Heal Thy Practice 2010: How to Go From Bad Dream to Dream Practice

The dream is a noble one: a fulfilling career of dedicated service as a healer, teacher, and friend to one’s community. That vision is what leads most people into primary care.

These days, that dream has become a nightmare for far too many doctors. Administrative hassles grow ever more complex; reimbursement cuts have driven many to either sell their practices or leave medicine altogether; time pressures have squeezed all the fun out of clinical practice and made it almost impossible to provide good, prevention-focused care.

It is possible to wake up from that nightmare. Primary care doctors all over the country are doing it: they’re re-defining their values, re-asserting their autonomy, and re-structuring their practices.

Holistic Primary Care’s Heal Thy Practice-Transforming Primary Care conference, to be held June 10-13, in Charlotte, NC, is a forum for sharing successful strategies, learning from past mistakes, finding inspiration and gaining practical skills for creating a financially-viable practice focused on prevention and high-quality, compassionate, comprehensive care.

Never Too Late to Change

It’s never too late to transform your practice, according to Dr. William Lee,  a family physician from Raleigh, NC. One of the top-rated primary care doctors in the state, Dr. Lee found himself in his late 50s struggling harder and harder to provide quality care, working at a pace that was neither healthy for himself nor his patients.

The situation reached a crisis point when Dr. Lee realized he still needed—and wanted—to practice, but that his insurance-based model was simply unsustainable. So he stepped outside the insurance grid and into the world of direct-pay medicine by implementing the MDVIP model.

MDVIP is one of the nation’s best-known “concierge” practice systems, a model in which patients pay their physicians a fixed annual fee to be members of the practice. In exchange, they obtain unlimited access to a comprehensive set of prevention-focused services—the “VIP” in the company’s name stands for “Value in Prevention.” The model gives Dr. Lee the time needed to really focus on patients as individuals and to provide good preventive care, something that’s almost impossible in insurance-based medicine.

Like many clinicians who’ve left insurance, Dr. Lee says it was one the best decisions he’s ever made. At Heal Thy Practice, he’ll describe the benefits and challenges of transitioning to a “concierge” model. Along the way, he’ll right some of the common misconceptions about this model (“It’s only for the rich,” “It means abandoning people in need,” “It’s just another form of capitation.”)

Healing Medicine’s Deep Dysfunctions

Functional medicine is one of the fastest growing disciplines within holistic healthcare, and one with the greatest potential for interface with mainstream allopathic care. Among the pioneers in the clinical implementation of functional medicine is Patrick Hanaway, MD, Director of the Family to Family Clinic, in Asheville, NC, and president-elect of the American Board of Integrative Holistic Medicine (ABIHM).

Dr. Hanaway will give Heal Thy Practice attendees an overview of the core principles of functional medicine as well as insight on how it works both clinically and fiscally as a platform for renewed primary care practice.

In a nutshell, functional medicine is about the inter-relationships between organ systems, biochemical signaling pathways, and the interface between a person’s genes and environment. It is inherently holistic yet scientifically rigorous. It views health as a positive state of optimal inter-relationship, and diseases as manifestations of imbalances and dysfunctions between systems.

The doctor’s job is to assess a patient’s unique predispositions to imbalance, determine what types of functional imbalances drive the current symptom patterns, and then design comprehensive lifestyle- based programs to restore optimal function. Though the interventions can and sometimes do involve prescription drugs, a core premise is that food is information that strongly influences gene expression and that nutrition is a cornerstone of healing.

Functional medicine provides primary care doctors with a well-wrought but very flexible model for incorporating nutrition, nutraceuticals, botanical medicine, exercise, and stress management into their practices.  

Re-Discovering Values, Rekindling Enthusiasm

Change is scary, especially when it involves something as important as one’s livelihood. It takes courage, inspiration, and energy to go in a new direction and change the way one has been practicing. J. David Forbes, MD, founder of Nashville Integrated Medicine, and current president of the American Holistic Medical Association, knows the challenges well. But he also knows the rewards.

“I go to the office every day excited about the work I’m doing, and I come home at night with a sense of fulfillment. Even though there are some real financial challenges in making an integrative practice work, I would never go back to the way I was practicing.”

In his lead-off address, Dr. Forbes will help attendees re-connect with the impulses that first led them to a career in healing, and then re-envision their practices in alignment with these core values. He’ll share insights from his own clinical journey as well as practical lessons on what to do—and what not to do—when developing an integrative clinic.

Heal Thy Practice also features talks on the Patient Centered Medical Home model, implementation of health information technology, medicolegal issues, medical fitness & health coaching, implementing clinical nutrition, and much more.

It’s all being quarterbacked by conference chairman, Dr. Brian Forrest, who was recently featured on the cover of Medical Economics. The article, part of MedEc’s “Practicing Excellence” series, profiles Dr. Forrest’s innovative, low-overhead, cash-only practice, where he provides 50-minute office visits at fees even families with modest means can afford.

The key? Eliminate the insurance overhead! “What’s gone wrong in medicine is we’ve assumed the burdens of overhead that the insurance companies should have. It’s bureaucracy that they caused, yet it’s on our payroll,” Dr. Forrest said.

In many ways, Dr. Forrest is living every physician’s dream: regular hours, satisfied patients, minimal paperwork, no third party headaches, freedom to focus on patients’ real needs, and time for life outside the office. At HPC’s first Heal Thy Practice conference in Tucson last year, Dr. Forrest described the details of his practice model. This year he will again outline his model, and also offer a special Q&A intensive, as will Alan Dumoff, JD, our medicolegal mentor.

If your professional life has become a bad dream, it’s time to wake up. Let Heal Thy Practice be your alarm clock, your morning coffee and your breakfast buffet! Visit www.holisticprimarycare.net for more details and registration information. Don’t miss the only conference focused exclusively on practice development for holistically-minded physicians.

Holistic Primary Care’s Heal Thy Practice-Transforming Primary Care conference, June 10-13, in Charlotte, NC, is a forum for sharing successful strategies, learning from past mistakes, finding inspiration, and gaining practical skills for creating a financially-viable practice offering patients high-quality, compassionate, comprehensive care.

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