The Doctor Is In, If You're Under 40

As many of you know, I work in health policy. I know a lot about the practice of medicine in this country. So this story that hit the blogosphere today struck my fancy: A young doctor in NYC has set up a virtual practice, limiting his patients to the under 40 crowd. He doesn't see people over 40 because they could be *big gulp* actually sick. He charges people with insurance less money than he does people with cash (and they say medical schools don't teach doctors how to make money). Hospitals and clinics aren't "his thing." To get a better idea of this plastic, fantastic doctor, see interview below.

I sincerely hope he is flooded with hypochondriacal phone calls from 20-somethings with major mental illness. Is that mean of me?

How did you get the idea to do this?

Well, I’m not a typical doctor. I get along fine with other physicians, but I didn’t enjoy the hospital or clinic environment. I’m a photographer as well. I shoot for Men’s Journal and stuff like that.

Are there any special hurdles to running your practice this way?

No, not really. You have to have your New York State license. The e-visits are more for things like acne, allergies and follow-up labs. Things that aren’t life-threatening. There’s no way in hell I would prescribed narcotics online. It’s a kind of telemedicine. People have traditionally used it for access [for care in rural areas]. I’m looking at it as a way to practice convenient medicine.
Is your service cash only?

If somebody has insurance, I’ll charge them less and provide them with receipts. You can get cheaper care. But you can’t get it immediately, nor will you get care where people will help you spend your money wisely. I’ve spent the the last two or three months calling physicians associated with the best hospitals in New York City and getting their prices. I called one radiologist and found he’d do a chest X-ray for $75 and another would charge, say, $300. For cash-paying patients the prices are all over the place. I’ll make referrals based on quality and price.
What’s your online process for taking a patient?

I have a few questions that I ask whenever patients contact me. Name, age, that sort of thing. If they’re over 40, I’m not going to see them. The disease profile changes after that. If you’re under 40 you have the same disease profile as an older child, adolescent or young person that I saw during my preventive medicine and pediatrics training. I’m not going to deal with people who have old-people diseases.

How many patients do you think you’ll take on?

I want to keep this small. About a 1,000 patients. It fails in its mission if it’s a large corporate thing.

Without an office, how will you pull this off?

I run this entire thing off my iPhone and a laptop. I can access any patient records from my iPhone. Patients can make an appointment on my website and it’ll text me and I’ll go see them. This is, to me, what’s missing from medicine: personalized attentiveness. Going to someone’s home allows you to get to know them ridiculously well.