Doctor goes solo in search of 'ideal' practice

Doctor goes solo in search of 'ideal' practice

by Dr. Gary Seto

I believe everything happens for a reason, even if we never fully understand what that reason is.

In 2001, I was a family doctor at a large managed-health organization, busy seeing patients every 15 minutes and constantly running behind. It was rewarding, but stressful. I'd resigned myself to the pace. Then everything changed.

On May 18 of that year, my oldest daughter, Elizabeth, just 10 years old, died suddenly of an acute asthmatic reaction. We suspected food allergies triggered the reaction, but never knew for sure. I was devastated, hardly able to believe what had happened. After a month of mourning, I returned to work.

But once I was back, I realized spending 12 hours a day at the medical office and working weekends wasn't what I wanted to do anymore. I started looking for a way off the hamster wheel.

Over the past few decades, there has been a trend toward doctors joining large medical groups and salaried positions, and fewer going into solo practice. In my search for an alternative, I learned of a small but growing number of doctors doing just the opposite.

I read about a Rochester, N.Y.-area physician, Dr. Gordon Moore, who developed a practice model that hinges on keeping overhead low and seeing fewer patients to provide unrushed, high-quality care.

In getting connected with the movement associated with this model, called simply the Ideal Medical Practice, I encountered an eclectic group of health care providers not afraid to try different ideas. A discussion in the group led me to try a day where patients without insurance could pay whatever they wanted for their visit.

This spurred several other practices to do likewise. I learned most patients are willing to pay something for medical care, sometimes more than expected, and that one day isn't enough to take care of many patients' problems. I'm planning to hold future "Pay What You Can" days on a recurring basis.

Since starting my solo practice in 2004, I have continued to refine and grow it. I have about 600 patients, with a goal of about 900 to 1,000 — still less than half the number in a traditional practice.

But because my practice is small, I'm never overbooked and can see patients the same or the next day. I usually spend at least 30 minutes listening and talking to them, an hour with new patients. In exchange, I charge $120 a year per individual or family, in addition to typical fees for visits, to help cover overhead costs since I see fewer patients.

I have no receptionist or nurse, but I'm accessible 24/7 by cell phone or e-mail. And I've hired a part-time billing administrator to help with insurance paperwork.

It is still a work in progress. But so far I've found it extremely fulfilling to practice in a way that eliminates many of the barriers to optimal care, while affording me the time to balance work and family life.

I'm still not sure of the reason for Elizabeth's death. But it led me to a more satisfying way of practicing medicine. And ultimately that allows me to spend precious time with my wife and two teenage daughters.

Dr. Gary Seto is a highly rated family physician in South Pasadena, Calif., and a clinical instructor at the UCLA and USC schools of medicine. When he isn't working, he says, he's taking his daughters to UCLA football games, Comic-Con International — an annual comic book show in San Diego — and Fosselman's for ice cream.

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Dr. Gerald Roth packs boxes at Madera Medical Clinic in Tucson, Ariz. in preparation to close the practice. He joined Northwest Allied Phyisicians in September. (Photo by Al Mida)

Doctor says his solo practice couldn't survive on rates Medicare pays, but he can treat Medicare patients again after joining a group practice.

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I was very touched by this story and wish that we had a Dr. like him in Michigan. The only doctors I know of here, send you to many other doctors and as a results of that I am trying to pay many doctors and can't afford to see a Dr. now even though I need to.
I thank this kind Dr. for sharing his story...he is a very special person.



I greatly admire Dr Seto fort he "Pay what you can" day! But, I have to ask: if you're avilable by phone/email 24/7, how does that "shorten" your day? Do you not spend a lot of time basically being on-call 24/7?

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