My Medical Groups 

I basically worked all weekend in the hospital. I have been too busy to blog. But I am back now.

Last week I went to a Medical Meeting of my group of Ob/Gyns. I used to be solo, but no more. Solo medical practice is dumb and inefficient.  This time, our meeting was in Red Bank, New Jersey. My Group is called Lifeline Medical Associates. We are based in Parsippany, NJ. We are composed of about 90 Ob/Gyns. Our website is www.lma-llc.com. Our web site is really very good. It requires Flash, though, so it won't work very well on an iphone. Lifeline is one of the biggest Ob/Gyn groups in the country. We are also a founding member of what is called the Women's Healthcare Alliance. Our Alliance is an over arching group of big Ob/Gyn groups. The Alliance is not very formal yet, but it seems to be rapidly growing in capabilities. 

When we get groups this big, something magical happens. All of a sudden, we get gigantic economies of scale. For instance, as a progressive Ob/Gyn, I wish to be on the cutting edge of Electronic Medical Records (EMR).  One problem of being a solo doctor, is that picking an EMR is hard. I have to pick an EMR out of what seems to be thousands of different types, then I have to install it, make a million decisions about what to do with this bit of data or that, and then actually go through the extensive, risky, and somewhat brutal process of changing my medical practice to fit the new paradigm of digital medicine. But, in a large group, only a few motivated and technically proficient Ob/Gyns have to make all of the beginning decisions. Then, they can debug the brutal "going live" stage, and give all the rest of us a ton of help and pointers about "best practices". 

And there are a million other gigantic economies of scale. Such as Human Resources, Protocol Development, Contract Negotiation, Business Practices, Billing Practices, etc. 

Because I am in Lifeline Medical Associates, I no longer have to work until midnight running the "business" of my business. I can, instead, focus on the "medical care" of my business. This frees up some time for me to, for instance, write this blog. In my experience, running the "business" of the business, takes up about 30 hours a week for any generic type of business, to do the job properly. This means, in no particular order, doing all of the "human resources" type of work, creating and mailing all of the bills, producing information for the accountant, going over the IRS forms, signing and sending them, checking the bills for fraud and then paying them, picking a phone company, fixing the phone system, hiring a cleaning service, fixing the plumbing, calling the landlord to get the building maintained, and all of the rest of the things that a business must do before it even starts creating the product that the business exists to create. For a solo doctor to try to do all of these things himself is a ridiculous wast of time. And that time wastage will certainly take time away from their family, and likely take time away from patient care.  

The business of the business is handled for me by Lifeline. This is so efficient it should be scary. It really ought to be scary for the medical doctors who try to do all of this on their own. They are simply not going to be efficient. They are wasting their efforts doing things that ought to be done by people who do the "business" of the business for a living. They do it all day long and are good at it. 

There are still many solo doctors and small groups around. The ones that are good at it are still doing well. But for most, it is at least a struggle. 

So, for about 4 years now, I am in Lifeline. And Lifeline is a founding member of this Women's Healthcare Alliance. This alliance is Big, on a Big Scale. It consists of many groups of large Ob/Gyn groups. It covers about a thousand Ob/Gyns in several states, hundreds of thousands of patients, and controls many billions of dollars of medical services. We, as Ob/Gyns, are now on a national stage. We can use this size to do a lot of good for the women of the world. I am really glad to be a part of this. If there are national, or international, sized decisions to be made that affect women's health care, we aim to be part of it, sitting at the table. And this will directly benefit my patients and my community. 

The future of medical care is a giant unknown. We don't know what medical advances will bring. We don't know what political changes will affect our future. But there are a few certainties. One, medical care in the US is technically proficient. Two, medical care is gigantically too expensive. Three, we don't have better outcomes than other advanced countries, despite spending a lot more money on health care. Four, many medical doctors are struggling to pay their bills. Five, most insurance companies are making so much money that their biggest expenditure is buying other insurance companies. Six, many doctors have not had a pay raise in decades, despite providing great care to their patients. 

The business of providing medical care in the US is an industry that is very inefficient and seems to many people to be entirely broken, and even dangerous in some peoples opinion.  Lifeline, and the Women's Healthcare Alliance, and even my college, the "American College of Obstetrics and Gynecology", are doing what we can to fix it. Our Mission is to provide the best medical care possible, to the most women that we can, proficiently, safely, and efficiently. We aim to do this while using evidence based medicine, and keeping ourselves on scientifically based protocols. We aim to do all that we can do while staying at the advancing edge of medicine. We are very far along on the process of introducing EMR, when many practices have not even begun yet. We are well into our second generation of EMR, and evaluating the next steps now. It is not possible for a solo or a small group to do this much work on this problem. 

I do have stories to tell about EMR, though. On my first day, going live, I booked half the usual number of patients. I should have booked one tenth. I had five patients in the office before I finished the first one. I was kind of worried, to say the least. But I held my commitment, worked as best I could, and finished the day. Somehow. It has not been perfect. I am not completely EMR yet, even after a few years. I still have some paper charts. I don't think they will, or should, ever go completely away. 

Thanks for reading. Comments are appreciated. 

Sincerely, 

John Marcus Ob/Gyn 

Ridgewood, NJ 07450 

201-447-0077