The practice of medicine is rapidly changing. Physicians can no longer afford to keep small, private practices with personalized care open for business. Soaring medical malpractice premiums along with high rent costs, staff salaries and uncompensated administrative burdens have physicians searching for a more cost-effective solution.
The Affordable Care Act, with high deductibles, turned doctors into collection agencies chasing unpaid deductibles. Many are finding the only alternative is to become employees of a large healthcare system or group. These systems tend to require physicians to keep referrals “in house,” essentially crushing small private practices that are not in their network. Hedge funds and venture capitalists who are buying up these practices are finding out that physician productivity drops once doctors become 9–5 employees. Patients don’t like the new medicine where they are rushed in and out of an appointment while the doctor is busy inputting data on a tablet or computer.
There is a growing national movement of patients seeking private care, concierge care and integrative medicine. These patients are seeking an attentive physician who will give them the time and attention they require to seek and get answers for their visit. I had the opportunity to speak with Dr. Magdalena Swierczewski, a board-certified internal medicine doctor who received her training at NYU Medical Center in New York. When asked what is Integrative medicine, Dr. Swierczewski explained that it is a healing-oriented medicine that takes account of the whole person (body, mind and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.
As defined by the National Center for Complementary and Alternative Medicine (CAM) and Integrative Health at the National Institutes of Health, “Integrative medicine combines the mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness. Integrative health care often brings conventional and complementary approaches together in a coordinated way. It emphasizes a holistic, patient-focused approach to healthcare and wellness-often including mental, emotional, functional, spiritual, social, and community aspects-and treating the whole person rather than, for example, one organ system. It aims for well-coordinated care between different providers and institutions.”
When I asked Dr. Swierczewski what are the principles of integrative medicine, she explained that it was a partnership between patient and practitioner in the healing process and the appropriate use of conventional and alternative methods to facilitate the body’s innate healing response. She went on to say that they consider all factors that influence health, wellness and disease, including mind, spirit and community as well as body. They adhere to a philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically. Dr. Swierczewski recognizes that good medicine should be based in good science, be inquiry driven, and be open to new paradigms as well as using natural, effective and less invasive interventions whenever possible.
She also tries to use broader concepts of the promotion of health and prevention of illness as well as the treatment of disease. One of the goals as physician educators is the training of practitioners to be models of health and healing, committed to the process of self-exploration and self-development. Dr. Swierczewski stated, “My mission is to help each patient achieve their optimal health through various treatment modalities, which are founded in Conventional as well as Integrative Complementary Medicine. My goal is to choose scientifically validated therapies from both conventional and CAM systems. I am not wedded to a particular dogma, Western or Eastern, only to the get-the-patient-better philosophy”.
All acute and chronic medical problems/concerns are addressed using conventional internal medicine along with (if requested) Integrative Complimentary Medicine to achieve optimal health. Her practice offers 24/7 access to her via phone, email or video, face-to-face extended appointment time (90–120 minute initial visit), same-day sick visits, and home visits/house calls.
I asked the doctor if the patient would be seeing her or a medical assistant, which seems to be the new normal, and she responded by telling me in her practice she spends two hours with her patient on the initial visit. Followup exams are one hour, during which physical exams are done with vitals; bloodwork and labs are reviewed as well as medication and supplement reviews, along with a medical plan. In most conventional offices, the patient is lucky to get 15 minutes with the physician, and sometimes they are only seen by the physician’s assistant. Dr. Swierczewski stressed that her practice is focused on face-to-face patient-to-doctor extended visits.
Dr. Swierczewski limits the number of patients in her practice. This enables her to give the highest quality of care to each and every patient. She prides herself on getting to know her patients well on a medical and personal level as it pertains to their medical treatment. By doing this, she stressed that she can better understand and discover the root cause of disease which allows her to formulate a treatment plan that heals the patient and creates their optimal health.
The last question I posed to Dr. Swierczewski was why she went into medicine. Her response was that she comes from a long line of doctors, teachers and artists. She enjoys working with people and getting to know them with the intention of helping them get back to balance with body, mind and soul. “There are not many things more satisfying than truly helping transform a person’s life to optimal health and wellness.”
It seems like private care is growing in America like Harley Street in London, where people seek private care outside the long waits and rationed care of socialized medicine.
Peter Michalos, MD is Associate Professor of Clinical Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons; Past President of Medical Staff and Past Chief of Surgery Southampton Hospital; Chairman Hamptons Health Society. He has been a resident of Southampton for three decades.