Off the Beaten Path

Alumni chart their own courses in non-traditional medicineRoad Map to Different Alternative Ways to Practice Medicine

Working in familiar settings, such as hospitals or in private practice, doesn’t always cut it for physicians. Though some are comfortable in those places, others aren’t, and there is a perceivable shift in the openness many doctors have to working in non-traditional settings.

Take two Dayton-based alumni from the Wright State University Boonshoft School of Medicine. One works as a radiologist from his home, pulling second shift for emergency rooms across the country. Another is a visiting physician who makes drives to deliver care to those who can’t make it to a doctor’s office.

There are lots of reasons why some doctors want to transition to a more novel delivery of care. These include work-life balance, finances, and a desire to have more time with patients, among other things.

“I left private practice because I felt that the traditional model was failing me.”

“I left private practice because I felt that the traditional model was failing me. It was tough to provide the time and attention that people needed yet still generate enough revenue to pay the bills and have adequate time away from the office,” said Kelli Melvin, M.D., ’00, a visiting physician. “While I still have financial challenges doing housecall medicine, I only see a fraction of the patients per day, usually eight to 10, allowing me to focus more on their needs.”

Radiologist Norman (Norm) Pennington, M.D., ’83, left the traditional setting after decades working in hospital-based radiology. For him, it also was a combination of factors that led him to make the plunge.

He began working remotely from home to help a colleague in Youngstown, Ohio. When he first started out, computer and Internet technology hadn’t advanced enough to make working from home full time a possibility. But after 15 years of doing it part time, technology was ready, and Pennington had a choice to make.

“I was hesitant at first, but there were a few trigger points. One is that I had a daughter and, because I worked so much, I was almost a stranger to her. Making the switch changed that because I was able to be at home to help her with her physics homework,” Pennington said. “The second was that I was in a car accident on I-75. Two semi trucks destroyed the car I was driving, and I thought, ‘Why am I doing this?’ The car was crushed on three sides. I’d been hit on two. The first thing I did was to check if my arms and legs were attached. Then I went and sat on the guardrail. I can’t believe I lived through that.”

Pennington walked away with minor injuries, but the experience was enough to make a lasting impression. He said it was almost like a sign, and the choice he made is one that he would gladly make again.

There are some differences in how the two doctors go about their days. Pennington’s typical workday begins at 5 p.m. and ends at 1 a.m. He commonly works around six days per week. For Melvin, she works four days a week, visiting patients during normal business hours. Her work is mobile, completed with the help of a medical assistant who drives while she finishes tasks on a computer, while Pennington’s work is stationary.

Melvin sees a handful of patients per day, with a service area focused around the Dayton area. Pennington’s duties cover dozens of emergency departments at a time from various locations around the country. He is currently on staff at nearly 25 hospitals. In the past, he’s worked at as many as 114. The positions are possible because he carries licensure in 26 states.

Melvin typically treats those who are in situations preventing them from making it to hospitals, such as suffering from dementia, and who are often on Medicare or Medicaid. Pennington sees MRIs, X-Rays and CT scans of many different patients, from nursing homes in Arizona to trauma units in New England.

But there are also many similarities. Both have contracted with companies to do the work, and both require their own set of tools. For Melvin, that includes a car and instruments needed for primary care.

On Pennington’s end, he has some incredibly high-resolution monitors to make it possible for him to review images he receives. Since his equipment is required to operate at the same precision as in a health care facility, Pennington also has to have it certified annually by a physicist.

“The hospital has to have the ability to convert X-Rays, MRIs and other things into digital format to send over the Internet. My computers can also handle big files. I have to have two computers on at all times,” Pennington said. “And then you have to have high-resolution monitors, the kind that cost $10,000 a piece — you can’t get those at Best Buy.”

Both physicians also would argue that their novel methods of delivering care have resulted in better and more efficient patient treatment.

“I get to know them better, and seeing them in their home is more personal. I can better understand their struggles and barriers to treatment by seeing how they live,” Melvin said. “I look at the foods they are eating, how they are living, and check their medications. Often, they can’t afford them or don’t remember to take them. I get to see the family interactions and how they interact with their caregivers.”

Most of her patients are elderly and homebound. Some have chronic medical conditions or are on feeding tubes and ventilators. Some are younger, paraplegic or quadriplegic, or have other serious illnesses. Many have poor access to health care, and Melvin’s services make a difference in keeping them out of the emergency room and hospital.

“I see all walks of life. They all receive the same quality of care, and it is very comprehensive care. We draw blood, do EKGs, order X-Rays and ultrasounds, and do minor procedures in the home,” Melvin said. “My work is very rewarding but can be tough at times. I do a lot of end-of-life care, which is very fulfilling for me.”

Pennington believes that having the flexibility to stay current in his field has helped him to deliver more efficient and informed recommendations for patient care. In addition, he can consult with other doctors much quicker than in the past to find the information he needs. Back in the day, a puzzling case would require printing film and mailing it to other doctors for consideration. Now he can just email a central dispatch and get a response in about 10 minutes.

“There are two challenges doctors face. Balancing home and work, and the other is keeping current. For me, I’m an instant message away from consulting a doctor in that area. I can get a call in a few minutes,” Pennington said. “Also, the company I work for has meetings reviewing interesting cases. Those are valuable for peer review. There’s also an online lecture every day. A lot of the lectures are from India but I can ask questions. Now I’m as current in my
field as I was during training. Not many people can say that.”

Similarly, there aren’t many specialties suited for working remotely from home. Though there have been great advancements in telemedicine, radiology and psychiatry appear to be those most likely to suit the structure. There are some applications for video calling in rural medicine to reach patients who would have to travel far to see a doctor, typically one working in primary care.

For Melvin’s track, it could be adapted for physicians working in a decent number of specialties. “Family practice, internal medicine or geriatrics are ideal specialties, but any specialist who can adapt to primary care can be considered,” Melvin said.

In the future, her novel method of delivering care, like Pennington’s, will likely become more popular as both caregivers and the health care field begin to realize their benefits to patients, doctors and the bottom line.

“Medicare and other insurance companies are really starting to see the value in this type of work. It can save patients a great deal of money by preventing hospitalizations and ER visits,” Melvin said. “I see my patients about once every four to six weeks. Seeing them frequently helps me keep on top of their medical conditions before they get out of control.”

“Being able to practice in a virtual practice has improved the speed and quality of patient care that I offer,” Pennington said.

— Daniel Kelly

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