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Small Practice in America: Perspectives from Patients, Physicians and Their Teams

This series of videos is the result of the work of the Center for Practice Innovation, a two-year project funded by the Physicians’ Foundation for Health Systems Excellence to provide customized assistance to small practices wishing to improve the quality and efficiency of care. These videos highlight some lessons learned by the physicians and staff who participated in the project. Each video segment focuses on a different aspect of practice. These videos are for a wide audience including practicing physicians, office staff, residents, and medical students. They can also be used as motivational pieces for physicians in training because they highlight what patients want, what private practice is like, and how they – as the future of medicine – can offer high quality, personal care. Office staff may find the video useful for staff meetings to stimulate ideas and innovative approaches to improving care and office operations. Most importantly, the entire video is intended to inspire and motivate clinicians and practice teams to continually strive to improve their practice across all aspects of care.

  • Introduction (play time 3 min) Filmed over a period of three months in the spring of 2008, this video distills nearly 50 hours of interviews with clinicians in solo- and small-practices, staff members and patients. The seven practices profiled were selected from among the 30 participants in the Center for Practice Innovation project. The interviews were intentionally unscripted. We let the conversations develop based on the interests and responses to our initial questions and were impressed by the candor, creativity and innovation of the clinicians and staff in each of these practices. Physicians described the tough decisions and management complexities of the current healthcare environment. Patients shared their thoughts about what they want and expect from their physicians and primary care office staff. Above all, we were struck by the dedication and hope expressed by physicians who have chosen to practice in solo or two-clinician offices.

  • Patient Centered Care (play time 7 min 40 sec) We asked patients about what they want from their doctors – and what they like/don’t like; how technology may improve aspects of their care, and how practices respond to their needs. Real patients talk about their experiences. Highlighted practice: Drs. Mohammed Ismail and Zahid Nazir of Waterford, NY.

  • Access and Communication (play time 5 min 06 sec) Patients and physicians discuss efficient and effective ways of communicating (email, web visits, etc.). Highlighted practice: Dr. Keith Michl of Manchester Center, VT.

  • Education of Patients (play time 4 min 17 sec) Physicians and patients discuss how to effectively communicate health information. Highlighted practice: Dr. Barbara Magera of Charleston, SC.

  • Care Management (play time 10 min 45 sec) Physicians, team members, and patients discuss the critical role of coordinated health care. Highlighted practices: Drs. Jacqueline Fincher of Thomson, GA and Arvind Cavale of Feasterville, PA.

  • Adoption & Use of Technology (play time 7 min 45 sec) Physicians and patients discuss use of EMRs, e-Prescribing, web portals, etc.

  • Teamwork (play time 9 min 00 sec) Physicians and their staff discuss the vital role of teamwork in creating and maintaining an efficiently run practice. Highlighted practices: Drs Christopher Mays of Olney, MD; Arvind Cavale of Feasterville, PA; and Keith Michl of Manchester Center, VT.

  • Challenges (play time 6 min 6 sec) Physicians discuss the challenges of operating a small internal medicine practice in an increasingly complex healthcare environment.

  • Future of the Small Practice (play time 4 min 15 sec) In spite of numerous challenges such as increasing costs, decreasing reimbursement, increasing complexity with 3rd party payors, etc., the physicians we interviewed remain optimistic. This segment highlights their reflections on the future of small practice in America.

  • Acknowledgements (1 min 28 sec)

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