In the first week of my residency, despite what I’d heard, I was surprised by the amount of paperwork I was required to complete. Trying to see all my patients, address their concerns, and fill out all the necessary forms within my work-hour limit was truly challenging. “When will I have more time to spend with patients?” I asked myself. I figured that once I adjusted to residency and the health care system, I’d be able to devote more time to patient care.
Eighteen months went by, and the shift I was hoping for never happened. There were just too many demands on my time as a resident. Anxiety started to creep in; I began to wonder whether I would ever be able to have the freedom to practice how I wanted.
I started brainstorming about what else I could do to pay off my loans. Private practice? I knew I could do that, and it would allow me more freedom to spend time with patients, but that I’d be limited to a small number of patients. A hot dog stand? With hard work, I estimated I could make twice my resident salary.
I knew something was wrong when I was ready to leave medicine to start a hot dog stand. I was on the verge of quitting my residency. But then I came across an article in my email from The DO: “The simple appeal of capitated primary care: Practicing without copays, per-visit billing or RVUs.”
Reading the article gave me a glimmer of hope that there might be just a way to practice the way I wanted. I hadn’t been aware of a practice style that allowed physicians the time to comprehend the intricate barriers surrounding patient care and also navigate them to make sure patients received the care they needed.
The article’s author, Laura Selby, introduced me to one of its sources, Cole Zanetti, DO, MPH. Dr. Zanetti helped me arrange to complete a residency rotation at his Iora Health clinic (branded Iora Primary Care) in Denver, and within a few weeks, I was flying to Colorado, ecstatic to experience a different style of caring for patients.
A different way
The two weeks I spent with Iora passed far too quickly. Each day I spent there, I felt more refreshed, enthusiastic about medicine, and convinced that I still wanted to be a physician.
Iora Health contracts with Humana under a Medicare Advantage arrangement, and only accepts patients who are 65 or older. Each Iora clinic has a team: health coaches, a nurse, physician, clinical team manager, patient recruitment team, and a behavioral health specialist.
Staff and I would arrive at the clinic at 8 a.m. From 8:15 to 9 a.m., staff take care of business items and review the patients scheduled for that day; they identify the high-risk patients and discuss their health, their medical conditions, and most important of all, their barriers to health.
Patients are seen from 9 a.m. to 5 p.m. Throughout the day, I worked with the health coaches, who were the connection between the physician and the patient, to identify barriers for a patient, whether they were psychological, social, health literacy, or even distrust of physicians; categorize them in order of the patients’ priorities and come up with a game plan involving the patient. This allowed us to understand what mattered the most to the patients, and what they were willing to work on, so we could meet them there.
This was only doable because we had the time we needed to spend with our patients; many appointments were one hour, and if we went over that one-hour mark, there was no one breathing down our necks.
Toward the end of my rotation, I noted that the goal of most visits was education. I can confidently say that we spent close to 80% of our time educating patients and around 10% doing paperwork and completing medication reconciliations, often removing unnecessary medications. And that last 10% of the time? Doing what our patients needed.
Back to reality
After I finished my rotation at Iora Primary Care, I returned to my residency in New Jersey. The flow of seeing a large number of patients in a limited amount of time has returned. But this time, I know there’s a place that allows the type of practice that we as physicians envision as we enter medical school and our residencies.
I am almost two years into my training and have decided to complete it. My passion for medicine has been re-ignited. What I desire now is to help bring humanity back to health care.