MDVIP - a different way to approach primary care

Okay, so it has been brought to my attention by various people that I haven't blogged at all this rotation. So, before it is over, I thought I would get a few words in. I am in my second family medicine rotation and loving it. It has been very different from my previous rotation. If you remember my last rotation was on the East side, in the ghetto. The majority of the pts were of a fairly low SES. Their insurance was HMO, and the quality of care was very different, not worse, Dr. Orr still did a great job, but just different. I am currently on the West side, in Summerlin. Dr. Gunter has an MDVIP practice. Most of the pts are very wealthy, and though some may complain, for the most part money is no object (although that has changed since the recession).

Dr. Gunter has a very small practice. He has around 400 pts. He only sees a max of 15 pts a day, and all appts are 30 minutes, unless he is doing an executive physical, that takes 1 hr. The office atmosphere is very laid back and enjoyable. The staff are great. There is a great office dynamic. There are 2 medical assistants Robin (once again, names have been changed to protect the innocent) and Shaniqua. Then you have June at the front desk and Emily, the licensed medical esthetician. Fox News is always playing in the front office on the 32" flat screen. Pts can make themselves a cup of coffee or grab a cold bottle of "Sparklets" water while they wait, although the average wait time is only around 5-10 minutes.

So just in case you don't know how MDVIP works, let me explain. Each pt pays a set fee per year to have unlimited access to the Dr. They still pay their copay when they come in and their insurance is still billed, they are just guaranteed quicker service, shorter wait times, faster appointments, they have the Dr's cell phone and can call for whatever, and they get the 30 minute appointments and a yearly executive physical (very in depth thorough exam).

Okay, so now a little about what I think of the Dr. Gunter's practice. First, I have to say that for years I have had an idea and theory about how I have wanted to practice medicine. I have worked in and around the medical profession for many years and have yet to see anybody practice in the manner that I wish to do so, that is until I saw how Dr. Gunter practiced and his office. I have always thought that going to the doctor should be as much of a calming experience as possible. Dr. Gunter's office provides the ambiance to accomplish just that. There are no tacky drug rep advertisements on the walls, everything is clean and nicely decorated, the colors are cool and calming. Dr. Gunter also isn't one to just prescribe medications for everything and anything, he is open to trying natural alternatives and believes in pushing lifestyle changes before starting the prescription medications. There are many procedures performed in this office, from skin tag removal to circumcision. He also uses various types of alternative medicine - acupuncture and fire cupping. Dr. Gunter is also trained in OMT. These various aspects of his practice, along with the time he is able to spend with his pts really exemplifies the type of medicine that I would like to practice.

Now I do realize that a practice like this is not possible in all settings. It would never work in the HMO setting that I saw in my previous rotation, but it is definitely something that I think could and should be incorporated into the primary care practices. It is a step back to the way primary care used to be, the hands on taking care of the pt. So many Family Drs. just work as "triage specialists," sending their pts to different specialists without treating or using their clinical skills to take care of their pts, in some cases not even touching or examining the pt. That is not how I want to or plan to practice medicine. I want to be hands on. I want to interact with my pts. That is one of the main reasons I became a doctor, for the humanistic interactions that it could provide, for the ability to actually touch and treat pts, to listen and experience life with them.

This month I have seen many things. I will discuss them more in depth in a later post, but I have seen new life, and I have seen those whose lives are ending due to disease. I have felt sorrow as I have become attached to certain pts that have been regulars or those I have seen in the hospital (yes, Dr. Gunter takes care of all of his pts if they go to the hospital and manages their care, if their insurances doesn't require hospitalists), realizing that after this rotation I will probably not see them again. There is part of me that wishes I could stay, continue to be part of their lives and continue to help them.

This has been an excellent rotation, there is not doubt about it. It has been difficult, a long commute every morning and evening, and some days have been pretty long with early morning drives to the hospital, but I have learned so much. Dr. Gunter has been a great teacher, and the office staff have been great. That is one thing that doesn't change, the office dynamics are the same on the West side as they are on the East. You have the same personalities and the same funny interactions. I love it, all of it, and can't wait to one day be part of it on a permanent basis, and not just a drifter, traveling through.