When he told friends and family he wanted to be a family doc, they told him he was crazy. So he proved them wrong and set up a practice that defied all the stereotypes.
By Chad Krisel, M.D.
APRIL 7, 2014 – I went to medical school in order to become a family doctor. My goal was to help people realize their optimum health by treating the root cause of their problems. Knowing that more than 75 percent of total health care costs are incurred treating chronic diseases and their devastating end-points, I aspired to prevent illness in the first place or reverse problems in early their early stages.
My friends and family thought I was crazy. I heard more than once that I should become a dermatologist or go into one of the other so-called “lifestyle” specialties. They predicted I would spend more time buried in paperwork and red tape than actually doing my job. Having a precedence in my life of making my dreams manifest, I proceeded onward. I went to medical school and residency and saw the realities of status quo medicine. I witnessed the treadmill pace that most primary care doctors (and their patients) are enduring: the eight-minute office visit after the patient’s 45-minute wait. With further investigation, it became clear that the reason for the slow and steady decline in quality of care over the years has been due to primary care physicians taking on third-party payers. The treadmill pace of primary care docs seeing upwards of 25 to 30 patients per day is a necessity to pay for the greater than $83,000 in annual overhead costs associated with third-party payers. I witnessed a heavily skewed dependence on treating symptoms with pharmaceuticals, instead of tackling the root cause of problems – mainly because there was no time to do so in an eight-minute office visit. No matter what our intentions are as primary care doctors, we will not be able to do our job in an eight-minute office visit.
My now-medical partner and I had no interest in participating in this broken system. Toward the end of residency, we intentionally sought out experts in various practice styles from around the country to see what other options existed. A key ingredient was finding a model that would allow us the time needed to really solve problems with patients. We decided on a direct primary care financial model combined with an integrative philosophical model.
We opened Integrative Family Medicine of Asheville in January 2012. Our daily reality has been a paradigm shift from what I previously considered the status quo of primary care. We spend an average of 25 to 55 minutes with patients, depending on need. We are able to respect our patients with an average five-minute wait time. We use pharmaceuticals judiciously, but we also look favorably upon high-impact modalities that are practical, effective, and affordable. Examples include identifying barriers to lifestyle changes and having serious discussions with patients about nutrition. To realistically accomplish this, we have found the increased time with patients invaluable.
A key ingredient in generating change on a bigger scale than just our clinic alone has been collaboration with other experts in our community. We work directly with acupuncturists, psychotherapists, and others to yield the best possible outcome for patients. We host a free monthly class on a wide range of topics. Speakers have shared their expertise on topics including cooking, gardening, yoga, qigong, and many others. We donate all our proceeds from supplement sales to local organizations that provide our community with critical services. Together we are showing that through collaboration, the sum of us working together truly is bigger than each individual could be on their own.
Regarding insurance, I encourage my patients to have a plan that provides catastrophic coverage. This is about where my recommendation ends. By allowing insurance to do what it does best – protect us in case of catastrophe – opportunities open for primary care physicians to contract directly with patients to focus on the patient as the primary concern, not which billing code is the most appropriate. Since the Affordable Care Act was passed, we have the best of both worlds. A catastrophic insurance plan will cover us against financial bankruptcy and no one will be excluded due to a pre-existing condition. The money saved by going with a catastrophic plan can be spent on a direct primary care practice.
I am very pleased to see both direct primary care and integrative medicine gaining traction nationally. Our very broken system may yet be evolving into something that will bring true hope for primary care doctors and their patients.
Chad Krisel, M.D., is a family physician in Asheville, NC. He is co-owner of Integrative Family Medicine of Asheville.