Female Physicians on Creating Alternative Career Paths

Stephanie Cajigal; Jessica Freedman, MD; Farzanna S. Haffizulla, MD; Pamela L. Wible, MD


April 03, 2015

Medscape: How much more time are you able to spend with patients now?

Dr Wible: Initial appointments are 60 minutes. Physicals are 60 minutes. Most follow-up appointments are 30 minutes, unless I know that the patient is demented or has a traumatic brain injury or might need more time. I know my patients really well, so I know how to schedule them so that they're not overlapping in ways that would make me run late.

I'm on time for every patient, and if I'm more than 10 minutes late for some unforeseen reason, they get a gift. I have a big gift basket by the door, and they get to pick something from there. I have patient appreciation days, and they get balloons and chocolates.

It's really, really fun, and I'm solving their medical problems. Whether uninsured or insured, I see everyone. And I've never turned anyone away for lack of money in 10 years.

Medscape: About how many patients a week do you see?

Dr Wible: In a half-day it would be about eight to 11 at the most. Over the past 10 years, I've seen approximately 30 patients per week because I work part-time.

Medscape: How does this work out financially?

Dr Wible: Physicians are squeezing in so many patients per day because practice management "experts" advise that in order to make more money, you should ramp up the volume. But when you ramp up the volume, you ramp up your overhead too, because you need more phone lines and more staff and all those sorts of things to handle that higher volume. It's also undoable. Using a parenting analogy, you're going to be a much better parent to two children than to 17.

Financially, it works because my overhead is really low. It went from 74% at my "factory job" to close to 10% my first year of opening the practice. So I'm walking away with a lot more money at the end of the day and having to see a lot fewer patients.

The patients whom I'm seeing are getting much better care, so they're not having to come back. I'm not churning people through for multiple visits. They're coming in for a substantial visit and getting their problems solved, and they're leaving self-reliant. I'm addressing multiple medical conditions in one visit, not placing piecemeal Band-Aids all over patients.

Medscape: Do you have any staff at all?

Dr Wible: No; I have no staff, which is kind of like the model that used to exist. Back when my dad worked in the 1950s in his little neighborhood clinic, he had no staff.

Medscape: Do you do your own scheduling and billing and all of that?

Dr Wible: Yes, and it's been really fun and great and I love it. The thing is, we need more physician mentors who are doing this to demonstrate how fun it is to practice this way, because the patients love it, I love it, and the medical students love it when they come by and see that this is a possibility. Of course, they're told in medical school this doesn't exist by people who don't really get out of the ivory tower much, so they don't really know.

Medscape: Could you explain why this model works particularly well for female physicians?

Dr Wible: Female physicians are more relational by nature. We are about relationships: hugging, touching, loving people. I think we went into this with our hearts and souls wide open, which many men did too, but this patriarchal, reductionist medical model really favors male values of speed, volume, being tough—the suck-it-up, man-up mentality.

There are really just only two ways of practicing medicine: You're either on a production-driven model or a relationship-driven model. Women in general really need to be in a relationship-driven model, because that's most congruent with who they are.

The beauty of this is that you can make a really great income working in a relationship with your patients and still have time for relationships with your children, your husband, and your family. Yes! You can pick your kids up from daycare and make dinner at night and do all the other things that you want to do as a mom and a wife, plus have a great relationship with your patients. You're unlikely to be able to do that at 30 patients a day, feeling frazzled and having 50 call-backs by the end of the day and feeling like you never really solved anyone's problems.

In an assembly-line practice, you get the feeling that you just layered Band-Aids all over your patients' heads all day. You feel like you never really solve peoples' problems. You just send them away and tell them, "Good luck."

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