Oregon Public Broadcasting

Many primary care doctors say they feel stuck on a treadmill.

A CNN poll last year showed almost half of them would consider leaving medicine if they had an alternative. They complain of low salaries, burdensome paperwork and time pressures. Research has shown the constant rush can also affect quality of care.

Primary care doctors have long hoped that health care overhaul would improve their situation. But Heidi Lang found that's easier said than done.

Pamela Wible was one of those primary care physicians unhappy with the status quo. 

Heidi Lang / Northwest News Network

Dr. Pamela Wible checks in on patient Amanda Duquette in a clinic practice designed after community meetings.

Pamela Wible: "It's sort of like you are in bed with your spouse and you wonder why is your CPA there? There are certain people that just don't belong in the sacred healing relationship between a patient and a physician."

But instead of giving up on medicine, Wible decided to reinvent it - for herself and her patients.

She held a series of town hall meetings in her hometown of Eugene. She asked people to describe their vision of an ideal medical practice. Three months later Wible opened a clinic designed entirely by her community.

She now works part-time and sees patients for as long as an hour. Her patients appreciate the difference.

Amanda Duquette came to see Dr Wible after consulting several other doctors about a rapid heart rate.       

Amanda Duquette: "She did all the tests. But then she also, you know, takes the time to actually look at the big picture, because she has enough time to sit with you and interact with you on a human level, to actually know you."

Wible determined that the real cause of Amanda's rapid heart rate was her high-stress job. After several months of trying yoga and meditation classes, Amanda quit her job. Her heart rate is now completely normal.

Many primary care doctors would love to build the kind of relationships Dr Wible has with her patients.

Gordon Moore is a primary care physician in Seattle who also runs IdealMedicalPractices.org. It's a program to help small practices become more innovative and efficient.

Gordon Moore: "It's time, we've gotta take charge. We've gotta take this back b/c it's just awful. It's hurting our patients."

He's looked extensively at how primary care doctors can get off the big-clinic treadmill. He says they face many barriers.

Gordon Moore: "First, there are unfortunately many ways to fail in small business. But even when doctors get all those things right there are some parts of the country where the combination of average malpractice, insurance rates and cost of living are so out of whack that you could do everything beautifully and still fail."

Dr. Kurt Brewster is another primary care physician giving it a try in Eugene. When he heard about Pamela Wible's clinic, he decided it was time for him to get off the treadmill of traditional medicine as well.

He describes the practice he joined out of medical school.

Kurt Brewster: "This is the term that people used – it was called ‘treat em and street em.' And the problem was there was no structure for time. In fact, if anything there was a structure against time. The structure was for efficiency."

Brewster says most medical practices operate in what he calls a "culture of interruptions." He wants his practice to be different.

Kurt Brewster: "We purposely don't have a lot of exam rooms, so that when a person is there, they're going to be seen pretty much the minute they hit the door. And we'll try to give them as much time as they can."

But in a small clinic, giving that time is one of Dr. Brewster's main challenges.

For example, he could spend an hour on the phone coordinating an elderly woman's care, and his payment from Medicare?

Five dollars.

From his perspective, every aspect of the system seems to be designed to prevent doctors from doing things differently.

Another hurdle is getting appproval from Medicaid.

Kurt Brewster: "There's a credentialing process that requires three peer references of people in your field that must have worked directly with you within the last two years. I don't work in a multi-specialty group. What are you supposed to do then?"

But wait – what about the health care overhaul that just passed? Wasn't one of it's goals to find new and better ways of practicing medicine?

Dr. Lori Heim is President of the American Academy of Family Physicians. She says primary care and family physicians are currently rewarded for volume rather than for quality of care.

That's why Dr Heim has looked closely at how the new law attempts to change that framework.

Lori Heim: "The culture shift now has a platform to move on. When you look at payment, when you look at aspects of the legislation, none of it goes far enough to get us where we need to be."

Back in Eugene, Dr Brewster is determined to do his part to heal health care from within. He says he's tired of working in an industry that he thinks is asking all the wrong questions.

Kurt Brewster: "What do patients really want? Have we looked at that? We've looked at what makes medicine profitable, I think, but have we really looked at what makes patients happy?"

Despite the challenges ahead, Dr. Brewster's colleagues are rooting for him to succeed as he tries to break the mold. Because maybe then, they can be next.