A healthy dose of independence

When Michael Oldenburg, a burned-out family doctor from Crystal, landed in Sweden for a sabbatical, he found "nirvana" -- doctors spent 30 minutes with each patient, took mandated coffee breaks and actually enjoyed their jobs.

When he returned, Oldenburg couldn't bear the thought of getting back on the treadmill. Last month, he and his wife opened what they called a "mom and pop" urgent care in Calhoun Village, installing kitchen cabinets from IKEA themselves and handing out fliers in the neighborhood.

He's among a sprinkling of Twin Cities doctors escaping the pressures of modern American medicine by striking out on their own. Some are offering "concierge care," where a limited number of patients pay a membership fee for 24-hour access to a physician. Even University of Minnesota Physicians is experimenting with a small clinic opening soon in Minneapolis' Warehouse District, where two doctors will make house calls on bicycles.

These experiments amount to tiny rebellions against increasingly large and impersonal health care systems and their emphasis on the bottom line. But they also speak to a hankering for something many doctors feel they've lost in the hurly-burly of seeing up to 30 patients a day -- the personal relationship between doctor and patient.

The same thing is happening around the country, said Dr. Pranav Kothari, co-founder of Renaissance Health consultancy in Cambridge, Mass.

Actual numbers are elusive and it's unclear how many will survive financially. "It is a trend, small but growing," Kothari said.

Forces favor group practices

It's particularly challenging for solo practitioners or small groups in primary care -- family medicine, pediatrics and internal medicine -- because they are reimbursed less than for specialty care. Many compensate by fitting ever more patients into the work day.

The number of solo family doctors in the state plunged from 89 in 1990 to 36 this year, according to the Minnesota Academy of Family Physicians. Two-person partnerships fell from 58 to 35. By contrast, the number of family medicine groups grew from 484 to 578 and multi-specialty groups soared from 489 to 738.

High overhead for billing, administration staff and now electronic medical records plus smaller payment from insurers make going solo daunting. Those who do it have to be very determined or very disillusioned, or both.

In 2002, Rochelle Taube left her group practice to start Edina Sports, Health and Wellness. Four banks refused her a small business loan before one loaned her $100,000 with her house as collateral. The practice was making money within four months and now has four doctors.

On a recent day, Taube saw 16 patients. "We have no desire to go fast," she said. "Patients like how you're not a number, you're a name."

Others who have gone independent are having second thoughts.

Five years ago, Alex Axelrod and a partner started a part-time cash clinic in St. Louis Park called AM Physicians. Axelrod is from Belarus and treats many immigrants lacking health insurance.

Last year, he left his full-time job at the Quello Clinic to focus on his cash clinic and another clinic for insured patients.

For complex patients, Axelrod often calls specialists and negotiates prices, going as far as tracking down charitable foundations to help pay a medical bill. His patients have his cell number.

But the 16-hour days are taking a toll. He's considering re-joining a big group.

His task, he said, is to create the "iPod of clinics" -- with same-day appointments, e-mail consultations and drugs delivered by Fairview Pharmacy right to patients' townhouses and condos. Hallberg expects to spend about 10 percent of his time doing house calls and is buying a bicycle.

To get to know his neighbors, Hallberg intends to host a regular evening at the Guthrie called "Hippocrates Cafe," where actors read short pieces on medicine.

"My charge is to make [the clinic] one of the highest in patient satisfaction in the system, if not the highest in the system," he said.

Lessons from Sweden

In his first job at a suburban Crystal practice with 18 doctors, Oldenburg saw up to 28 patients a day, spending just moments with each.

After seven years, he and his family took a year-long sabbatical in a rural town in Sweden. Oldenburg, who emigrated from Stockholm at age 2, spoke Swedish but not "medical Swedish." He wondered if he was up to the challenge.

The Swedish doctors were equally worried about his American ways. The clinic chief swiftly laid down the rules. Oldenburg was to take a half-hour morning coffee break, like everyone else, and then a lunch break from noon to 1 p.m. and another half-hour afternoon coffee break. During these breaks, he was to socialize with his co-workers, including lab and cleaning staff, and there was to be no shop talk.

Oldenburg was stunned. In Minnesota, doctors routinely ate lunch at their desks, sandwich in one hand and tape recorder in the other. When his patients said they would miss him while he was gone, he realized he could scarcely remember who they were.

In Sweden, with 30 minutes for each patient, he had time to chat not just about their ills but about their lives. "Before I knew it," he said, "I was in love with medicine again."

He knows Swedish health care, funded by taxpayers, is not perfect. Those seeking specialty care often wait months. But he liked a lot of what he saw. American medicine, he concluded, is "very efficient but not very effective."

When he returned in 2005, Oldenburg knew he wanted his own clinic. He rented an office in St. Louis Park and started doing immigration exams for people seeking green cards. He moonlighted at urgent care centers in the evening.

Oldenburg looked into "concierge care," an idea that's taken off in other cities. Some doctors here are experimenting with it, but as a solo practitioner, Oldenburg didn't think he could handle being on call after hours.

In early July, Oldenburg opened a 2,000 square-foot clinic called TCMC Urgent Care above a Hollywood Video store in Calhoun Village.

The small reception area is decorated with a vase of flowers and an oil painting by Oldenburg's uncle. A small refrigerator holds vaccines and there's a used X-ray machine.

His wife, Niki Oldenburg, handles the clinic's insurance contracts. Billing is outsourced. He can't yet afford health insurance for his full-time nurse and part-time medical assistants. His own family is covered through his wife's University of Minnesota job. Oldenburg says he's sunk a quarter-million dollars into the new clinic. Counting equipment accumulated over two years and the fact that he didn't pay himself during that time, he's invested up to $1 million to get where he is today.

"It's just like having children," Oldenburg mused. "If you'd known [what it would take] before you did it, then you might think twice or not have done it at all."

Chen May Yee • 612-673-7434