I’m Dr Ruth Freeman, Internal Medicine. I have a vision for the future of medicine. I have the experience and the platform to make our medical system work better for patients and for doctors. As Doctors, we start out with great intentions, but we become overworked, unhappy and jaded as we are forced to comply with the restraints placed on us by our current medical system. Over the past twenty years, I have seen marked a shift downward in the quality of medical care in our region. I have put together a plan for a sustainable model which will allow doctors to spend more time with their patients thus improving patient outcomes while maintaining a healthy work life balance.
As a freshman at the University of Georgia at the tender age if 16, I had already chosen my path to medicine. I graduated with a B.S in Biology then went on to earn my Doctor of Medicine from Howard University College of Medicine. I completed my Internal Medicine Residency at the Montefiore Division of Albert Einstein in Bronx New York. I spent the first two years after residency working first in the ER at Montefiore Medical Center then at Saint Francis Hospital in Grand Island, Nebraska.
I spent the first 18 years of my Internal Medicine career working as a Primary Care Physician for large multi-specialty groups. Because of my excellence in managing complicated patients, I attracted some of the sickest patients to my practice. Though undaunted by the complexity of these patients, making time for such patients within the time constraints the industry demanded proved challenging. I lived everyday with the fear that something important would be missed. I spent hours after the patients were gone reviewing their charts to ensure that nothing was missed. I was constantly under pressure from management but I refused to compromise. Though I was well aware of the negative financial impact seeing fewer patients would have on the practice, the safety and health of my patients had to take priority.
“The maximum allowable”
The time constraints placed on Primary Care doctors is directly, though not totally, related to the value insurance companies place on our time and our skill as Primary Care physicians. Many insurances do not compensate a Primary Care Physician for additional time spent to care for a complex patient. Insurance plans have fixed amounts that they pay to physicians for a single visit. The cap per visit is deemed “the maximum allowable.” If a primary care physician needs an hour for a complex patient, the physician will often be paid no more than if the patient was seen for no more than 15 or 25 minutes. It is impossible for a Primary Care practice to survive on insurance reimbursements alone particularly if the practice contains more complex patients. Adequate staffing and time with patients are required to provide safe and excellent care. Many Primary Care practices survive by reducing the visit lengths and by operating with less staff that is needed.
How It Happened
Looking back at the trends in medicine over the last twenty years, doctors, particularly those in Primary Care, have moved away from private practice to join large multi-specialty groups. Gone are the days when we lamented about the cost of malpractice insurance. There are now greater financial burdens. For example, every physician must have an electronic medical record system. To get on the most popular system in this region, even though I am solo, I would need $120,000.00 to acquire the system. Once acquired, the system costs $75,000.00 yearly. These and other soaring cost has made the solo practitioner extinct. Unless a Primary Care Physician had an additional source of income, it was imperative that we become employees of one of these large institutions. Sadly, the result has been a marked reduction in the quality of care provided in the primary care setting. For physicians, the time constraints can be harrowing. Physician burnout rates are high, particularly for doctors that truly care.
I thought of retiring
I reached that burnout point in August of 2016. For eighteen years, I refused to stay within the time constraints dictated. The increased hours and the stress of caring for patients under those conditions took their toll. In the summer of 2016, I decided to retire from medicine.
As I prepared for a new career, my plan was sabotaged by a longtime patient of mine, Paul Anthony Morrier. His words were simply, “Don’t quit on me. I need you. You saved my life.” At that moment, I realized that, with all the skills I had amassed and with my years of experience, I was more valuable than ever.
I could have accepted another six-figure salary with yet another multi-specialty group. Instead, I decided to go against the industry grain by opening my own practice. I was determined to find a way to give my patients the care they needed and deserved I knew my impact on the world of medicine would be far greater if I was able to do all I thought best for my patients. Paul became my friend and mentor. For the next 2 years, under Paul’s guidance, we built Dr. Ruth Freeman and Well Beyond Pain. We created a place we could be proud of. Within those walls, I can practice medicine the way it should be practiced, with excellence.
A Primary Care Gym
In addition to providing our patients with excellent medical care, the clinic houses a gym that offers supervised exercise sessions. By providing my patients with an effective program to improve their health, I have expanded the scope of my influence on positive outcomes. There is no single medication that can take the place of a healthy diet and an effective exercise program. An exercise program with the right amount of “the right kind of exercise” saves lives, reduces the incidence of heart attack, stroke, diabetes, hypertension and mitigates damage for those who already suffer from such issues.
Helping patients with Chronic Pain
The third arm of the practice, Well Beyond Pain, will roll out at the end of this year. This program is dedicated to those who suffer from chronic pain. Our clinic will be a place where patients suffering chronic pain will be treated with dignity. We will pair Exercise, Nutrition, Techniques in Mindfulness and Cognitive Behavioral Therapy for chronic pain. We will help those who suffer from chronic pain to regain the lives they have lost. The key to success is to provide these particularly vulnerable patients with a readily available, comprehensive support system. We will target additional long-term goals for chronic pain suffers. Being sedentary increases the risk of heart attack, stroke. diabetes and hypertension. Risk reduction for this particular population will be addressed as well.
Our Primary Care Clinic opened on May 1st of 2018. I am glad to be back. The joy I have been met with has been overwhelming. The new addition to the practice, CardioFit, began on August 11th, 2018. Classes are conducted by our certified trainer. I am thrilled at the improvements I have seen in our patients already. The improvements in strength, mobility, reduction blood pressures, and pain reduction have occurred more quickly than I expected.
Though I have always encouraged my patients to exercise, without our supervised CardioFit classes, it typically takes patients 6-8 months to see significant reductions in their blood pressures. In only 3 months in our program, patients have seen marked improvements in their blood pressures. Some results were so good that blood pressure medications were lowered. Patients have also reported measurable improvements in strength and mobility. One of our patients who had not been able to walk up a flight of stairs unless both feet were brought to the same step, reported that she was able to walk up stairs normally for the first time in many years. Our patient who suffered a stroke a few years ago is now strong enough to help with his transfers from his wheel chair. When I met him 4 months ago, we needed two people. Even then, we struggled to transfer him to the exam table.
Our Team and Goals
We have an excellent team. Our Director of Clinical Services runs a tight ship. Our trainer has been met with rave reviews. His degree in Exercise Physiology and his CrossFit certification has been a winning combination. In just 3 months from launch, because of the rapid growth, we added our MA Lynne who has duties both on the Clinical and the administrative sides. Currently we need a full time receptionist to keep up with the volume of incoming calls. We also need an additional person for the clinical side to maintain the efficiency of daily physician encounter work flow. The demand for gym hours is growing. Currently we need to add two additional classes daily. Saturday classes are also in demand. We will then need to add a second trainer.
In the eight months we have been open, we have amassed 300 patients on the Primary Care side. Many of them are former patients who have waited 2.5 years without seeing a doctor as
they heard I would be back. The practice has grown simply by word of mouth.
My venture will not attract large investors who have millions to risk. The rewards are great but the profit margins are small. The satisfaction of getting patients well and helping them stay well is more valuable than anything money can buy. Primary Care doctors who spend time with their patients don’t become millionaires. We can however, with smart business plans, make enough to sustain our practices.
My business plan is sound. The growth of the business is on target. My plan takes into account that I will receive roughly 50% of what I bill for on the Primary Care side. The income from the gym will off-set the deficits on the Primary Care side as planned. It typically takes 12-18 months to bring a medical practice to the point where it can support itself. With already 300 patients and 15 gym sessions a week since opening in May 2018, we are on target.
We Need to get the Word Out
The gym is only at 16% capacity. We need advertising to get this off the ground. A window sign and the building sign will increase visibility from the street. We also plan on adding print and electronic media to our advertising platform.
Based on our current path, we will reach full sustainability in just 10 months. At this point, working capital is needed to increase the number of classes we offer. The office space had to be sizable to accommodate the gym making the lease payments a hardship for a growing business. Because of growing class sizes, the gym floor has to be expanded.
I need your help to give our gym a proper launch.
I hope that my venture will inspire other good doctors to take a chance on themselves for the sake of our patients. Together we can restore the heart and soul to the profession I love.
Dr. Ruth Freeman