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Doctors find benefits in smaller practice

Doctor with stethoscope on patient's back

KAI RYSSDAL: They call them primary care doctors because that's what they do. Family practitioners and pediatricians spend a lot of time keeping us well. Studies show they're a pretty cost-effective part of the whole health care system. They don't make the salaries that fancy specialists do, and their numbers have been dropping as big managed-care's become the norm. But Pat Loeb found one doctor who's made the switch back to a small practice. Really small.


GARY SETO: OK, Mr. Berry.

MR. BERRY: Hello.

SETO: Now, just have a seat . . .

PAT LOEB: Dr. Gary Seto is his own receptionist. He answers his own phone calls. He schedules his own appointments and makes sure they're at least 30 minutes apart. He makes house calls.

He sounds like a throwback but, in fact, he on the cutting edge of a new trend: the micropractice.

Here's how Dr. Seto explains it:

SETO: I wanted to be like the iPod of medical practices. I mean, when you have an iPod, it just works, right? I mean, you know . . . So when a patient calls up, what could be simpler than the doctor answering the phone?

Dr. Seto was inspired by Gordon Moore, a doctor who quit his big practice six years ago and wrote about starting a micropractice.

Dr. Moore's account inspired a lot of physicians. Dr. Seto administers a Web listing of solo practitioners. There are about a hundred now.

They're motivated by the same stress Dr. Seto was feeling in a big practice: 15 minutes a patient — the standard appointment time — was not enough.

SETO: When you first start out, you don't know that much. So maybe 15 minutes is enough time to go over all the things you can possibly go over. But as you learn more and know more to do, 15 minutes gets smaller and smaller.

Dr. Seto explains that insurance companies reimburse primary care doctors about $70 a visit. It doesn't matter how long a visit lasts or what the doctor does — the fee is the fee.

Large practices with high overhead squeeze in as many patients as possible. They need a lot of reimbursements to cover their costs. That means shorter visits, and it creates a vicious cycle: primary care becomes less attractive, fewer doctors want to do it, those who are left have to see more patients.

SETO: The United States health care system is heavy with specialists rather than primary care doctors. And it's getting worse, because the lifestyle for primary care doctors is so awful.

The micropractice tries to overcome the problem of low reimbursements by lowering overhead. That's why Dr. Seto does everything himself. He's learned to give his own shots — something a nurse does in a big practice — and do his own billing.

These are things that don't compromise patient care. In fact, patients seem to prefer the personal touch.

Matt Berry is a patient. He says his medical care is better since he started seeing Dr. Seto.

MATT BERRY: Uh, you know, my calf, I had been running . . .

BERRY: Dr. Seto's a guy who . . . he knows you. He remembers what you were in for the last time. He calls you up after you've been there to follow up on things. When he says he'll check into something, he checks into it. You know, we kept saying, now we've kind of gotten used to the fact that he's the way he is, but we couldn't believe it in the beginning. We really could not believe . . . I used to say to him, "I don't believe that this is actually the case here." And he'll say, "What time is good for you?" The words that no doctor in America is allowed to say anymore, which is, "What time is good for you?"

SETO: When did it start hurting?

BERRY: It started hurting when I was . . . you know, I was running a lot . . .

After three years as a solo practitioner, Dr. Seto has 725 patients — about as many as he feels he can handle right now. This year, he expects to show a profit for the first time: $20,000. It's a far cry from the $140,000 he made in a large practice, but he's achieved his goal.

SETO: I wanted to be able to practice the way I thought things should be done.

In Los Angeles, I'm Pat Loeb for Marketplace.

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