Think About It: Mission or assembly line driven medicine?

A giant and unexpected revolution occurred in the delivery of medical care during the first years of this century.

It’s not that it started then, rather the forces of our insurance-driven health care system finally drove physicians from independent private practices into the reluctant arms of hospitals.

I was a witness, in fact, a participant at the very beginning of the movement that brought Olympic Medical Center (OMC) and physicians together in a way unknown and not entirely wanted by either of them.

Up until this point, physicians and hospitals worked together in symbiotic balance. Physicians needed good hospitals and outpatient diagnostic services to adequately do their job for their patients and hospitals needed good physicians to treat patients in hospitals and, importantly, refer patients to hospital services.

Physicians employed by hospitals wasn’t unheard of on the peninsula. A number of physicians chose to become employees of Virginia Mason Medical Center. Virginia Mason scooped up rural physician practices in the 1990s as part of a plan to build referral bases in rural communities.

Alas, Virginia Mason pulled out of Sequim in the early aughts, saying the bang wasn’t worth the buck. They soon left Port Angeles as well.

Both withdrawals left the former Virginia Mason physicians in a state of upheaval. This was no time to restart independent private practices.

Health care ecosystem forever changed

The delicate ecosystem of physician and hospital co-existence was forever disrupted.

OMC, of which I was part of the administration, was reluctant to add physician services to its core services; it was perfectly satisfied providing financial support to start-up practices planning to locate to the hospital district service area or existing practices needing to recruit additional physicians.

Meanwhile, patients with former Virginia Mason physicians were in serious panic and called upon OMC to do more.

Soon, OMC became the largest employer of primary care and specialty physicians on the peninsula.

Power relationships shifted as physicians negotiated salary and hospital administrators negotiated productivity incentives based on reimbursement. Each was doing its job to preserve its integrity of quality work and financial survival while trying to preserve a working professional relationship.

To this day, neither can be blamed for the resulting dysfunction because neither had the power to change the driver. Instead, it was brought on by the system mixed with government accountability, for-profit incentives and lack of control over costs such as pharmaceuticals.

Physicians and hospitals continue to need each other. Hospitals overall do pretty well, but primary care physicians are flaming out at a rate higher than any other employment category. A 2012 study reported that 45.6 percent of 7,288 physicians surveyed nationwide experienced at least one symptom of serious burnout.

One of the key indicators of burnout mentioned was “low sense of personal accomplishment.”

Enter Dr. Lissa (like Melissa) Lubinski’s message sent in an email that was forwarded to me and many others in the community that sparked immediate interest on my part. Dr. Lubinski was inviting the community to help her design a patient-centered clinic different from “assembly line” medicine. She is intent on reversing course!

How could I resist meeting someone who has spent years in education and training to become a primary care physician and significant time practicing her chosen profession who is leaving the security of an outpatient physician clinic setting to strike out on her own?

Community-designed, patient-centered, low overhead

Dr. Lubinski eagerly agreed to meet with me for an interview; it wasn’t just me. She is eager and willing to meet with anyone who has an interest in her mission.

In fact, she is determinedly eager to bring a community-designed, patient-centered, low-overhead medical clinic to the peninsula.

She has worked as a physician in many clinic settings and has come to believe the problem is the model of outpatient clinics medicine that has evolved. She describes it as “an assembly line approach that accommodates the insurance industry’s demands of doctors.” In order to escape the model and return to her “calling” and “the freedom to be a family medicine doctor,” she intends to develop a new model.

Dr. Lubinski tells me the best part of her clinic day is the time with patients, but it is the least part of her day in a typical clinic. She describes being surrounded by supports intended to make efficient use of her time; yet, somehow those supports are taking the essence of her work away.

She misses the “getting to know my patients” part of her work. She longs for the relationship with the patient that results in individualized and relevant care; that she thinks also results in lower cost in the long run.

So, I asked her how she would accomplish her renewed mission. Again, evidencing how much she had thought about what is important, she easily answered — less space, less support staff and more of her, including home visits if needed.

Low overhead and patient-centered, indeed. Then, there is the community designed piece. Dr. Lubinski is planning several town hall type meetings in which she wants to hear what the community thinks. She asks,

“What does the community think would be an ideal medical clinic?”

“What does the community think would make going to the doctor ideal?”

The first of these meetings is being held from 2-3 p.m. Saturday, March 11, at the Carver Room in the Port Angeles Library, 2210 S. Peabody St. She hopes to have others in Sequim and with as many groups as want to give input into the design.

I’m going. She wants me there. She wants you there. She wants to learn from us. She wants us to free our minds from the way outpatient medical care is delivered nowadays and imagine the ideal service.

Keep your eye on this; it’s important. We need and want professionally fulfilled physicians who can freely spend the necessary time with their patients; to get to know us and to feel they are making the difference their profession promises.

We are losing too many primary care physicians. Studies tell us that too many are dropping out, burning out, succumbing to depression, addiction and, worse case, suicidal thoughts.

The fault is not the employee physicians or the large private clinic employer or the hospital employer; rather, it’s the system incentives that fail to recognize the importance of the physician-patient relationship.

Try to attend an opportunity to make a difference.

Bertha D. Cooper is retired from a 40-plus year career as a health care administrator focusing on the delivery system as a whole. She still does occasional consulting. She is a featured columnist at the Sequim Gazette. Reach her at