Feature Article
A Matter of Identity
By Ari Hauptman, MD
When I finished pediatric residency, I envisioned my
young patients and their families planning to visit me, as in: “Come
on, Billy, we’re going to go see Dr. Hauptman.” It was important
that these families identified me as their personal physician, someone
with whom they had established a long relationship based on mutual trust
and dedicated care. I wanted the office staff and myself to be an extension
of the family, and for the office visit to be as intimate and familiar
as a stopover at a friend’s house.
Idealistically seeking my identity, I joined a small-group private practice
after residency. I did not consider joining a large group or even an organization
like Kaiser. My fear was that in a large group, the family preparing to
visit me might say, “Billy, we’re going to Kaiser to see Dr.
Hoppman.” Neither the need for “increased control” nor
the added pressure of running a business were important to me at that
point in my career.
Over the next decade, the clinical practice grew easier, but the reality
and challenges of the business of medicine became daunting. Where in medical
school or residency was a class on contracts, personnel, and budgets?
Why does my once-friendly relationship with another community pediatrician
seem to have become more competitive? Do I really have long-term job and
financial security?
I was increasingly pulled into the administrative and management aspects
of the practice. My once-small group merged with others. My identity was
fading, and I began to question my long-term financial security. I looked
for a change that would provide low administrative hassle and high job
security without sacrificing my identity.
I have been a Kaiser Permanente physician for the last
four years. The aforementioned advantages of a large-group practice and
a salaried position are obvious. I greatly underestimated, however, the
power of “integration” and “best practices” a
large group can offer. The pride, community, and teamwork of our Santa
Rosa facility is reminiscent of the medical center at which I trained.
On the other hand, I miss the true sense of ownership that my private-practice
colleagues possessed.
The guarantee of a salary despite the peaks and troughs in workload can
result in some of my new colleagues being resistant to “doing more”
because the incentive is not as tangible as in a “do more, earn
more” model. But what about patient care? I truly find the care,
measured by both quality and compassion, to be equal in both the Kaiser
and private-practice models. Some patients find the large scale difficult
to navigate, but others recognize and cherish the convenience of having
laboratory, radiology, pharmacy, and specialists all on site, working
together and communicating with one another. Creating a small-office atmosphere
in a large group is a challenge, but I have nevertheless forged intimate
relationships with my patients and colleagues equal to those in my small
group.
The practice of medicine is a business, and—like all businesses
in the 21st century—it must rise to the challenges of the information
age and the need for increased efficiencies. The medical practices of
the future will have to achieve these efficiencies through close collaboration,
something that a large integrated system of physicians, hospitals, nurses,
pharmacies, and laboratories is built upon. On the other hand, the intimate
doctor-patient relationship must not be lost. My hope is that the efficiency
of the large group and the intimacy of the small group will drive us to
a model of health care delivery of which we can all be proud.
Dr. Hauptman is a pediatrician at Kaiser Santa Rosa.
Sonoma Medicine, Volume 56, Number 2 (Spring 2005).
