My new country doctor

How much do you pay for a visit to your family doctor?  $60.00?  $75?  More? Do you even know what their ‘reasonable and customary” charge actually is?  If you have health insurance, probably not.  All you care about is the ‘co-pay’, right?

I went to get a complete physical yesterday at the offices of Dr. Mark Fields.  I have known Mark for several years and when I decided it was time for a physician to have a look-see at my rode-hard-and-put-up-wet body, I decided to adopt him as my GP.  First off, he’s just a real nice guy, and second off, I like the way he does business – the old fashioned way.

Stepping into his office I was greeted by Elaine, his receptionist.  After filling out the initial visit forms she provided, I followed her down the hallway where she took my height, weight (their scales are surely defective on the high side), temperature and blood pressure (100/70, thank you very much).  In other words, Elaine is the receptionist, nurse, and billing staff.  But here’s the thing… there are no bills.  And I don’t care how good your insurance is, they don’t take it – but they do give you a ‘coded’ receipt so you can file for re-imbursement, on your own time.  We have insurance, but we set the deductible very high so we could afford it – they used to call it “major medical”, or “catostrophic” coverage.

Fields’ practice is, as the sign says on the door, designed and priced to serve “the working uninsured” and the costs for services are clearly posted in the waiting room: Initial visit – $60 (paperwork set up) Regular visit – $45.  Sports/work physical – $25.  Complete physical – $125. 

That’s why I was there; a complete physical.  My last one was five years ago.

Dr. Fields did all the right poking and prodding and asked all the right questions and ordered all the right follow-ups.  I spent just over an hour talking with him as he drew out the particulars of my lifestyle, diet, habits (good and bad), fears and ailments.  All the while, he plied his trade with professionalism and a gentle, caring country-doctor demeanor that one reads about in nostalgic novels.

Of course his hook is simplicity and low overhead.  Because he doesn’t have to pay a staff to file insurance forms, and because Elaine is chief nurse and bottle washer, and because there are no soothing fountains bubbling in his office along with the fact that Dr. Fields designed his own record keeping software from off-the-shelf programs… an office visit is a flat $45.00 (cash or check only).

I truly hope that Dr. Fields’ way of doing business is a harbringer of where family medicine is headed; which is, (thankfully, affordably) back to basics.

So if you don’t have insurance, or if do but you want to actually do something about runaway health care costs, go see Dr. Fields.  He’s located near Wesley Long Hospital, 614 Pasteur Dr, GSO  336-834-9779.  But don’t trust his scales.

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9 Comments

  1. Posted July 21, 2006 at 8:04 am | Permalink

    Thank you for your timely post this morning. Bundle of Joy #2 was sent home from work yesterday with some sort of something that may end up being strep. But the big part of the issue is that he is without health insurance. His, from his new full-time job, kicks in August 1. The kid is NEVER sick. Last sick visit was December 2004, an ear infection. If he needs to go to the doctor over this, our regular family practice, for a simple exam for strep, will be over $400.00. The scenario will go something like this; he’ll arrive and check in, wait for 30 minutes, get taken back into a room and wait for another 30 minutes, and see the doctor for less than 5 minutes.

    Of course he could by-pass all that and get go visit his girlfriend, who is a med student at Wake, except she’s a first-year and probably doesn’t even know HOW to do a strep test.

    Anyway, he was feeling better this morning and will hopefully not need to go to the doctor. But if he does, we will definitely see if he can get in to see your doc.

    There goes the money he was saving for a bike!

  2. Posted July 21, 2006 at 8:32 am | Permalink

    This is excellent. Yes, I might be persuaded to pay the extra 20 bucks to see him just to feel responsible in my choice of health care professionals.

    Thanks, David, for sharing this… now, do get paid per referral? :)

  3. Posted July 21, 2006 at 9:16 am | Permalink

    David,

    Thought you’d be interested in this blog that is being done by a retired doctor re. the healthcare system. http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/

    He’s a big proponent of price transparency which you allude to with the sign clearly indicating what everything costs. That’s my kind of doctor/businessman.

  4. Posted July 21, 2006 at 12:33 pm | Permalink

    David, I agree that this is the direction the system needs to go– and it fits in extremely well with the concept of HSA’s. I was not aware that someone is doing this in Greensboro, and am glad you discovered it. (I wish I could feel confident that I could make it work economically– forsaking group health insurance and various other forms of third party payment– where I practice.)

    The widespread adoption of this model, however, depends on markets– patients and employers, both– disabusing themselves of the unstated feelings of entitlement to low co-payment, low-or-no deductible care.

  5. David Wharton
    Posted July 21, 2006 at 12:46 pm | Permalink

    JW, keep an eye on Bo’J's strep. My Bo’J #2 developed scarlet fever from it last winter — not at all a pleasant experience for any of us! Two nights in the hospital.

    David — given that GP’s are making less and less each year in our current med-payment set up, maybe your doctor is the wave of the future.

    In my own experience, we’ve gotten very good service from one of the local Urgent Care centers, which has served as our de facto pediatrician for a few years now. This was after our regular pediatrician told us we’d have to wait a month to get a camp physical.

  6. Mike K.
    Posted July 21, 2006 at 3:01 pm | Permalink

    Great post. I’ve been involved in picking insurance providers for my place of employment (as part of an employee benefit team) the last two years and I really wonder if the insurance packages are designed to help employees or keep the employer’s costs low. There’s no question that insurance paperwork has hurt the ability of small practices to offer timely (and affordable service). Joe, the thing I’m not real keen about regarding HSAs is that they’re designed around people that are generally healthy and without chronic conditions and are based on the premise that once people are faced with the true costs of health care they’ll choose cheaper options. That can work to some degree but the price of medicines and medical procedures has increased rapidly across the board so you don’t have a lot of choices to choose from in some cases. Of course David’s story does mean there’s at least one more out there…

  7. Posted July 21, 2006 at 4:31 pm | Permalink

    I know where I’m taking my wife. I appreciate you posting about this.

    The last time I heard of a Dr like this, I was in NJ. My then Dr(who is still practicing now at 80+) made house calls in the NY/NJ area for his patients on certain days. This sort of health care professional is rare and a genuine treasure finding. No offense Joe, you are a kind and caring Dr just from talking to you. You have helped family with advice greatly.

    I do wish more Dr’s would go in this direction. My family doesn’t make enough to afford health insurance, but we make too much to get any Social Services help as well. With my wife having an existing chronic condition, health care insurance for my family of three would be over $1000 a month. I’ve looked. A genuine catch 22, tha a lot of Americans are feeling the effects of.

    I hope that Dr. Guarino thinks about this path in the future, surely is a nice enough guy and doesn’t seem to be out for the money, which I feel is a lot of the problem with most Dr’s today. Do it Joe, give in to the peer pressure. You know you want to.

    Thanks again David, I will be calling to set up an appointment soon, and I’ll tell her about the scales in advance.

  8. Posted July 21, 2006 at 7:34 pm | Permalink

    Mike, in fact, most HSA policies have out-of-pocket maximums per year. And some of the initial experience seems to be that they are serving those with preexisting medical problems reasonably well. Part of the idea, of course, is to unleash in the high utilizers of health care comparison shopping and awareness of cost; and in the marketplace, competition, lower cost alternatives and perhaps practices like David describes. Double digit health care inflation continues if the $10 and $25 copay remains the manner in which business is conducted.

  9. Mike K.
    Posted July 24, 2006 at 3:06 pm | Permalink

    Hey Joe (or I guess Dr. Guarino according to these posts). Yeah I’m aware about the out of pocket maximum caps for very expensive procedures or just a combination of many things, but getting to that point can be pretty tough for some people as the caps can be pretty high, particularly for spouse and family coverage (where health insurance costs also tend to be very high). HSAs have some potential for getting people to at least think twice before going to the doctor for every little thing and to give serious consideration to drug prices and costs for other treatments. I also like the fact that most plans I’ve seen focus on free or very reasonable costs for preventative care (like a regular physical), which is key to really keeping prices down from unnecessary ER visits and more intensive procedures when something could have been diagnosed and treated earlier. I’m just not completely convinced that the health consumer has as much choice as HSA proponents believe they do. Only time will tell as I think many employers will be heading this route, if for no other reason than it reduces their own health liabilities costs. At best I think these plans may help slow down the annual increases in medical costs, but every little bit helps.