This is a question I am often asked by friends and patients who imagine some of the crazy situations I must get into seeing patients at random hours and making house calls a regular part of our practice. I must admit that after 4 years of doing House calls regularly in San Francisco I have seen a lot of crazy things. But I have a very ready answer for this type of question that has stuck with me.
A big part of our practice and growth has been with help of other physicians who were closing their practices and either retiring, moving on to Kaiser, or simply leaving the profession. Much of our major purchases came from these doctors. One Family Practice Doc who was packing up his practice after 10 years and joining Kaiser was kind enough to supply us with several large and expensive pieces of equipment. We went to his office on a Saturday with a few of my friends to help me load up our truck with equipment. The doctor met us there with his entire family. He had two little girls around 8-10 years old that were there in the office playing. One of my friends was chatting with the kids while the rest of us tried to figure our how we were going to lift a 500lb medical exam table into a truck. I heard him ask the girl, “what do you want to be when you grow up?” The Doc overheard the question and almost instinctively blurted out, “she is not going to be a doctor if I can help it.” It is one of those things that I have heard before many times. Often times we as medical students or residents we are bombarded by negativity from our mentors in primary care who seem in many cases to have just given up and seem to be just running out the clock. But I had never seen it in such a poignant moment displayed in the scattered remains of a near empty family practice clinic that had only recently shuttered its doors to several thousand patients.
A recent poll suggested that primary care doctors in mass are considering alternatives and 50% polled said they would consider leaving the profession in the next three years if they had another opportunity. That is the state of health care in America. Much of the reason I founded Care Practice was to reverse that sentiment and to demonstrate that primary care can be rewarding outside of the retainer based model of care. We need to show that just being a doctor and caring for a local community can be all that we imagined it could be during the time we spent studying endlessly in medical school.
This social media massive growth and level of connection that has occurred over the past year and a half has been amazing. For us at Care Practice particularly since we are a shinning example and demonstration of what can be accomplished in business and primary medical care by utilizing new levels of connections with patients and our community. Being one of the first medical offices launched almost exclusively through social media I think we also are able to see some of the future difficulties that will plague us as these connections continue to grow. To grow to the size we did as a medial clinic in just six months is something that would not be possible in any other time without these new tools. I am not even talking about boundaries or privacy issues here. Just simple concepts like time and value. I am seeing increasingly that on this trajectory a growing cacophony is developing of people talking and fewer people listening particularly when it comes to business. There is nothing worse then pointless meetings or meaningless relationships that demand time.
The relationships and partnerships I developed on Twitter and Facebook have been amazing, but at some point if we project these networks out it very quickly becomes just noise. In the beginning it was amazing to have two patients discover Care Practice via Facebook because I had gone to grade school with them in the Midwest or seeing a video of me stitching up a patient posted on their Facebook page when a friend of theirs did an iphone video of me. The number of mentors and friends working on changing medicine I have developed through Twitter is something I will always value. It was humorous when patients had me waiting tables on their Facebook’s Cafe World, but with normal continued human connection and the ability of social media to link people together I just see it taking a toll and losing its significance or relevance in our daily lives. If I am struggling to handle 200 to 300 connections a day via email, text, FB, Twitter, Yelp, Linkedin, yahoo, telephone, and meetings where will I find myself in 2 to 3 years. I don’t see it decreasing, but 5 hours a day on the computer is not healthy for anyone and doesn’t add value to my life or health. We strive for connection and relationships are the true value I believe in our lives, but at some point these new technologies have now begun to significantly limit exactly what they supposedly enhance.
Aaron Blackledge, M.D. has started a new kind of primary care practice in San Francisco’s Mission Dolores neighborhood, a concierge-style practice without the high price tag and pricey address.
He opened his Care Practice Urgent & Primary Doctors on Election Day, November 2008, inspired, Blackledge said, by then-presidential candidate Barack Obama’s quote: “We are the change that we seek.”
The result: a 1,400-square-foot medical office at 508 14th St. with real art on the walls, a funky garden out back and four doctors who work in shifts. Its patient network includes waiters and waitresses from restaurants all over town, Kaiser Permanente enrollees who pay out-of-pocket for its quick in-and-out service, uninsured and Medi-Cal patients, and a host of tech entrepreneurs and their employees.
Seventy percent of its patients heard about the 24/7 practice online via Yelp, Twitter, Facebook and other social media sites. So far, six to eight new patients come in daily, and annual revenue is $1 million.
“I’m a social activist at my core. I’m driven by a mission,” said 39-year-old Blackledge. He is revolutionizing medicine from the bottom up, with easy access, low rates, and lots of communication, both in person and online Care Practice posts many fees online, like $145 for a new patient visit.
According to Blackledge, health care offers terrible customer service and escalating prices, and “it’s not viable long term.” He previously practiced at Current Health and as medical director of Santa Rosa’s Chanate Community Health Clinic.