Via the Healthcare Entrepreneur, today I learned Dr. Steve Harrison is closing his practice in King City, CA. (Image credit.)
King City is a very small agricultural town in central California. I've never been there but the residents in my program used to take care of King City's patients when their own rural hospital, Mee Memorial, couldn't provide needed services. The people of King City and surrounding environs don't have many options for obtaining health care except for a publicly-funded FQHC and Dr. Harrison's private practice.
Dr. Harrison used to come to our resident's clinic and supervise the residents one or two days per month. I always looked forward to his being there, because he offered a no-nonsense, real-life approach to family doctoring. He didn't spend a lot of time agonizing over theory but got right down to what-if scenarios. "If it's five o'clock on a Friday afternoon, what do you want to do?" I can hear him asking.
Dr. Harrison always belonged to what I call the Old School of Family Practice. These days people have forgotten what the original general practitioners, or GPs, used to provide to small communities such as King City: comprehensive medical care across all age groups. GPs used to see adults for sore throats, kids for immunizations, deliver babies, and take care of old folks at the end of life.
When general practice was phased out in the 1970s, it was replaced with the specialty of family practice, which you might think of as general practice academicized. Instead of a year's internship, you now had to complete a three-year residency, in which you learned to do all the things the GPs used to do, but with a greater academic grounding.
I have always been inspired by the Old School family doctors who were my preceptors during residency, Dr. Harrison included. These family docs ran clinics, saw their patients in the hospital, delivered babies, did C-sections and critical care, ran codes and stabilized critically ill newborns for transport. Even in the era of specialization and subspecialization, there was a niche for an Old School family doctor, in remote Alaska or even nearby King City, where the drive to the next largest hospital was two hours.
Despite my original hopes, I am not going to be joining the Old School. I never developed a taste for being in the operating room, and abandoned the pursuit of C-section privileges without regret. I do enjoy providing critical care as a hospitalist, but maintaining and improving my skills in this area has only been possible after giving up primary care--the cornerstone of the Old School philosophy. Furthermore, I no longer take care of hospitalized children, because our hospitalist group consists of internists as well as family doctors, so we have given up pediatric inpatients to the overworked pediatricians in town.
I do not mourn my decision not to join the Old School, because this decision is based in my own preferences and practice style. I do mourn the departure of doctors like Steve Harrison, who is closing his practice due to business factors, including an abortive investment in EMR and a major financial loss after over-purchasing influenza vaccines last year. In other words, his practice failed because he tried to do the right things to keep it going. Now he is exploring other opportunities which may take him into academic family practice or urgent care, but the Old School has clearly lost another giant.
I believe we need to keep the Old School philosophy alive, if only to provide rural areas such as King City with comprehensive care doctors of the ultimate kind: those who are able to manage 90% of the medical problems they see, whether the patient is a newborn or a nongenarian. The alternative--to recruit pediatricians, internists and OB/GYNs enough to staff every rural community--has eluded the best efforts of small towns everywhere.