The Micro Practice

MD Magazine®, Volume 2 Issue 2, Volume 2, Issue 2

A Detroit-area internist forges a new way to practice medicine.

“I’m working much harder than I ever have in my lifetime,” says the Detroit-area internist.

The breaking point

“Medicine today has been ruined by the MBAs,” she argues. “Once you get into the business aspect and start looking at the numbers, it becomes only the numbers. But all diabetics cannot be treated the same. I found when I was working for a big organization, all my diabetic patients were well controlled, all my cholesterol was on target, but I was over-medicating my patients because of what I was expected to do. That’s not good patient care overall, but this is what insurance companies want. They want good numbers.”

But the journey has been far from easy.

Chellam started down the path to a solo practice even before she left the VA. She woke one Saturday morning in September, 2007, and read an article in ACP Observer, a publication of the American College of Physicians, about a physician named Soma Mandal and the “no frills practice” she had started in New York City. Chellam found Mandal’s story strikingly similar to her own.

Patients would call me while I was at the VA seeing other patients, and I would have to call them back, try to schedule the appointment during my lunch break, and then drive back to the VA. I did that for about six months, and it was very difficult.The assisted living connection

“Once you do that, you actually get to know a lot of people,” Chellam explains. “Families got to know me,” as did hospice and the home care companies that serviced the assisted living facilities. And she got to know them. Before long she was asked to serve as director for one home care company and medical director of the hospice that the facility employed.

Chellam follows her assisted living patients to the hospital if they’re admitted, then to rehab, if appropriate, to monitor their progress, and back to the assisted living facility. That way, she explains, no one gets lost in the follow up.

Teamwork is key

“I really lucked out that I have a very good office manager who cares about these patients,” Chellam says. “At the beginning of the day, I send her an email about the tasks she has for the day, and at the end of the day she sends me an email about the tasks I have remaining to be done, like sending prescriptions or checking on somebody’s lab or returning an email. We try to get to all of the work by the end of the day so there’s nothing pending for the next day.”

And, of course, there are the patients, whom Chellam calls the leaders of the team.

No regrets

“I sometimes think, ‘This is crazy. I need to find a job,’” she laughs. “But then I realize there’s no way I could go back. It’s time consuming, but at the end of the day I’m my own boss and I decide what I’m going to do.”

<span style="Times New Roman" ,"serif""="">Ed Rabinowitz is a veteran healthcare journalist based in Upper Mt. Bethel Township, PA.