During the second half of the 20th century, knowledge about how to prevent and treat disease exploded. Doctors became more specialized and moved their offices out of the communities to be closer to hospitals and treatment facilities. Insurances, initially set up as a fringe benefit to lure employees, became the nearly universal way to pay for medical care, and insurance companies began to dictate how and how much physicians should get paid. As the costs of operating a medical practice increased, reimbursements remained constant and physicians were forced to see more and more patients a day just to make ends meet. They responded by industrializing (forming an “efficient” system of patient management from check-in to check-out) the office visit. Even though the doctors were working more hours, face-to-face time with the patient diminished and the doctor-patient relationship began to erode. The failure of this relationship has resulted in decreased quality of care, increased physician and patient dissatisfaction, and has fueled a spike in malpractice claims (which leads to higher overhead costs, necessitating seeing even more patients, creating a vicious cycle). Ironically, even though medicine is more scientific and specialized than ever before, patients are left longing for the healing professional they remember from their childhood and many physicians are stuck feeling like they are being forced to practice inadequate medicine.
In 2002, Dr. Gordon Moore, a family physician in Rochester, N.Y., proposed that by adopting electronic medical records and redesigning the practice style, overhead could be dramatically reduced. This freed the physician to spend more time with patients increasing both physician and patient satisfaction. With the doctor-patient relationship reestablished, quality indicators (blood pressure control for hypertensive patients, sugar control for diabetics) improved to two to three times above the national average. Amazingly, he found that physician compensation still approximated what it would have been in a “traditional” office.
By adopting many of Dr. Moore’s philosophies and reintroducing the office back into the Hilton neighborhood, the Village Doctor has returned family practice to its roots. This type of practice allows the service of yesterday (complete with home visits) to be integrated with the technology necessary to practice medicine today. It is the best of both medical worlds and should remain a viable way of practicing medicine for years to come.