When the going gets tough, choices get even tougher for independent physicians. But not all physicians struggling to maintain private practices have stuck with the options that have come to comprise today's standard menu: Go big, go concierge or get out.
Two recent articles from the Washington Post profile physicians that have created their own traditional-practice alternatives in an effort to keep their practices and meet community needs. But while their paths to these common goals are different, so too are community and regulatory reactions.
Most recently grabbing headlines is Rob Marsh, M.D., a primary care physician who has operated a secondary practice at TA Petro truck stop in Raphine, Virginia, since July 2012. In a twist on what's been dubbed the "Blockbuster strategy" used by retail clinics, Marsh has made it convenient for truck drivers to obtain healthcare they might otherwise skip while on the road.
Still considered by his patients and himself to be a country doctor, with many patients paying cash, Marsh also uses electronic medical records to forward information from his exams to other health providers, so patients can get prescriptions and follow-up care farther along their routes, according to the Post.
Because many of his patients are literally "just passing through" his clinic, Marsh doesn't get to build the same relationships with his truck stop patients as he does with longtime patients of his traditional office in the small town of Middlebrook. Nonetheless, the decorated U.S. Special Forces medic told the newspaper, "I'm a survivor--I'll make this work. I'm willing to make those adaptations because I love what I do so much."
Meanwhile, in the tiny, remote and poor town of Edwards, Mississippi, 88-year-old Carrol Frazier Landrum, M.D., has made adaptations that could cost him his medical license. Landrum, who has been in private practice for more than 55 years, began using his car as a makeshift office two years ago, according to the Post. Previously, he practiced out of an apartment in a low-income housing complex, until crime and gang activity forced him to leave the location, full of patients in need, for safety reasons.
While he planned to find a new office but never secured one, Landrum told the newspaper that calls for medical care kept coming. So now he sees three or four patients per week, many of them old friends he's treated for years, wherever they are, which could be in a home, a parking lot or alongside a country road.
But despite the community's support for Landrum, upon learning he's been practicing out of his car, the Mississippi State Board of Medical Licensure has asked the World War II veteran to surrender his medical license. According to Landrum, at a recent hearing the board labeled him "incompetent," a term he described as a catchall designed to avoid citing a specific occupational violation.
The board's executive director, H. Vann Craig, declined to comment, according to the Post, other than to state its mission is to protect the public.