Jay Parkinson Sees The Healthiest Adults
Matthew Holt has a few posts about Jay Parkinson, MD’s medical practice in Brooklyn, which is cash based and all digital and electronic–electronic medical record, online chats, video chats, emails to patients–totally awesome. I love the practice style.
My main concerns? Two things: he’s stealing all the easy work from people, and while I’ll admit I don’t know much about preventive medicine residencies, how much training does he really have in treating adults, when he did a pediatrics residency?
On the first point: he will only see adults age 18-39. If you look at adult preventive health care guidelines for people 18-39, it’s really mostly blood pressure checks and physical exams, with an occasional cholesterol check and pap smear and STI check for women. After kids, 18-39 year-olds are the healthiest group of people there are. For the most part, their main health problems consist of viral illnesses and substance use. Are there sick 18-39 year-olds, sure, but they’re the vast minority. Bottom line: 18-39 year-olds are, for the most part, incredibly easy to care for. Do they need to be seeing a doctor, sure, but man, low-hanging fruit.
My second concern: adults are not big children. The majority of a pediatrics residency is spent taking care of very sick babes and children. (Or seeing them in clinic and learning all the rashes and viral syndromes that most kids get seen for, the milestones, the vaccines, how to talk to parents, etc.) The closest you come to adults in pediatrics are adolescents that come in for physical exams for school for the most part. But you certainly don’t see adults, besides the occasional 18 year-old who wanders in and hasn’t changed doctors yet. Maybe this isn’t much of an issue, since taking care of these patients is pretty straight-forward, but still, it doesn’t seem like the training fits the job description.
Of course he has to see only the healthiest people. He has no clinic equipment to do anything other than check blood pressure.
http://www.waittimes.blogspot.com
Of course we can find the negative in the story, thats easy, health care workers are good at that, me being on of them. The issue is not who he sees, but how he does it. He is pioneering a new way to see patients. Of course there are some logistical issues, but there are in any new innovation. The fact is, he started something new and people are scared.
Instead of finding the negative, lets look at how we can use this technology and philosophy and apply it to our practices. That would be the right thing to do!
He’s starting something called [a href="http://blog.jayparkinsonmd.com/post/28073454"]‘hello health’[/a] that will see all age groups.
While I agree that it’s easy to raise those concerns, the fact is that he’s improving access. And he’s using current technology–communicating the way many people want to communicate.
Personally, I think the guy comes across as full of himself but I think he’s got a good idea and he’s at least getting attention for doing something that seems to be a good way for some people to get health care.
I think it’s great that he’s doing something new, and it’s totally in-line with what I think medicine will/should become.
His innovation side is great, it’s the rest that I’m curious about.
What Dr. Parkinson is doing sounds a lot like something that would be right up a family nurse practitioner’s alley.
I’m a senior nursing student, and NP is something I’ve been considering. When I saw what Dr. Parkinson is doing, I could seriously see myself (in the distant future) and other NPs filling much of the same role.
Especially with the physician shortage…
I admit that I like the idea of embracing the technology rather than making patients sit for a 15min appointment to get a requisition. But the way he is selecting patients bothers me — 1/3 of men age 20-39 don’t go to the doctor. That fact that he’s increasing access for them is laudable but I suspect it’s more to do with the practicality of being an itinerate doctor. When he applies his love of technology to more of the people that need it most — then I’ll be impressed. For now, I like the idea but am suspect of his motives.
http://www.waittimes.blogspot.com
Incidentally, I agree with you that internists should not be seeing children and pediatricians should not be seeing adults, but pediatricians are not trained to see adults up through college since college issues tend to bend more toward peds/adolescent medicine.
It’s actually an interesting issue. At the children’s hospital I rotate at, cystic fibrosis patients are seen for as long as they live, so the pulmonary team regularly has 2 or 3 30-50 year olds on their service since internists/adult pulmonolgists usually don’t see that much CF and aren’t well trained in it. Usually they’re seen by a PA since the theory is that the PA has more experience than the pediatrics-trained MDs in treating adults. Hopefully the Med-Peds track will help to fill some of those gaps, but a five year residency + a 1-3 year fellowship in pulmonology is a tough sell.
Brian: “Should not be seeing…”
I can name a couple MD’s who should not be seeing live patients…But our current “system” of state licensing, hospital priveleging would allow me, a board certified family doc to legally do whatever I can get away with(Joe’s Brain Surgery)…So you want to propose some quality assurance process? Limit scope of practice for MD’s? Go for it.
I thought Graham was going to propose dropping State licensing as a solution to the health care system. Talk about arcane…
Let some states repeal the Allopathic Monopoly. I suggest California and Wyoming. See what happens…Bet costs would go down…
In the mean time all these bloggers have opinions and solutions but NO LEVERAGE.
Reasons I’d consider having Jay as my doc:
1. He maximizes health while minimizing costs (both my out of pocket spend, HMO spend, and system-spend by finding most efficient pricing for services I need).
2. He maximizes my time and the value of doctor patient interactions as I, the patient, wish to define them. Telemedicine lets me see a doc when/where I want using only my laptop connection with built-in webcam.
Is it elitist medicine? Is he cherry-picking or ’stealing’ the ‘easy’ patients? It’s an interesting question. Stealing ‘easy’ patients simply means he’s found a way to attract patients who are less likely to be ill and more proactive about managing overall health and wellness.
Probably we have higher income levels and education levels, but it’s self selecting- if you build a business that appeals to the ‘easy’ patients the ‘easy’ patients will come to you.
I’d pursue a knee replacement or cardiac procedure at a specialty hospital for the same reason - they leverage tech and philosophy to create an environment of care that does one or two service lines extremely well.
And speaking of motives - why do any of us pursue vocations, workplaces, and cultures that allow us some leeway to practice our profession at will? Because we want to design our lives around work of course. I met Jay at Health 2.0 and if he took international patients I’d be next on his list to be seen.
Again, I think he’s doing great ground-breaking stuff. I just question if he training prepared him to be seeing adults. Apparently that doesn’t concern people as much as me.
i have nothing against jay, i hope his venture succeeds in improving medicine for everyone.
how does anyone know if he is getting better pricing? just because he says he is? i have no idea whether it is true or not.
the stealing of patients will come back to haunt us all when we are sick if it drives the traditional providers who actually care for the less healthy out of business. if it succeeds, it will obviously further cannibalize primary care and decrease the number of docs who see the older, less healthy patients on medicare. i’m curious as to whether it will withstand lawsuits. who covers when he is on vacation.
i find the comment from jen interesting-i don’t mean to pick on jen, but am interested in the response-you would go to a specialty hospital presumably because you feel that you would get better care; you would go to jay because it is convenient even knowing he hasn’t been trained to see adults and also that he is not even board certified in his own specialty based on convenience and degree alone?
Hi anon-
Don’t worry about picking…they’re good questions and each one advances the conversation.
Absolutely I will select healthcare goods and services based on where I feel I will get better care. My evaluation of ‘quality care’ is based on both quanitative and qualitative factors. For the quant side, I’d consider going to a specialty hospital based on information I can find regarding infection rates, complications, etc.
Currently, it’s easier to find this type of data for specialty hospitals. Although I’m a risk taker, I enjoy knowing as much as I can about my odds before a procedure, and I undoubtedly feel safer if my hospital of choice (”medical home”) is willing to reveal outcomes and quality data.
As an aside, I ask for this type of information from my current doc, who operates at a large AMC, not a specialty hospital.
I would see Jay because I’ve corresponded with him, have asked questions about his treatment plans, patients, and how he operates. I get along well with him, he isn’t afraid to ask me tough questions and work with me on progressively improving my health.
I have been to a PCP who is not Board certified - he was one of our family docs and shepherded me through several illnesses, including a really nasty case of mono.
The lack of board certification alone doesn’t discourage me from selecting a provider - it’s the total package I’m interested in - convenience, perspective, yes, professional qualifications and training (yes, I usually look up where a doc went to school as well), and finally the way a physician relates to me as a prospective patient.
That said, if I was a patient, and Jay’s clinical/practice outcomes are horrid in the next year I’d reevaluate my options, of course.
Excellent points.