A Country Doctor Writes:

Yesterday I went for my annual physical at Cityside Family Practice, which is now part of Northside Hospital Health Systems. I have been with Cityside for years, but never really seemed to get a doctor there, who stayed with the practice or cared much for me as a patient. Dr. Wilford Brown was great, but he retired and later came to my own clinic, both as a patient and a part time physician; Dr. Royson became a Hospitalist, and Dr. Washburn seemed to be longing for the beach.

My blood pressure medicine needed to be renewed, and I was overdue for a checkup, so I called for an appointment several weeks ago. Dr. Washburn didn’t have any openings, but Dr. Bill McIntyre, one of the clinic founders, did. I took that appointment, and made arrangements to take the whole day off. This way, I could also get my car serviced, take care of some banking issues and get a new set of passport pictures.

Friday morning’s newspaper had a front page article about Medicaid reimbursement cutbacks and delays in payments to hospital-owned physician practices. There was also a story about layoffs at a small, rural hospital that was taken over by Northside Hospital Health Systems just a few years ago.

The last time I visited Cityside, they were an independent group. The waiting room was cold and uninviting, but the front desk area was buzzing with activity. This time things seemed to move a lot slower. The woman who took my insurance information appeared to be laughing at something. Finally she told me her computer was acting up, and this was a daily occurence since the new management put in a whole new system when they took over the practice.

In the exam room there were a few new posters on the wall and a laptop computer. Dr, McIntryre appeared without a paper chart in his hand and we took care of our introductions. We had met only once or twice before before, were well aware of each other’s professional reputations, but didn’t know anything about each other as human beings.

Bill quickly understood that I really didn’t need a lot of high-tech interventions from him. I am up to date on my health maintenance, and he agreed with me that my cholesterol isn’t high enough to worry about with my high HDL. Our conversation instead drifted toward the business of medicine in America today.

My annual checkup turned into more of a checkup on the status of primary care physicians today. Two mid-fifties physicians, one rural and one in a small city, compared notes. He had always been fiercely independent, and was now taking marching orders from a hospital Vice President and reporting to a Medical Director whose training and experience are in a subspecialty and not in primary care.

He surprised me a little by telling me that during all the years he had been working and building a practice in the small city north of my home town, he had actually lived near the ski slopes west of here, and “camping out”, as he put it, in the city.

“A year or two from now,” he confided, “I won’t be here. I’d like to start a small housecall practice and work out of my home in the mountains. I’ve had it with beureaucrats, insurance companies and big organizations.”

I quietly counted my own blessings, dealing only with a small beaureaucracy in a small town clinic five minutes from my home. I also made a mental note that, once again, I’d be looking for a new personal physician for my next checkup.