25 years ago today, I started my career in private practice. My notes were written in paper charts, I carried a pager but not a cell phone, and I had a head full of hair. Appointments were written in a book, controlled prescriptions were written on duplicate pads, and antibiotics were handed out like candy. HMO medicine was new and so was the group I joined. It was an exciting time.
My practice had a very wide scope back then. I had an active hospital practice and managed the inpatient care of both children and adults at Hoag hospital. I managed septic patients in the ICU, patients with diabetes out of control and with heart failure, often without consulting specialists. I took care of children hospitalized with bronchiolitis, dehydration and asthma attacks. I felt there was nothing that I could not do. One particular patient utilized all of my skills, a young pregnant woman with viral meningitis and pre-term labor. I performed the spinal tap myself, gave medications to stop labor, and managed her inpatient care without consulting anyone. Those heady days are long gone!
Hospital patients are much sicker nowadays. Many of the conditions that previously resulted in hospital admissions are now managed as outpatients. Skin infections, kidney infections and even new onset atrial fibrillation, conditions once thought to be serious, now do not even merit a visit to the emergency room. Those patients sick enough to be hospitalized are now beyond my knowledge and expertise.
For 12 of my early years in practice I provided maternity care and delivered babies. I was perpetually on call, only unavailable when I was out of town. It was demanding and challenging but I loved it. Welcoming new life into the world was one of my great joys, and it is what I miss most about those days. I delivered my last baby in 2007.
My office practice has changed as well. The era of “one problem per visit” is long past. Every visit to my office is now an opportunity to address multiple health concerns. Patients who come in for respiratory illnesses may find themselves leaving with orders for cancer screenings and routine blood work. Other routine visits evolve into impromptu counseling sessions. The result is fewer patient visits per day, but more care per visit. Where once I saw as many as 35 patients a day, my Physician Assistant and I seldom see that many patients between us.
The business of medicine had changed for me as well. In 1994 I was part of a multi-specialty group of over 30 doctors. Neurologists, cardiologists, obstetricians, internists, surgeons and family doctors, we were all in the same building with shared management. The business styles of the doctors proved to be as diverse as our specialties, and there was frequent conflict. The three physicians with whom I shared a suite joined together with me to leave and found our own Family Practice, Beach Family Doctors, I’m 1995. I managed that practice for 7 years.
By 2002 the practice had grown to 5 doctors and I had grown weary of managing it. In February of that year I went on my own, moving into a small suite across the hall from my former partners. Ours was an amicable parting, and we remain friends to this day.
Two years later, when driving back to my office one afternoon I passed a small house on Beach Boulevard. The “For Sale” sign caught my eye and two days later I was standing in the doorway of the home, imagining where I could put up and tear down walls to convert it into a medical office. Escrow closed in February 2004 and I moved into the office November 1st. It has been my medical home ever since.
Much has changed in the last 25 years but the most important thing hasn’t. I wake up every day knowing I will have the opportunity to make a difference in the lives of the patients who come to see me. This knowledge still brings me joy, and it is that joy that will sustain me in the years to come.
Bart
A special thanks to the many patients who have entrusted me with their health over the years. It has been a blessing, a privilege and an honor.