Tayma S. Shaya M.D
This blog is my story. I suppose it’s somewhat cathartic to type out my journey, and 9 months into my own practice I can tell you that I’ve never been professionally happier. I’m a family doctor practicing the scope of family medicine in Sugar Land, TX outside of Houston. How does Doxy.me add to my professional happiness you ask? It provides me a platform to be accessible, affordable, compliant, flexible and my patients think it’s cool.
In a nutshell- I started practice in 2002 and was in a typical hospital employed contract for the past 14 years. My practice philosophy and style have evolved over the years into a hybrid integrative approach to traditional medicine. I straddle both worlds, and engage the patient on their terms and coach them through health crossroads and decision trees.
Being a self-proclaimed tech junkie, I embraced electronic medical records (EMR) early on and helped implement my first EMR in 2000. EMR is the gateway drug to telehealth. There is some patient molding that happens with EMR-doctor-patient triad, and that molding is how you get telehealth off the ground in your practice. In the past 5 years, the Meaningful Use portal requirement created this newly empowered patient consumer. We have created the environment of tele-communicating with our patients and telemedicine is a natural extension of that instrument.
That being said, the other transformation that happened in the past 5 years was the patient accountability of cost. Patients went from either being uninsured, or have a $25 copay to a majority under-insured with deductibles of $2500 or more. These folks don’t want “market price” medicine. They want price transparency, a menu of options, and would rather go to a minute clinic when ill than come in to see me because our price point was elusive and unclear. Don’t get me wrong, I was plenty busy with follow up visits, and well visits, and what I call ‘third sick’ visits (they went to minute clinic twice and now dragged themselves in to see a “real doctor”). Having minute clinics around has lowered my on-call burden and improved my quality of life on some level but at the cost of loss of continuity. How could I offer my services in a more convenient way? Instead of competing with those clinics maybe I just needed to change how I did things?
As my employment contract came up for renewal at the end of 2015, I found myself dragging my feet, not interested in signing up for 3 more years of the same. I felt that I was becoming a victim of physician burn out movement- not because I hated my job, but mostly because I didn’t fit into the primary box. Every medical journal I got in the mail had some article about physician burn-out. I didn’t want to lose me. My stylistic head butting with the hospital probably helped me more than I realized, it pushed me to recognize my passion, embrace my future self, nurture my strengths and try something different. I decided to open my own practice.
Yeah, I know…. I heard it all already. How are you going to make any money? Don’t you want job security? Benefits? Here is where I had to dig deep and brain storm on what the ideal practice was for me. I figured that if it’s good for me, it’ll be good for my patients. Being an outlier has its benefits. I decided to let my patients build my practice for me. Let them tell me what they wanted, what they didn’t want, and what we could compromise on. I knew I wouldn’t make everyone happy, but in the end I needed to feel fulfilled and valued. The rest would be details. Using the veterinary world as a template, I decided to set reasonable prices, a menu of options, and set realistic follow up expectations. This technically falls under “Direct Primary Care” umbrella – which I see like the autism spectrum. On one end is concierge annual membership/takes insurance guarantees physicians salary, in the middle is the gym membership monthly fee model, and on the other end is me. So here I am 9 months into my new practice and at capacity, and have met my goals in the first month. One of the top patient satisfiers is having “virtual visits”. I haven’t done a formal survey, but verbally I hear all the time “this is so cool", "I love this", and "want me to follow up virtually”.
So how does it work?
Firstly, know the laws in your state. Your medical board should have a telehealth section. Read it. I use drchrono as my EMR and set up a seperate schedule for virtual visits- which can be scheduled online. I have those appointments set for the afternoon M/W/F. $75 for 15 minutes, etc. At appointment time, the patient goes to https://www.doxymewpstage.local/shayahealth and logs in with their name. I get a notification on my phone to let me know the patient is waiting for me in my virtual waiting room. Difficulties I have experienced are usually technical (can’t hear, can’t see, call dropped, picture freezes), but honestly they are so few and far between I’ve never reached out for help. Sometimes the patient doesn’t want to stare at the screen, or is driving and we just talk on the phone instead. I leave it up to them. We can go over lab results, follow up on blood sugars, let me look at a rash, discuss depression, birth control, and their alcohol problem. Really pretty much anything short of a pap smear or abscess drainage. In reality we don’t need to touch our patients so much as we need to hear them. 99% of the time they will tell you what is wrong if you really listen.
Incidentally, being in a patient home/work/car affords me a voyeuristic opportunity to see how they live. (hoarder? 7 cats on the desk? Nudist? Multitasker? fancy car?) If I had a magic wand each patient would have an assortment of attachments on their phone so I can interact remotely – look in their ear, check their blood pressure and have it all documented in the chart. I’m sure that will be the standard someday.
The best thing about doxy.me is that its FREE to use!! It’s HIPAA compliant and also logs a list of calls and length of time on each. You can upgrade to get screen share etc but since I’m in my startup year that isn’t in the budget. Patients pay me by either leaving a credit card on file, or will give it over the phone. I can tell you that parents of teenagers are thrilled that their kid has access to healthcare, I’ve done calls to nursing homes, and have taken care of my international population/ex-pats and the like this way. It’s a global marketplace, we’ve engaged patients electronically and transitioning to tele-medicine is natural extension to your connected practice. I call it practice rejuvenation. Give it a try! You might love it like me.