Dr. Doug Roberts, solo practice — Sacramento, California

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Dr. Doug Roberts spent years working for the mega-health care corporations, the ones that force doctors to treat patients like a fork-lift driver treats cartons in a warehouse. As he cared for those who came to him for help, he gradually developed a better idea. Now he has put it into practice, and he expects that other physicians will follow.

Roberts and a couple of other doctors have, as he puts it, "hung up a shingle" in Sacramento. By careful management and cutting overhead dramatically, he and his colleagues are able to dispense good medical care out of small offices. Their guiding principle, Roberts says, is that the doctor takes responsibility for and develops a long-term relationship with his patient.

That is a shift in focus from the large HMOs and medical groups where, as Roberts says, a physician "serves two masters."

Roberts is a rheumatologist specializing in arthritis and diseases involving abnormally regulated immune systems, such as lupus. He worked for a large medical group in Arizona, was transferred here in the mid-1990s, and tried to hold on to some professional stability as the ownership of his medical group changed three times.

He noticed a fundamental problem in medical care delivery during these financial comings and goings: "a basic lack of commitment or feeling of responsibility for patients as being your own. In a big group, you’re serving two masters."

"You want to know the patient," he said. That was difficult in the factory-like HMOs.

In Sacramento, a large group of cardiologists bought a building, and had extra space. Roberts and a couple of internists went in on a piece of it.

By sharing, they cut costs, which allowed them to provide better treatment and, incidentally, make their own lives more fulfilled, which in turn leads to better medical care.

Their office, Roberts says, is "like a barber shop, where you rent a chair," or the medical equivalent thereof. The doctors share staff, and that staff is minimal: one receptionist-scheduler.

There is one exam room. The doctors use a computer for medical records, which eliminates filing and "saves the need for another room to store charts."

"The technology has allowed me to go back" to the days when doctors focused on patients and not paperwork and bureaucracy. "I take an hour with each new patient, half an hour with everyone else." Roberts estimates that he has reduced overhead by as much as 70 percent.

Most of his patients, Roberts says, are from Medicare, which he describes as "a sort of single-payer system for seniors." Others have PPOs, some are insured through their employers, some are self-insured.

The key, he says is "to remove the for-profit" aspect of medical care. This is do-able if you have the right model. I’d like to see the formation of a non-profit plan."

"This," Roberts says, is the way I want to practice. I didn’t want to (struggle) with HMOs, getting approval of tests that have to be done."

He stresses that a happy doctor is good for the system. "I get a lot of enjoyment," he says. That includes working three long days and taking off the other two, so he can spend more time with his children, who are 3, 5, and 9. "I can’t tell you how nice it is to stay at home two days." The doctors cover for one another when the situation calls for it.

"Job satisfaction," Roberts says, "is better for everybody."

Roberts believes the model is catching on. "It has in our building. If there are enough doctors, and a plan that is available to the general population," it should spread, Roberts says.

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