A Doctor Grows in Brooklyn
Doctor Jay Parkinson became a minor media celebrity last year as word spread about his unconventional practice in Williamsburg, Brooklyn. Instead of maintaining a traditional office and paying support staff, Parkinson’s operation is entirely virtual and requires almost no overhead. (Unless you consider a Mac overhead.) Using his apartment as a base, He runs a web site loaded with Web 2.0 touches that allows patients to communicate with him easily and explains his services in plain English. After an initial in-person consultation, exchanges can be online and are conducted through either instant messaging or web chat.
“The healthcare industry is so stuck in 1994,” he says, “The only way they’ve used the Internet is to provide information. I look at the Internet as something that provides communication.”
By concentrating on technologies that are inexpensive and readily available, Parkinson is able to focus on usability and efficiency and bypass many of the road blocks that have slowed other doctors trying to wire their practices. The web cam he uses is a standard feature on his system. He uses Gmail to handle his email load and has neatly integrated Google Calendar into his web site - allowing patients to see his schedule at a glance and book their own appointments. For cases requiring referrals, he has built a simple database of inexpensive providers, creating his own social network of several thousand specialists and other care givers local to Brooklyn and Manhattan.
Parkinson resists the argument that technology has created a new Race to the Bottom in health care, by making medicine less human and the healthcare system increasingly complex. Instead, he argues that when used properly, Web 2.0 tools like mash-ups, mobile devices, instant messaging, digital video and social networking can free doctors to spend more time with patients - not less.
“It’s really just practicing medicine in an old-fashioned way,” he says.
Health 2.0 Developer Challenges
The reality is that technology has little to do with Parkinson's practice, and everything from removing himself as a participant in the insurance system and safety net that provides care to the poor and elderly. There are many such "concierge" practices that do not accept insurance payments, and as such can cut costs and overhead dramatically. It also makes a much more pleasant practice environment for the physician. Parkinson's is different that his software is snazzy, but many others work with a part time assistant and old fashion vanilla folders. Many of these docs (and I bet Parkinson is one of them) are able to then provide much better care at a lower cost than their competition.
However, it also means that Parkinson and physicians like him don't see patients under Medicaid, Medicare or state "free care" systems - patients that are generally "money losers" for primary care docs. Bluntly, this means that concierge practices shirk their portion of collective responsibility, transferring it to others.
These concierge practices (no matter their fee structure) *are* part of the race to the bottom, in the sense that they are indicators of a failing safety net. I don't personally blame Parkinson - I didn't stay in primary care as I couldn't stand spending as much time dealing with paperwork, insurance, billing etc as I did with my patients. I'll probably entirely give up my sub-specialty practice as well for the same reasons. The reality, however, is that with each defection from the system, it becomes more unstable. Not very sexy from a Web 2.0 standpoint, but true.