspoken and a wonderful resource for answering any questions you might have.Lynn is a superstar. Learn as much as you can from her (without getting too clingy—nobody likes that). B From: [mailto: ] On Behalf Of drmachataSent: Tuesday, February 22, 2011 11:03 AMTo: Subject: Out of the Frying Pan into the Fire! Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out. Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was " too inefficient and messy " . Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff " did not have time " to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule. Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager. I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients. Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six weeks to prompt conservative me to contemplate so radical a move.Hope everyone has a productive and happy day. Machata MD

[Guest guest]

Dear Doctor Machaca.

I used to work in a clinic doing family Med. I had a meeting with the owner one day: I was told that I was a good clinician but

I needed to order more carotid US, PFT, dexa scans.

I learned that the owner had a guy with a mobil US to do US q weekly, they also had equipment to do PFT and a dexa scan.

I responded to the owner that I order a test when is indicated not because I want to trick or get money.

I was not liked and few months later I got a dear letter notice to look for another job.

IMP idea/dream allows me to practice Medicine without any middle man/woman in between.

I spoke to my town's Hospital CEO. I requested some market analysis of my area.

She asked me about the reasons. I told her that I wanted to open up a small practice in town.

She made a face and told me that primary care in order to be successful needed to be in big groups.

she recommended me to visit some people in the community. I told her that I declined since I have PTSD to join another group.

I am tired of corporate people trying to talk me like a kid. They shake your hand and look in the eye and lie with no remorse.

I am straight forward kind guy. I do not sugar coat stuff and that kind of approach is liked by my patients.

Good look Doctor in your endeavors.

Adolfo Teran

To: " " < >Sent: Tue, February 22, 2011 11:14:51 AMSubject: RE: Out of the Frying Pan into the Fire!

Run away as quickly as you can.

From: [ ] On Behalf Of drmachata [drmachata@...]Sent: Tuesday, February 22, 2011 9:03 AMTo: Subject: Out of the Frying Pan into the Fire!

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I

worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out. Six weeks ago I joined a private 7 member Family

Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was "too inefficient and messy". Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff "did not have time" to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule.

Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager. I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients. Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six

weeks to prompt conservative me to contemplate so radical a move.Hope everyone has a productive and happy day. Machata MD

[Guest guest]

Dear Doctor Machaca.

I used to work in a clinic doing family Med. I had a meeting with the owner one day: I was told that I was a good clinician but

I needed to order more carotid US, PFT, dexa scans.

I learned that the owner had a guy with a mobil US to do US q weekly, they also had equipment to do PFT and a dexa scan.

I responded to the owner that I order a test when is indicated not because I want to trick or get money.

I was not liked and few months later I got a dear letter notice to look for another job.

IMP idea/dream allows me to practice Medicine without any middle man/woman in between.

I spoke to my town's Hospital CEO. I requested some market analysis of my area.

She asked me about the reasons. I told her that I wanted to open up a small practice in town.

She made a face and told me that primary care in order to be successful needed to be in big groups.

she recommended me to visit some people in the community. I told her that I declined since I have PTSD to join another group.

I am tired of corporate people trying to talk me like a kid. They shake your hand and look in the eye and lie with no remorse.

I am straight forward kind guy. I do not sugar coat stuff and that kind of approach is liked by my patients.

Good look Doctor in your endeavors.

Adolfo Teran

To: " " < >Sent: Tue, February 22, 2011 11:14:51 AMSubject: RE: Out of the Frying Pan into the Fire!

Run away as quickly as you can.

From: [ ] On Behalf Of drmachata [drmachata@...]Sent: Tuesday, February 22, 2011 9:03 AMTo: Subject: Out of the Frying Pan into the Fire!

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I

worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out. Six weeks ago I joined a private 7 member Family

Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was "too inefficient and messy". Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff "did not have time" to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule.

Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager. I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients. Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six

weeks to prompt conservative me to contemplate so radical a move.Hope everyone has a productive and happy day. Machata MD

[Guest guest]

Dear Doctor Machaca.

I used to work in a clinic doing family Med. I had a meeting with the owner one day: I was told that I was a good clinician but

I needed to order more carotid US, PFT, dexa scans.

I learned that the owner had a guy with a mobil US to do US q weekly, they also had equipment to do PFT and a dexa scan.

I responded to the owner that I order a test when is indicated not because I want to trick or get money.

I was not liked and few months later I got a dear letter notice to look for another job.

IMP idea/dream allows me to practice Medicine without any middle man/woman in between.

I spoke to my town's Hospital CEO. I requested some market analysis of my area.

She asked me about the reasons. I told her that I wanted to open up a small practice in town.

She made a face and told me that primary care in order to be successful needed to be in big groups.

she recommended me to visit some people in the community. I told her that I declined since I have PTSD to join another group.

I am tired of corporate people trying to talk me like a kid. They shake your hand and look in the eye and lie with no remorse.

I am straight forward kind guy. I do not sugar coat stuff and that kind of approach is liked by my patients.

Good look Doctor in your endeavors.

Adolfo Teran

To: " " < >Sent: Tue, February 22, 2011 11:14:51 AMSubject: RE: Out of the Frying Pan into the Fire!

Run away as quickly as you can.

From: [ ] On Behalf Of drmachata [drmachata@...]Sent: Tuesday, February 22, 2011 9:03 AMTo: Subject: Out of the Frying Pan into the Fire!

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I

worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out. Six weeks ago I joined a private 7 member Family

Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was "too inefficient and messy". Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff "did not have time" to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule.

Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager. I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients. Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six

weeks to prompt conservative me to contemplate so radical a move.Hope everyone has a productive and happy day. Machata MD

[Guest guest]

Please forward a copy of both of your experiences to the NYT, Washington Post, The White House, and some sort of mass appeal social network.... The truth needs to be told... Hang in there and save yourselves as best as you can. Only then can you hopefully save a small but substancial part of the world within your area of influence...

To: Sent: Tue, February 22, 2011 12:54:06 PMSubject: Re: Out of the Frying Pan into the Fire!

Dear Doctor Machaca.

I used to work in a clinic doing family Med. I had a meeting with the owner one day: I was told that I was a good clinician but

I needed to order more carotid US, PFT, dexa scans.

I learned that the owner had a guy with a mobil US to do US q weekly, they also had equipment to do PFT and a dexa scan.

I responded to the owner that I order a test when is indicated not because I want to trick or get money.

I was not liked and few months later I got a dear letter notice to look for another job.

IMP idea/dream allows me to practice Medicine without any middle man/woman in between.

I spoke to my town's Hospital CEO. I requested some market analysis of my area.

She asked me about the reasons. I told her that I wanted to open up a small practice in town.

She made a face and told me that primary care in order to be successful needed to be in big groups.

she recommended me to visit some people in the community. I told her that I declined since I have PTSD to join another group.

I am tired of corporate people trying to talk me like a kid. They shake your hand and look in the eye and lie with no remorse.

I am straight forward kind guy. I do not sugar coat stuff and that kind of approach is liked by my patients.

Good look Doctor in your endeavors.

Adolfo Teran

To: " " < >Sent: Tue, February 22, 2011 11:14:51 AMSubject: RE: Out of the Frying Pan into the Fire!

Run away as quickly as you can.

From: [ ] On Behalf Of drmachata [drmachata@...]Sent: Tuesday, February 22, 2011 9:03 AMTo: Subject: Out of the Frying Pan into the Fire!

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I

worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out. Six weeks ago I joined a private 7 member Family

Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was "too inefficient and messy". Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff "did not have time" to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule.

Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager. I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients. Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six

weeks to prompt conservative me to contemplate so radical a move.Hope everyone has a productive and happy day. Machata MD

[Guest guest]

Please forward a copy of both of your experiences to the NYT, Washington Post, The White House, and some sort of mass appeal social network.... The truth needs to be told... Hang in there and save yourselves as best as you can. Only then can you hopefully save a small but substancial part of the world within your area of influence...

To: Sent: Tue, February 22, 2011 12:54:06 PMSubject: Re: Out of the Frying Pan into the Fire!

Dear Doctor Machaca.

I used to work in a clinic doing family Med. I had a meeting with the owner one day: I was told that I was a good clinician but

I needed to order more carotid US, PFT, dexa scans.

I learned that the owner had a guy with a mobil US to do US q weekly, they also had equipment to do PFT and a dexa scan.

I responded to the owner that I order a test when is indicated not because I want to trick or get money.

I was not liked and few months later I got a dear letter notice to look for another job.

IMP idea/dream allows me to practice Medicine without any middle man/woman in between.

I spoke to my town's Hospital CEO. I requested some market analysis of my area.

She asked me about the reasons. I told her that I wanted to open up a small practice in town.

She made a face and told me that primary care in order to be successful needed to be in big groups.

she recommended me to visit some people in the community. I told her that I declined since I have PTSD to join another group.

I am tired of corporate people trying to talk me like a kid. They shake your hand and look in the eye and lie with no remorse.

I am straight forward kind guy. I do not sugar coat stuff and that kind of approach is liked by my patients.

Good look Doctor in your endeavors.

Adolfo Teran

To: " " < >Sent: Tue, February 22, 2011 11:14:51 AMSubject: RE: Out of the Frying Pan into the Fire!

Run away as quickly as you can.

From: [ ] On Behalf Of drmachata [drmachata@...]Sent: Tuesday, February 22, 2011 9:03 AMTo: Subject: Out of the Frying Pan into the Fire!

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I

worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out. Six weeks ago I joined a private 7 member Family

Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was "too inefficient and messy". Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff "did not have time" to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule.

Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager. I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients. Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six

weeks to prompt conservative me to contemplate so radical a move.Hope everyone has a productive and happy day. Machata MD

[Guest guest]

Hi welcome  What a storyHope you will be able to get through all this, put  bad  stuff behind you  Let us kno w  how we can help you.Lynn who? :)Jean

 

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.

My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out.

Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was " too inefficient and messy " . Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff " did not have time " to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule. Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager.

I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients.

Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.

Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six weeks to prompt conservative me to contemplate so radical a move.

Hope everyone has a productive and happy day.

Machata MD

--      MD          ph    fax impcenter.org

[Guest guest]

Hi welcome  What a storyHope you will be able to get through all this, put  bad  stuff behind you  Let us kno w  how we can help you.Lynn who? :)Jean

 

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.

My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out.

Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was " too inefficient and messy " . Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff " did not have time " to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule. Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager.

I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients.

Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.

Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six weeks to prompt conservative me to contemplate so radical a move.

Hope everyone has a productive and happy day.

Machata MD

--      MD          ph    fax impcenter.org

[Guest guest]



RE real life

1) Can you get out of your contract?

2) Do you have resources to live right now?

3) If Lynn is nearby, maybe she can help you set up with overflow pts while getting credentialed.

It will still take you 3+ months to really get set up --> you may want to take a deep breath (or 3!) and work for the money while trying to exit strategize.

You can do this but you still need to survive to do it.

Other comments from others:

1) Ancillaries can make money if the insurers will pay for them -- I do some ancillaries in the office (EKG, PFTs) but mainly see pts, my ancillaries probably are a break even for me.

2) Corporate medicine continues to look for "economies of scale" which probably do NOT exist, as bigger organizations make more money but have higher and higher overheads, then they insist the insurers pay the additional cost if the "groups" ie hospital owners are enough of market to insist on it.

I'll keep enjoying being solo.

Matt in Western PA

Solo since 2004

FP residency completed in 1988

Goal at 50 pts/week, moonlight at local college health center 1/2 day a week during college year (I love it and they pay me hourly stipend), occ med site 1/2 day every other week

Re: Out of the Frying Pan into the Fire!

Jean-

Love your new website by the way. Inspired- I will use local pix on mine.

As for where I am- fact is- I am OK inside and vis-a-vis family and friends- where it really matters. I will do fine. Proceeding deliberately. Hope I did not sound too whiny. Even observing the interface between caring practitioners in this group has been reassuring and healing. Thanks for offering. I will need guidance as I take a leap into a new practice world.

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out. Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was "too inefficient and messy". Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff "did not have time" to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule. Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager. I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients. Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six weeks to prompt conservative me to contemplate so radical a move.Hope everyone has a productive and happy day. Machata MD

-- MD ph fax impcenter.org

[Guest guest]

! Congratulations!! We are so glad you are here.

I had to reach the depths of despair before I made

the switch, but I've NEVER been happier. The longest

I could ever handle an assembly-line job was about

2 years. I went through 6 jobs in 10 years an now

that I opened and ideal medical practice (designed

entirely by my patients!) I am finally a happy doctor.

Been at the practice 6 years. WOW!

Check out the website:

http://www.idealmedicalcare.org/

I would be happy to talk to you at any point and also help

you energize your community to help you design your

dream practice. That way you are never really " solo "

as our patients are waiting for us to stand up and

lead the way.

You can do it!

Pamela

Pamela Wible, MD

3575 St. #220

Eugene, OR 97405

www.idealmedicalcare.org

>

> Hello to everyone. I just joined this group. Impressed by the cooperative

spirit of the posts.

>

> My name is Machata. I am a family doctor, who recently joined a 7 member

family practice group after working for 13+ years in a community health center

setting. Loved serving patients in great need- was driven out of the health

center by bosses playing power politics. When I arrived at my health center five

years ago things were a mess- clinical numbers were abysmal, revenues barely

covered expenses, staff morale was terrible and patients hated visiting our

facility. As site medical director, I worked collaboratively with the site

director and all staff to get the center on track. Staff turnover was very high

early on. We hired hard working intelligent staff dedicated to our mission. I'd

like to think that sharing my productivity bonus with staff, who after all

shared in making seeing more patients possible, helped with boost staff morale.

I worked pretty hard at the health center, where my 3.5 patients an hours was a

high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone

patients and a large panel of not-to-difficult psychiatric patients who required

quarterly follow-up. Before I left our clinical numbers were enviable, revenues

far outpaced expenses, staff turnover was low and patient satisfaction was high.

Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from

1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished

within a larger organization of 300 with three practice sites and without much

input from senior management, who decided to reassert control over our facility.

With some stimulus money they purchased a building with the intention of again

tripling the size of staff. But if they were to control the move, the needed a

new medical director. I was out.

>

> Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I

should have done a better job vetting them. They are caring, intelligent

practitioners but practicing a style of medicine that would burn me out in no

time! I am allotted 10 minutes for follow-ups even if I have never met the

patient. Same for acute visits. There is no time to breathe during the 20

minutes scheduled for a new patient. Clinical concerns were even more

disturbing. I discovered that having a microscope to perform wet preps was " too

inefficient and messy " . Practitioners are managing cases over the phone when

patients clearly needed to come in to be seen. When I worked a weekend, vital

signs became a weight and temperature because support staff " did not have time "

to perform a full battery. In the interest of efficiency, there are times when

three doctors are supported by only one MA. Patient waits at the front desk to

verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind

schedule. Patients routinely wait interminably only to spend a few rushed

minutes with me. Adding insult to injury, I was informed that I was not

permitted to discuss anything with medical assistants. If I had concerns of any

kind, I was to contact the often unavailable office manager.

>

> I love being a family doctor. I am honored to serve folks as they struggle

with disease and strive to live healthy lives. I enjoy the intellectual breadth

of primary care. It is a wonderful gift making a living serving appreciative

patients.

>

> Until these last six weeks I was perplexed by doctors who never would have

become physicians had they known how odious the current practice environment has

become. I hate this ridiculous rat race. There are no winners. Patients get

inferior care. Providers burn out.

>

> Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping

aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six

weeks to prompt conservative me to contemplate so radical a move.

>

> Hope everyone has a productive and happy day.

>

> Machata MD

>

[Guest guest]

Yes! Keep talking. Keep sharing and supporting one another.

Voices must be heard. We are actually carrying the voice of the

voiceless - our patients. It is our duty to find a way to care

amid the despair. We are the future of health care.

Blessings to you, .

Pamela

Pamela Wible, MD

3575 St. #220

Eugene, OR 97405

www.idealmedicalcare.org

>

> Please forward a copy of both of your experiences to the NYT, Washington Post,

> The White House, and some sort of mass appeal social network.... The truth

needs

> to be told... Hang in there and save yourselves as best as you can. Only then

> can you hopefully save a small but substancial part of the world within your

> area of influence...

>

>

>

>

>

>

> ________________________________

>

> To:

> Sent: Tue, February 22, 2011 12:54:06 PM

> Subject: Re: Out of the Frying Pan into the Fire!

>

>  

> Dear Doctor Machaca.

>

> I used to work in a clinic doing family Med. I had a meeting with the owner

one

> day: I was told that I was a good clinician but

>

> I needed to order more carotid US, PFT, dexa scans.

> I learned that the owner had a guy with a mobil US to do US q weekly, they

also

> had equipment to do PFT and a dexa scan.

> I responded to the owner that I order a test when is indicated not because I

> want to trick or get money.

>

> I was not liked and few months later I got a dear letter notice to look

for

> another job.

> IMP idea/dream allows me to practice Medicine without any middle man/woman in

> between.

> I spoke to my town's Hospital CEO. I requested some market analysis of my

area.

> She asked me about the reasons. I told her that I wanted to open up a small

> practice in town.

> She made a face and told me that primary care in order to be successful needed

> to be in big groups.

> she recommended me to visit some people in the community. I told her that I

> declined since I have PTSD to join another group.

>

> I am tired of corporate people trying to talk me like a kid. They shake your

> hand and look in the eye and lie with no remorse.

> I am straight forward kind guy. I do not sugar coat stuff and that kind of

> approach is liked by my patients.

> Good look  Doctor in your endeavors.

> Adolfo Teran

>

>

>

>

> ________________________________

>

> To: " "

> < >

> Sent: Tue, February 22, 2011 11:14:51 AM

> Subject: RE: Out of the Frying Pan into the Fire!

>

>  

> Run away as quickly as you can.

>  

>

> ________________________________

> From:

> [ ] On Behalf Of drmachata

> [drmachata@...]

> Sent: Tuesday, February 22, 2011 9:03 AM

> To:

> Subject: Out of the Frying Pan into the Fire!

>

>

>  

> Hello to everyone. I just joined this group. Impressed by the cooperative

spirit

> of the posts.

>

> My name is Machata. I am a family doctor, who recently joined a 7 member

> family practice group after working for 13+ years in a community health center

> setting. Loved serving patients in great need- was driven out of the health

> center by bosses playing power politics. When I arrived at my health center

five

> years ago things were a mess- clinical numbers were abysmal, revenues barely

> covered expenses, staff morale was terrible and patients hated visiting our

> facility. As site medical director, I worked collaboratively with the site

> director and all staff to get the center on track. Staff turnover was very

high

> early on. We hired hard working intelligent staff dedicated to our mission.

I'd

> like to think that sharing my productivity bonus with staff, who after all

> shared in making seeing more patients possible, helped with boost staff

morale.

> I worked pretty hard at the health center, where my 3.5 patients an hours was

a

> high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone

> patients and a large panel of not-to-difficult psychiatric patients who

required

> quarterly follow-up. Before I left our clinical numbers were enviable,

revenues

> far outpaced expenses, staff turnover was low and patient satisfaction was

high.

> Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from

> 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished

> within a larger organization of 300 with three practice sites and without much

> input from senior management, who decided to reassert control over our

facility.

> With some stimulus money they purchased a building with the intention of again

> tripling the size of staff. But if they were to control the move, the needed a

> new medical director. I was out.

>

>

> Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I

> should have done a better job vetting them. They are caring, intelligent

> practitioners but practicing a style of medicine that would burn me out in no

> time! I am allotted 10 minutes for follow-ups even if I have never met the

> patient. Same for acute visits. There is no time to breathe during the 20

> minutes scheduled for a new patient. Clinical concerns were even more

> disturbing. I discovered that having a microscope to perform wet preps was

" too

> inefficient and messy " . Practitioners are managing cases over the phone when

> patients clearly needed to come in to be seen. When I worked a weekend, vital

> signs became a weight and temperature because support staff " did not have

time "

> to perform a full battery. In the interest of efficiency, there are times when

> three doctors are supported by only one MA. Patient waits at the front desk to

> verify insurance can take up to 45 minutes. I am routinely 45-60 minutes

behind

> schedule. Patients routinely wait interminably only to spend a few rushed

> minutes with me. Adding insult to injury, I was informed that I was not

> permitted to discuss anything with medical assistants. If I had concerns of

any

> kind, I was to contact the often unavailable office manager.

>

>

> I love being a family doctor. I am honored to serve folks as they struggle

with

> disease and strive to live healthy lives. I enjoy the intellectual breadth of

> primary care. It is a wonderful gift making a living serving appreciative

> patients.

>

>

> Until these last six weeks I was perplexed by doctors who never would have

> become physicians had they known how odious the current practice environment

has

> become. I hate this ridiculous rat race. There are no winners. Patients get

> inferior care. Providers burn out.

>

> Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping

> aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last

six

> weeks to prompt conservative me to contemplate so radical a move.

>

> Hope everyone has a productive and happy day.

>

> Machata MD

>

[Guest guest]

Matt-Real Life it is...Appreciate your practicality.1) Lawyer to review my current contract, of course.2) Yes, I have the resources to live3) Lynn already offered to assist- certainly direct overflow patients my wayI anticipate about a 3+ month segue-thanks for reaffirming my thinking.As for deep breaths- decided to reflect and breathe for days before GO!



RE real life

1) Can you get out of your contract?

2) Do you have resources to live right now?

3) If Lynn is nearby, maybe she can help you set up with overflow pts while getting credentialed.

It will still take you 3+ months to really get set up --> you may want to take a deep breath (or 3!) and work for the money while trying to exit strategize.

You can do this but you still need to survive to do it.

Other comments from others:

1) Ancillaries can make money if the insurers will pay for them -- I do some ancillaries in the office (EKG, PFTs) but mainly see pts, my ancillaries probably are a break even for me.

2) Corporate medicine continues to look for "economies of scale" which probably do NOT exist, as bigger organizations make more money but have higher and higher overheads, then they insist the insurers pay the additional cost if the "groups" ie hospital owners are enough of market to insist on it.

I'll keep enjoying being solo.

Matt in Western PA

Solo since 2004

FP residency completed in 1988

Goal at 50 pts/week, moonlight at local college health center 1/2 day a week during college year (I love it and they pay me hourly stipend), occ med site 1/2 day every other week

Re: Out of the Frying Pan into the Fire!

Jean-

Love your new website by the way. Inspired- I will use local pix on mine.

As for where I am- fact is- I am OK inside and vis-a-vis family and friends- where it really matters. I will do fine. Proceeding deliberately. Hope I did not sound too whiny. Even observing the interface between caring practitioners in this group has been reassuring and healing. Thanks for offering. I will need guidance as I take a leap into a new practice world.

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out. Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was "too inefficient and messy". Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff "did not have time" to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule. Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager. I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients. Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six weeks to prompt conservative me to contemplate so radical a move.Hope everyone has a productive and happy day. Machata MD

-- MD ph fax impcenter.org

[Guest guest]

Dr. Teran-Thank you for sharing your story of how you were invited to leave corporate medicine then found satisfaction as a solo doctor serving your patients. All the best to you, MachataSubject: Re: Out of the Frying Pan into the Fire!To: Date: Tuesday, February 22, 2011, 12:54 PM

Dear Doctor Machaca.

I used to work in a clinic doing family Med. I had a meeting with the owner one day: I was told that I was a good clinician but

I needed to order more carotid US, PFT, dexa scans.

I learned that the owner had a guy with a mobil US to do US q weekly, they also had equipment to do PFT and a dexa scan.

I responded to the owner that I order a test when is indicated not because I want to trick or get money.

I was not liked and few months later I got a dear letter notice to look for another job.

IMP idea/dream allows me to practice Medicine without any middle man/woman in between.

I spoke to my town's Hospital CEO. I requested some market analysis of my area.

She asked me about the reasons. I told her that I wanted to open up a small practice in town.

She made a face and told me that primary care in order to be successful needed to be in big groups.

she recommended me to visit some people in the community. I told her that I declined since I have PTSD to join another group.

I am tired of corporate people trying to talk me like a kid. They shake your hand and look in the eye and lie with no remorse.

I am straight forward kind guy. I do not sugar coat stuff and that kind of approach is liked by my patients.

Good look Doctor in your endeavors.

Adolfo Teran

To: " " < >Sent: Tue, February 22, 2011 11:14:51 AMSubject: RE: Out of the Frying Pan into the Fire!

Run away as quickly as you can.

From: [ ] On Behalf Of drmachata [drmachata@...]Sent: Tuesday, February 22, 2011 9:03 AMTo: Subject: Out of the Frying Pan into the Fire!

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I

worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out. Six weeks ago I joined a private 7 member Family

Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was "too inefficient and messy". Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff "did not have time" to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule.

Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager. I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients. Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six

weeks to prompt conservative me to contemplate so radical a move.Hope everyone has a productive and happy day. Machata MD

[Guest guest]

I am in the process to open my IMP, I am working the business plan and working the details.

thanks for your wishes, Adolfo

To: Sent: Wed, February 23, 2011 7:10:21 AMSubject: Re: Out of the Frying Pan into the Fire!

Dr. Teran-Thank you for sharing your story of how you were invited to leave corporate medicine then found satisfaction as a solo doctor serving your patients. All the best to you, Machata

Subject: Re: Out of the Frying Pan into the Fire!To: Date: Tuesday, February 22, 2011, 12:54 PM

Dear Doctor Machaca.

I used to work in a clinic doing family Med. I had a meeting with the owner one day: I was told that I was a good clinician but

I needed to order more carotid US, PFT, dexa scans.

I learned that the owner had a guy with a mobil US to do US q weekly, they also had equipment to do PFT and a dexa scan.

I responded to the owner that I order a test when is indicated not because I want to trick or get money.

I was not liked and few months later I got a dear letter notice to look for another job.

IMP idea/dream allows me to practice Medicine without any middle man/woman in between.

I spoke to my town's Hospital CEO. I requested some market analysis of my area.

She asked me about the reasons. I told her that I wanted to open up a small practice in town.

She made a face and told me that primary care in order to be successful needed to be in big groups.

she recommended me to visit some people in the community. I told her that I declined since I have PTSD to join another group.

I am tired of corporate people trying to talk me like a kid. They shake your hand and look in the eye and lie with no remorse.

I am straight forward kind guy. I do not sugar coat stuff and that kind of approach is liked by my patients.

Good look Doctor in your endeavors.

Adolfo Teran

To: " " < >Sent: Tue, February 22, 2011 11:14:51 AMSubject: RE: Out of the Frying Pan into the Fire!

Run away as quickly as you can.

From: [ ] On Behalf Of drmachata [drmachata@...]Sent: Tuesday, February 22, 2011 9:03 AMTo: Subject: Out of the Frying Pan into the Fire!

Hello to everyone. I just joined this group. Impressed by the cooperative spirit of the posts.My name is Machata. I am a family doctor, who recently joined a 7 member family practice group after working for 13+ years in a community health center setting. Loved serving patients in great need- was driven out of the health center by bosses playing power politics. When I arrived at my health center five years ago things were a mess- clinical numbers were abysmal, revenues barely covered expenses, staff morale was terrible and patients hated visiting our facility. As site medical director, I worked collaboratively with the site director and all staff to get the center on track. Staff turnover was very high early on. We hired hard working intelligent staff dedicated to our mission. I'd like to think that sharing my productivity bonus with staff, who after all shared in making seeing more patients possible, helped with boost staff morale. I

worked pretty hard at the health center, where my 3.5 patients an hours was a high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone patients and a large panel of not-to-difficult psychiatric patients who required quarterly follow-up. Before I left our clinical numbers were enviable, revenues far outpaced expenses, staff turnover was low and patient satisfaction was high. Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished within a larger organization of 300 with three practice sites and without much input from senior management, who decided to reassert control over our facility. With some stimulus money they purchased a building with the intention of again tripling the size of staff. But if they were to control the move, the needed a new medical director. I was out. Six weeks ago I joined a private 7 member Family

Medicine group. Mea culpa. I should have done a better job vetting them. They are caring, intelligent practitioners but practicing a style of medicine that would burn me out in no time! I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient. Clinical concerns were even more disturbing. I discovered that having a microscope to perform wet preps was "too inefficient and messy". Practitioners are managing cases over the phone when patients clearly needed to come in to be seen. When I worked a weekend, vital signs became a weight and temperature because support staff "did not have time" to perform a full battery. In the interest of efficiency, there are times when three doctors are supported by only one MA. Patient waits at the front desk to verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind schedule.

Patients routinely wait interminably only to spend a few rushed minutes with me. Adding insult to injury, I was informed that I was not permitted to discuss anything with medical assistants. If I had concerns of any kind, I was to contact the often unavailable office manager. I love being a family doctor. I am honored to serve folks as they struggle with disease and strive to live healthy lives. I enjoy the intellectual breadth of primary care. It is a wonderful gift making a living serving appreciative patients. Until these last six weeks I was perplexed by doctors who never would have become physicians had they known how odious the current practice environment has become. I hate this ridiculous rat race. There are no winners. Patients get inferior care. Providers burn out.Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six

weeks to prompt conservative me to contemplate so radical a move.Hope everyone has a productive and happy day. Machata MD

[Guest guest]

As well as to you too Pam... Thanks.

To: Sent: Wed, February 23, 2011 3:08:08 AMSubject: Re: Out of the Frying Pan into the Fire!

Yes! Keep talking. Keep sharing and supporting one another.Voices must be heard. We are actually carrying the voice of thevoiceless - our patients. It is our duty to find a way to careamid the despair. We are the future of health care. Blessings to you, .PamelaPamela Wible, MD3575 St. #220 Eugene, OR 97405www.idealmedicalcare.org>> Please forward a copy of both of your experiences to the NYT, Washington Post, > The White House, and some sort of mass appeal social network.... The truth needs > to be told... Hang in there and save yourselves as best as

you can. Only then > can you hopefully save a small but substancial part of the world within your > area of influence...> > > > > > > ________________________________> > To: > Sent: Tue, February 22, 2011 12:54:06 PM> Subject: Re: Out of the Frying Pan into the Fire!> > Â > Dear Doctor Machaca.> > I used to work in a clinic doing family Med. I had a meeting with the owner one > day: I was told that I was a good clinician but > > I needed to order more carotid US, PFT, dexa scans.> I learned that the owner had a guy with a mobil US to do US q

weekly, they also > had equipment to do PFT and a dexa scan.> I responded to the owner that I order a test when is indicated not because I > want to trick or get money. > > I was not liked and few months later I got a dear letter notice to look for > another job.> IMP idea/dream allows me to practice Medicine without any middle man/woman in > between.> I spoke to my town's Hospital CEO. I requested some market analysis of my area.> She asked me about the reasons. I told her that I wanted to open up a small > practice in town.> She made a face and told me that primary care in order to be successful needed > to be in big groups.> she recommended me to visit some people in the community. I told her that I > declined since I have PTSD to join another group.> > I am tired of corporate people trying to talk me like a kid. They shake your

> hand and look in the eye and lie with no remorse.> I am straight forward kind guy. I do not sugar coat stuff and that kind of > approach is liked by my patients.> Good look Doctor in your endeavors.> Adolfo Teran> > > > > ________________________________> > To: " " > < >> Sent: Tue, February 22, 2011 11:14:51 AM> Subject: RE: Out of the Frying Pan into the Fire!> >  > Run away as quickly as

you can. > Â > > ________________________________> From: > [ ] On Behalf Of drmachata > [drmachata@...]> Sent: Tuesday, February 22, 2011 9:03 AM> To: > Subject: Out of the Frying Pan into the Fire!> > > Â > Hello to everyone. I just joined this group. Impressed by the cooperative spirit > of

the posts.> > My name is Machata. I am a family doctor, who recently joined a 7 member > family practice group after working for 13+ years in a community health center > setting. Loved serving patients in great need- was driven out of the health > center by bosses playing power politics. When I arrived at my health center five > years ago things were a mess- clinical numbers were abysmal, revenues barely > covered expenses, staff morale was terrible and patients hated visiting our > facility. As site medical director, I worked collaboratively with the site > director and all staff to get the center on track. Staff turnover was very high > early on. We hired hard working intelligent staff dedicated to our mission. I'd > like to think that sharing my productivity bonus with staff, who after all > shared in making seeing more patients possible, helped with boost staff

morale. > I worked pretty hard at the health center, where my 3.5 patients an hours was a > high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone > patients and a large panel of not-to-difficult psychiatric patients who required > quarterly follow-up. Before I left our clinical numbers were enviable, revenues > far outpaced expenses, staff turnover was low and patient satisfaction was high. > Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from > 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished > within a larger organization of 300 with three practice sites and without much > input from senior management, who decided to reassert control over our facility. > With some stimulus money they purchased a building with the intention of again > tripling the size of staff. But if they were to control the move,

the needed a > new medical director. I was out. > > > Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I > should have done a better job vetting them. They are caring, intelligent > practitioners but practicing a style of medicine that would burn me out in no > time! I am allotted 10 minutes for follow-ups even if I have never met the > patient. Same for acute visits. There is no time to breathe during the 20 > minutes scheduled for a new patient. Clinical concerns were even more > disturbing. I discovered that having a microscope to perform wet preps was "too > inefficient and messy". Practitioners are managing cases over the phone when > patients clearly needed to come in to be seen. When I worked a weekend, vital > signs became a weight and temperature because support staff "did not have time" > to perform a full battery. In

the interest of efficiency, there are times when > three doctors are supported by only one MA. Patient waits at the front desk to > verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind > schedule. Patients routinely wait interminably only to spend a few rushed > minutes with me. Adding insult to injury, I was informed that I was not > permitted to discuss anything with medical assistants. If I had concerns of any > kind, I was to contact the often unavailable office manager. > > > I love being a family doctor. I am honored to serve folks as they struggle with > disease and strive to live healthy lives. I enjoy the intellectual breadth of > primary care. It is a wonderful gift making a living serving appreciative > patients. > > > Until these last six weeks I was perplexed by doctors who never would have > become

physicians had they known how odious the current practice environment has > become. I hate this ridiculous rat race. There are no winners. Patients get > inferior care. Providers burn out.> > Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping > aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six > weeks to prompt conservative me to contemplate so radical a move.> > Hope everyone has a productive and happy day.> > Machata MD>

[Guest guest]

As well as to you too Pam... Thanks.

To: Sent: Wed, February 23, 2011 3:08:08 AMSubject: Re: Out of the Frying Pan into the Fire!

Yes! Keep talking. Keep sharing and supporting one another.Voices must be heard. We are actually carrying the voice of thevoiceless - our patients. It is our duty to find a way to careamid the despair. We are the future of health care. Blessings to you, .PamelaPamela Wible, MD3575 St. #220 Eugene, OR 97405www.idealmedicalcare.org>> Please forward a copy of both of your experiences to the NYT, Washington Post, > The White House, and some sort of mass appeal social network.... The truth needs > to be told... Hang in there and save yourselves as best as

you can. Only then > can you hopefully save a small but substancial part of the world within your > area of influence...> > > > > > > ________________________________> > To: > Sent: Tue, February 22, 2011 12:54:06 PM> Subject: Re: Out of the Frying Pan into the Fire!> > Â > Dear Doctor Machaca.> > I used to work in a clinic doing family Med. I had a meeting with the owner one > day: I was told that I was a good clinician but > > I needed to order more carotid US, PFT, dexa scans.> I learned that the owner had a guy with a mobil US to do US q

weekly, they also > had equipment to do PFT and a dexa scan.> I responded to the owner that I order a test when is indicated not because I > want to trick or get money. > > I was not liked and few months later I got a dear letter notice to look for > another job.> IMP idea/dream allows me to practice Medicine without any middle man/woman in > between.> I spoke to my town's Hospital CEO. I requested some market analysis of my area.> She asked me about the reasons. I told her that I wanted to open up a small > practice in town.> She made a face and told me that primary care in order to be successful needed > to be in big groups.> she recommended me to visit some people in the community. I told her that I > declined since I have PTSD to join another group.> > I am tired of corporate people trying to talk me like a kid. They shake your

> hand and look in the eye and lie with no remorse.> I am straight forward kind guy. I do not sugar coat stuff and that kind of > approach is liked by my patients.> Good look Doctor in your endeavors.> Adolfo Teran> > > > > ________________________________> > To: " " > < >> Sent: Tue, February 22, 2011 11:14:51 AM> Subject: RE: Out of the Frying Pan into the Fire!> >  > Run away as quickly as

you can. > Â > > ________________________________> From: > [ ] On Behalf Of drmachata > [drmachata@...]> Sent: Tuesday, February 22, 2011 9:03 AM> To: > Subject: Out of the Frying Pan into the Fire!> > > Â > Hello to everyone. I just joined this group. Impressed by the cooperative spirit > of

the posts.> > My name is Machata. I am a family doctor, who recently joined a 7 member > family practice group after working for 13+ years in a community health center > setting. Loved serving patients in great need- was driven out of the health > center by bosses playing power politics. When I arrived at my health center five > years ago things were a mess- clinical numbers were abysmal, revenues barely > covered expenses, staff morale was terrible and patients hated visiting our > facility. As site medical director, I worked collaboratively with the site > director and all staff to get the center on track. Staff turnover was very high > early on. We hired hard working intelligent staff dedicated to our mission. I'd > like to think that sharing my productivity bonus with staff, who after all > shared in making seeing more patients possible, helped with boost staff

morale. > I worked pretty hard at the health center, where my 3.5 patients an hours was a > high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone > patients and a large panel of not-to-difficult psychiatric patients who required > quarterly follow-up. Before I left our clinical numbers were enviable, revenues > far outpaced expenses, staff turnover was low and patient satisfaction was high. > Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from > 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished > within a larger organization of 300 with three practice sites and without much > input from senior management, who decided to reassert control over our facility. > With some stimulus money they purchased a building with the intention of again > tripling the size of staff. But if they were to control the move,

the needed a > new medical director. I was out. > > > Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I > should have done a better job vetting them. They are caring, intelligent > practitioners but practicing a style of medicine that would burn me out in no > time! I am allotted 10 minutes for follow-ups even if I have never met the > patient. Same for acute visits. There is no time to breathe during the 20 > minutes scheduled for a new patient. Clinical concerns were even more > disturbing. I discovered that having a microscope to perform wet preps was "too > inefficient and messy". Practitioners are managing cases over the phone when > patients clearly needed to come in to be seen. When I worked a weekend, vital > signs became a weight and temperature because support staff "did not have time" > to perform a full battery. In

the interest of efficiency, there are times when > three doctors are supported by only one MA. Patient waits at the front desk to > verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind > schedule. Patients routinely wait interminably only to spend a few rushed > minutes with me. Adding insult to injury, I was informed that I was not > permitted to discuss anything with medical assistants. If I had concerns of any > kind, I was to contact the often unavailable office manager. > > > I love being a family doctor. I am honored to serve folks as they struggle with > disease and strive to live healthy lives. I enjoy the intellectual breadth of > primary care. It is a wonderful gift making a living serving appreciative > patients. > > > Until these last six weeks I was perplexed by doctors who never would have > become

physicians had they known how odious the current practice environment has > become. I hate this ridiculous rat race. There are no winners. Patients get > inferior care. Providers burn out.> > Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping > aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six > weeks to prompt conservative me to contemplate so radical a move.> > Hope everyone has a productive and happy day.> > Machata MD>

[Guest guest]

As well as to you too Pam... Thanks.

To: Sent: Wed, February 23, 2011 3:08:08 AMSubject: Re: Out of the Frying Pan into the Fire!

Yes! Keep talking. Keep sharing and supporting one another.Voices must be heard. We are actually carrying the voice of thevoiceless - our patients. It is our duty to find a way to careamid the despair. We are the future of health care. Blessings to you, .PamelaPamela Wible, MD3575 St. #220 Eugene, OR 97405www.idealmedicalcare.org>> Please forward a copy of both of your experiences to the NYT, Washington Post, > The White House, and some sort of mass appeal social network.... The truth needs > to be told... Hang in there and save yourselves as best as

you can. Only then > can you hopefully save a small but substancial part of the world within your > area of influence...> > > > > > > ________________________________> > To: > Sent: Tue, February 22, 2011 12:54:06 PM> Subject: Re: Out of the Frying Pan into the Fire!> > Â > Dear Doctor Machaca.> > I used to work in a clinic doing family Med. I had a meeting with the owner one > day: I was told that I was a good clinician but > > I needed to order more carotid US, PFT, dexa scans.> I learned that the owner had a guy with a mobil US to do US q

weekly, they also > had equipment to do PFT and a dexa scan.> I responded to the owner that I order a test when is indicated not because I > want to trick or get money. > > I was not liked and few months later I got a dear letter notice to look for > another job.> IMP idea/dream allows me to practice Medicine without any middle man/woman in > between.> I spoke to my town's Hospital CEO. I requested some market analysis of my area.> She asked me about the reasons. I told her that I wanted to open up a small > practice in town.> She made a face and told me that primary care in order to be successful needed > to be in big groups.> she recommended me to visit some people in the community. I told her that I > declined since I have PTSD to join another group.> > I am tired of corporate people trying to talk me like a kid. They shake your

> hand and look in the eye and lie with no remorse.> I am straight forward kind guy. I do not sugar coat stuff and that kind of > approach is liked by my patients.> Good look Doctor in your endeavors.> Adolfo Teran> > > > > ________________________________> > To: " " > < >> Sent: Tue, February 22, 2011 11:14:51 AM> Subject: RE: Out of the Frying Pan into the Fire!> >  > Run away as quickly as

you can. > Â > > ________________________________> From: > [ ] On Behalf Of drmachata > [drmachata@...]> Sent: Tuesday, February 22, 2011 9:03 AM> To: > Subject: Out of the Frying Pan into the Fire!> > > Â > Hello to everyone. I just joined this group. Impressed by the cooperative spirit > of

the posts.> > My name is Machata. I am a family doctor, who recently joined a 7 member > family practice group after working for 13+ years in a community health center > setting. Loved serving patients in great need- was driven out of the health > center by bosses playing power politics. When I arrived at my health center five > years ago things were a mess- clinical numbers were abysmal, revenues barely > covered expenses, staff morale was terrible and patients hated visiting our > facility. As site medical director, I worked collaboratively with the site > director and all staff to get the center on track. Staff turnover was very high > early on. We hired hard working intelligent staff dedicated to our mission. I'd > like to think that sharing my productivity bonus with staff, who after all > shared in making seeing more patients possible, helped with boost staff

morale. > I worked pretty hard at the health center, where my 3.5 patients an hours was a > high productivity outlier. I boosted my numbers by serving nearly 100 Suboxone > patients and a large panel of not-to-difficult psychiatric patients who required > quarterly follow-up. Before I left our clinical numbers were enviable, revenues > far outpaced expenses, staff turnover was low and patient satisfaction was high. > Our patient panel mushroomed from 2,500 to 7,500, FTEs of providers grew from > 1.5 to 4.5, staffing increased from 18 to 45. All of this was accomplished > within a larger organization of 300 with three practice sites and without much > input from senior management, who decided to reassert control over our facility. > With some stimulus money they purchased a building with the intention of again > tripling the size of staff. But if they were to control the move,

the needed a > new medical director. I was out. > > > Six weeks ago I joined a private 7 member Family Medicine group. Mea culpa. I > should have done a better job vetting them. They are caring, intelligent > practitioners but practicing a style of medicine that would burn me out in no > time! I am allotted 10 minutes for follow-ups even if I have never met the > patient. Same for acute visits. There is no time to breathe during the 20 > minutes scheduled for a new patient. Clinical concerns were even more > disturbing. I discovered that having a microscope to perform wet preps was "too > inefficient and messy". Practitioners are managing cases over the phone when > patients clearly needed to come in to be seen. When I worked a weekend, vital > signs became a weight and temperature because support staff "did not have time" > to perform a full battery. In

the interest of efficiency, there are times when > three doctors are supported by only one MA. Patient waits at the front desk to > verify insurance can take up to 45 minutes. I am routinely 45-60 minutes behind > schedule. Patients routinely wait interminably only to spend a few rushed > minutes with me. Adding insult to injury, I was informed that I was not > permitted to discuss anything with medical assistants. If I had concerns of any > kind, I was to contact the often unavailable office manager. > > > I love being a family doctor. I am honored to serve folks as they struggle with > disease and strive to live healthy lives. I enjoy the intellectual breadth of > primary care. It is a wonderful gift making a living serving appreciative > patients. > > > Until these last six weeks I was perplexed by doctors who never would have > become

physicians had they known how odious the current practice environment has > become. I hate this ridiculous rat race. There are no winners. Patients get > inferior care. Providers burn out.> > Inspired by my wonderful personal physician, Lynn Ho, I am entertain jumping > aboard the Ideal Medical Practice bandwagon. I needed the trauma of the last six > weeks to prompt conservative me to contemplate so radical a move.> > Hope everyone has a productive and happy day.> > Machata MD>