Physician House Calls: An Old Model With a Modern-Day Twist

Where does your company currently operate?

At the moment, we operate in Los Angeles, Orange County, San Diego, San Francisco, Washington DC, and most recently Atlanta. We are fortunate to be growing rapidly, driven by strong demand for our services.

What is the structure of your physicians’ schedules?

The majority of our physicians are full-time, although we also have part-time shifts available. Our shifts tend to be about 12 hours at a time – usually from 8:00 AM to 8:30 PM. Our physicians do around 16 shifts monthly (each consisting of 12.5 hours), which averages to around 48 hours per week.

What is the structure of the actual patient visit?

Physicians go to the patient’s home, accompanied by a medical assistant, who does the driving. The medical assistants are also certified phlebotomists and during the appointment they do blood draws, strep tests, collect vital signs, and help with documentation.

The assistant carries a kit that contains almost everything you would have at a typical doctor’s office, including a stethoscope, otoscope, blood pressure cuff, thermometer, equipment to repair lacerations, etc.

Do you provide emergency services?

I’d like to make it clear that we don’t provide emergency services and there is a strict triage system in place to make sure that we are not being sent to emergency cases. Every now and then, we’ll arrive at a patient’s home and determine that the situation actually is an emergency, and we will send them to the emergency room. If we need imaging or a referral, we make those arrangements.

Are there differences in liability with this model?

There are no differences in liability.

Aren’t physicians vulnerable if they are going into people’s homes?

We make sure for safety reasons that a medical assistant, who plays an important role in preserving physician safety, always accompanies our physicians. Thankfully, there has never been any violence toward our staff. The medical assistant is always present for examinations.

What are other advantages of the house call model?

Most of the time when a person is ill, they don’t want to go out to see the doctor. It is a huge convenience if the doctor can come to them. I also think they get better care. People are being seen in their natural environment, so there is better medication reconciliation, and the doctor can assess for environmental hazards, such as a tobacco smell, or rugs, which can create a fall-risk for the elderly.

Most importantly, our physicians spend almost double the amount of time with each patient as they would in a typical office appointment. There is an unhurried atmosphere. Blood work is done in the convenience of one’s home.

People are so happy with Heal that we have received an unprecedented Net Promoter Score of +83.

Dr O’Brien

What made you decide to become a Heal provider?

One of the priorities of Heal is making physicians happy, and as a doctor, it’s hard to deliver good care if you’re stressed and burned out. There are so many challenges in delivering care in a traditional environment. In a traditional doctor’s office, the physician has only a few minutes with patients. We at Heal, on the other hand, can take 45 minutes with a patient, even if it’s something as simple as sinusitis. We can ask the patient to share whatever is medically most important to him or her, and we also set a high priority on ascertaining whether a patient has had recommended screening tests. For example, if a woman over age 40 has sinusitis, we will treat the sinusitis but also initiate a discussion about whether she has had a mammogram. We have the luxury, in terms of time, of bringing up and discussing lifestyle elements like diet and exercise.

And being in people’s home enables me to see their lifestyle first-hand. For example, I saw an asthmatic patient who said that the household was smoke free and everyone who smoked did so outside. But there were overflowing ashtrays everywhere, which suggested that smoking was taking place in the home. Because I saw this, I was able to bring it up with the patient.

This is the type of medical practice I like to do – to treat the whole patient, and do a comprehensive job.

How does this model fit in with your own lifestyle?

Each shift is 12 hours, which admittedly is a long shift. On the other hand, I do only 16 shifts in a month, so that I have 2 weeks off each month. I can organize my schedule so that I can dovetail my “off” time – for example, I didn’t work the last 2 weeks of April and the first 2 weeks of May, and I took 4 weeks off without using any vacation time.

Would you recommend that other physicians adopt this model?

I consider myself one of the happiest clams on the beach, doing exactly what I went to medical school to do. So I definitely encourage other physicians to try this.

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References

1. Kao H, Conant R, Soriano T, McCormick W. The past, present, and future of house calls. Clin Geriatr Med. 2009 Feb;25(1):19-34.
2. Fortin Ensign S, Baca-Motes K, Steinhubl SR, Topol EJ. Characteristics of the modern-day physician house call. Medicine (Baltimore). 2019;98(8):e14671.

This article originally appeared on MPR