Housecalls Are Back and Booming. Are They a Threat to PCPs?

Neil Chesanow


July 20, 2016

In This Article

Going on Housecalls: Two Physician Perspectives

Pediatrician Sam Kim, MD, MBA, and family physician Michael Oppenheim, MD, both work part time for Heal in Los Angeles, but their perspectives on the experience are very different.

Dr Kim, who is turning 36 this year, is employed at an outpatient group practice in California's San Fernando Valley. "The idea of a medical startup piqued my curiosity," he says, "and when I initially spoke to Dr Dua about her vision for Heal—how it was trying to disrupt the status quo and how healthcare is delivered to the population—I thought it was very interesting. So I jumped on board, and it's been working out really well."

"In a brick-and-mortar practice, it's more about efficiency of care and going from patient to patient," Dr Kim explains. "In my practice, I still feel like we give our patients excellent care; I'm not rushing anybody and I'm trying to answer all their questions and provide a high level of service. But in the end, it's more about numbers. If you want to survive as an outpatient physician, unfortunately, the reality of the situation is that you need a certain patient volume to make sure that your lights are on and your doors stay open. You're kind of beholden in that way to make sure that your practice is as busy as can be."

"With Heal, we can provide a longer visit and more satisfaction while meeting all a patient's healthcare needs," Dr Kim says. "By seeing the patient in the comfort of his or her own home, there's no apprehension about going to the doctor's office, and thinking, 'This is where all the bad stuff happens.' It makes the whole visit a lot easier and less stressful."

"This model allows a physician the freedom to really dig in and not only talk with the parents and the patients, but also to do true anticipatory guidance," Dr Kim says. "Even if the patient just has a cold or congestion, a minimum visit is half an hour. I end each visit by asking, 'Are there any other questions I can answer for you?' And then patients are thinking, 'Oh, there's one last question.' Until you get that full patient satisfaction, you don't have to leave. I really like that."

Dr Oppenheim, who is 76, has been going on housecalls for more than 30 years. He is the doctor hotels in Los Angeles call if a guest falls ill, and he has done video chat housecalls. Heal is one of two Uber-like firms he has worked for that offer housecalls on demand.

Ironically, the very thing that Dr Kim likes about working for Heal—that he can lavish attention on a patient who may only have a cold or congestion, which would be a luxury in an office setting—doesn't sit well with Dr Oppenheim.

"In my hotel business, I always talk to patients before I see them," Dr Oppenheim explains. "I ask them what the problem is and discuss it. My advice is free. Over half the time, I don't make a housecall. If the patient just has a cold, I tell them it's just a cold and they probably don't want to spend the money to have me come and see them. If they've forgotten their medicine, which travelers often do, I don't stick them for a housecall. I just tell them to go to a pharmacy and have the pharmacy call me and I'll approve it over the phone."

"Working for these Uber services, I have to make every visit they assign," Dr Oppenheim laments. "All I learn is a symptom: 'The patient has a cough or an allergy.' As a result, I often walk into situations where a housecall isn't appropriate. For example, 'Granny hasn't seen a doctor in 30 years. Could you check her out?' Many patients have problems I could have handled over the phone, and others require more than a housecall could provide."

"The Uber-housecall trend will continue," Dr Oppenheim predicts. " People love convenience. They love it more than quality. And it's cheap. Nobody is complaining that Uber drivers earn less than traditional cab drivers because Uber drivers are cheap. Everybody wants cheap."


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