Dr. Corrina Bowser outside her office,
a converted Victorian home, in Narberth
Sept. 30, 2015, was the fourth opening day of Dr. Jill Cohen’s practice. The first was in 1997, when she joined Great Valley Medical Associates, a seven-partner primary-care practice in Paoli. Then that practice became Great Valley Health, after the partners sold it to Main Line Health. But they chafed at some of the new rules, so they bought it back seven years later, reestablishing the practice as Great Valley Medical Associates while maintaining the affiliation with the healthcare system and its hospitals.
In September, Cohen initiated what she believes will be the last change in the way she practices medicine. While still a partner in GVMA, she has transitioned her practice to become part of MDVIP, a membership-based model. Now, Cohen’s patients have a host of medical services and benefits—chief among them, extended appointments. The first two are at least an hour each; follow-up appointments are 30 minutes. Having that much time with patients is a luxury, Cohen says with the same satisfied sigh people use when they talk about spa treatments. “It’s been an amazing experience,” she says. “I now get to have long, detailed conversations with my patients.”
But that luxury comes at a cost—to Cohen’s patients. The annual MDVIP membership fee is $1,650. It’s what’s known as concierge medicine, and Cohen knew that many of her patients wouldn’t—or couldn’t—pay. For that reason, she agonized over the decision to adopt the MDVIP model.
So did Dr. Ralph Lanza, another GVMA partner. A primary-care physician since 1989, he became an MDVIP doctor in January 2015. “For me, the conflict was potentially saying goodbye to patients I’d treated for more than 20 years, but facing the reality that, because of the way that healthcare now works—short appointments and heavy patient loads—I didn’t feel I was taking care of my patients in the best way I could,” he says.
It’s a lament echoed in a 2013 study conducted by the RAND Corporation, where physicians reported that the quality of care was adversely affected by seeing too many patients for too little time. “Physicians and practice managers described the cumulative burden of externally imposed rules and regulations as having predominantly negative effects on professional satisfaction,” the study noted.
Many of the rules in question come from insurance companies and large health-care systems—both necessary and important parts of this region’s medical community. But are private practices still a viable alternative?
Before she became an MDVIP doctor, Cohen had 2,600 patients. Now, she has fewer than 600. So does Lanza, and neither is accepting anyone new. “This is what you dream about when you dream of becoming a doctor,” says Cohen.
Then again, both Lanza and Cohen have been in practice for decades. These days, starting from scratch is expensive—and risky.
“Now, I have the luxury to spend as much time with patients as I want. I can perform the tests I want to, while staying within guidelines. I have more freedom to practice better medicine.” — Dr. Corinna Bowser
Tucked into the side porch of a renovated Victorian home is the entrance to Narberth Allergy & Asthma, the domain of Dr. Corinna Bowser. Hers is a very private practice. She is a sole practitioner, working just 22 hours a week. Patients get a one-hour initial visit; follow-ups range 15-30 minutes. If needed, she consults with them after-hours, even late at night. Bowser can easily access their charts on her laptop via an electronic medical-records system. In emergency situations, she meets patients in her office, which is a mere six blocks from her house. She just started seeing patients at the Havertown practice of Dr. Linda Green.
This was just what Bowser was after when she opened Narberth Allergy & Asthma in 2013. With two young kids, she’s balancing motherhood and medicine—a tall order when she worked at large practices in Havertown and Cherry Hill, N.J. “The main reason I went off on my own is that I didn’t enjoy the way I was supposed to practice medicine as an employee,” Bowser says. “Now, I have the luxury to spend as much time with patients as I want. I can perform the tests I want to, while staying within guidelines. I have more freedom to practice better medicine—patient-centered medicine.”
But, boy, did it cost her. Bowser says her start-up costs—for office space, diagnostic equipment and medical supplies—were about $20,000-$30,000, and she didn’t take a salary for the first year. Getting approved by insurance companies to be a participating provider took three months of paperwork and phone calls. There was no guarantee she’d get approved, and there was no guarantee she’d get patients.
A non-compete agreement prevented Bowser from soliciting patients from the practice where she’d previously worked. So she doubled down on her neighborhood involvement and found patients from the face-to-face interactions she had with people at community events she sponsored. Free asthma testing, face painting, sponsoring basketball teams—Bowser did all of that. Seeking referrals, she made cold-call visits to pediatricians and general practitioners in Narberth, Bala Cynwyd and Ardmore. Doing so was humbling and a bit awkward, but it worked. She received a huge number of referrals from colleagues who appreciate her personalized approach.
Bowser has an affiliation with Main Line Health, so she can admit patients to its hospitals and treat them there. “But there’s nothing in allergy care that I don’t have in my office,” she says. “Spirometry, skin testing, a fiber-optic scope—I have all of that. I have as much as the CHOP allergists. If things need to be evaluated further, I refer my patients to ENTs, immunologists, perhaps a dermatologist.”
Even so, respected names like CHOP, Nemours duPont Pediatrics, Main Line Health, Crozer-Keystone and Penn Medicine instill confidence in patients. How does a private practice compete?
Dr. Kenan Aksu found a way. Back in 2009, Aksu was a disgruntled doctor facing a life-altering decision. He loved orthopedics and his patients, but not the practice in which he worked for nine years. Aksu’s discontent stemmed from the typical heavy patient loads and short appointment times. Starting his own practice was an option, but Aksu wasn’t exactly sure how. “In medical school, they teach you to diagnose a disease and treat it, but not how to build a practice,” he says.
A spine specialist, Aksu knew that opening an orthopedic practice required a hefty financial investment. And as the father of two young children, he had his family’s future to consider. But he took out a $250,000 loan, signed a seven-year lease on an office space, and hung out his shingle in an Exton medical office building. “It was a risk to do that, but it was a risk not to,” he says. “How much longer was I going to be unhappy professionally? Eventually, that would affect other areas of my life.”
Within a year, Aksu Orthopaedic & Spine Center was a success, so much so that he added another physician, Dr. Michael Campbell, a joint-replacement specialist. Almost all new patients come to them via referrals from family and friends—a fact that makes Aksu proud. Appointments of 30 minutes or longer can mean long days for the two doctors. “But, at the end of those days, I know that I’ve done what’s best for my patients,” Aksu says. “And that brings me immense satisfaction.”
Less satisfying is the ever-changing, intensely convoluted maze of insurance reimbursements. That’s what convinced Aksu to join Premier Orthopaedics in 2013. “The contracts from insurance companies were getting more and more biased toward [them],” he says. “If you have a bigger group of doctors, you have more negotiating power. Premier is an umbrella organization—we’re all divisions of it. But I have autonomy to run my practice the way I want to. It’s a win-win for me and my patients.”
And that’s the key for Aksu. “Every physician loves medicine,” he says. “But practicing medicine can be difficult because of the way the system now works. For me, the answer was clear: Happy doctor? Happy patients.”
To see Top Doctors 2015: Adult Specialties, click here.
To see Top Doctors 2015: Pediatrics, click here.