No more assembly-line medicine

Steve Berberich

Dr. Robert Fields proudly displays a framed copy of the letter he sent to Mid Atlantic Medical Services LLC — MAMSI — and to Aetna, CareFirst and other insurers on Aug. 27, 2003, the day he opened his retainer practice, telling them he would no longer accept insurance.

Fields said in his previous, more conventional practice, he had an epiphany over patients struggling with insurance coverage and squeezing in doctor’s visits. The worst case was a 55-year-old woman who kept her appointment for a full physical the day after her husband died.

‘‘Why are you here?� he asked, only to learn she had been trying to get an appointment for six months and didn’t want to cancel.

Other patients his help in fighting insurers. He got sick and tired of writing form letters to insurance companies until 10 p.m. asking for approval, for example, to prescribe one allergy medicine instead of another. He was seeing up to 18 patients a day in a practice that started to resemble the chocolate factory assembly line scene in a famous episode of ‘‘I Love Lucy.�

‘‘If I would stayed in that environment, I would have died prematurely,� Fields said. ‘‘I am happy to go to work in the morning now and I see five to eight patients a day.

‘‘I now have more time to spend in preventative medicine,� he said. ‘‘I also got a reduction in my medical malpractice insurance premium.�

‘Closed my eyes and dove off the cliff’

Fields trained with physician Aimee Seidman at Washington (D.C.) Hospital Center in the 1980s and recently advised her to convert her Rockville practice to the retainer model. He said Seidman and her partner Dr. Marcia P. Goldmark spent some time visiting his office and ‘‘she was really sold.�

Seidman and Goldmark recently opened a retainer practice that’s limited to 400 patients, after breaking away from a four-physician practice of 10,000 patients.

‘‘In my case I just I closed my eyes and dove off the cliff,� said Seidman, who calls herself an old hospital center-type doctor. She wants to be like Marcus Welby, the gentle TV doctor portrayed by Robert Young in the late 1960s and ’70s.

In her previous practice, Seidman said, she ‘‘wasn’t able to give people the kind of quality care that they deserve.�

Seidman, a geriatrics and family practice physician, said the change had nothing to do with money, as she earns about the same as previously.

If her patients are too sick to go to her office, Seidman will make a house call.

‘‘You learn so much and they are so honored that you come to the house,� she said.

For example, one house call revealed that an elderly Urbana woman was taking the wrong mix of prescriptions. Seidman found herself tossing out bottles from the medicine cabinet, with the patient’s permission.

Other patients are busy executives with little time for even a cholesterol check. She visits them at their workplaces.
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