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Lowcountry doctor shuns office visits for house calls
By Dennis Quick
Senior Staff Writer
The future of primary care medicine may well lie in the past. So says family physician Dr. John Forney. Nowadays, while most doctors operate from offices, Forney travels against the grain.
He makes house calls. Strictly. He has no office. Just as doctors did once upon a time, the 38-year-old Forney grabs his little black bag and walks or drives to his patients.
Doing so enables him to give his undivided attention to his patients and spend more time with them. By seeing how his patients live or work—he makes office calls, too—he learns more about them and uses this knowledge to provide them with better care, Forney said.
And people can see a doctor when they need to see one.
“Who wants to wait long in a waiting room or an emergency room when you’re feeling bad?” Forney asked.
Not only are house calls ideal for people, particularly the elderly, who are too ill to go to the doctor’s office or lack the transportation to get there but, Forney said, such concentrated, one-on-one care can lower health care costs by eliminating unnecessary visits to what has become too often the source for primary care: the emergency room.
He charges $125 for an initial visit and $100 for subsequent visits. Patients pay him directly, and he fills out and files their insurance paperwork.
He bills himself as “Charleston’s house call only physician.”
The American Academy of Home Care Physicians, based in Edgewood, Md., estimates that between 1,000 and 2,000 doctors in the United States have house-call practices, said Constance Row, the academy’s executive director.
Row said she hopes more doctors start house-call practices to meet the demand of the nation’s aging population. There are 34 million older adults in the United States and that number is likely to double in the next 20 years. Also, by 2020, an estimated 2 million elderly will be chronically homebound, according to the academy.
However, a shortage of primary care physicians looms in the nation’s future as medical school students are veering away from family medicine and pursuing specialized medicine, where Medicare reimbursements and the overall pay are greater, Forney said.
The number of U.S. medical graduates going into family medicine fell by more than 50% between 1997 and 2005, according to the Leawood, Kan.-based American Academy of Family Physicians. There are currently about 100,000 licensed family doctors in the United States.
In addition to reimbursement issues, medical students are shying away from family practices because of the stressful work environment. With crowded waiting rooms and the pressing needs of administrative staff, doctors’ offices often are chaotic and hectic, Forney said.
Family doctors in Massachusetts apparently agree. A Massachusetts Medical Society survey conducted this year found that 42% of the doctors surveyed were dissatisfied with their work environment. The American Academy of Family Physicians featured the survey in a July news story about the shortage of family physicians.
Forney worked as a family doctor in a Savannah hospital before arriving at the Charleston Naval Hospital in North Charleston two years ago. He launched his house-call practice in November and continues to see about 40 patients he treated at the Naval Hospital, but now he sees them in their homes.
His black bag contains a stethoscope and diagnostic equipment, and he intends to buy a portable electrocardiogram machine. He also plans to load his patients’ files into a laptop.
As a house-call doctor, Forney spends 30 to 45 minutes with each patient compared with the 15 minutes he spent with patients while practicing in hospitals and in doctor’s offices.
“Patients are more relaxed at home and tell you more about their condition,” he said. “They feel less intimidated in a comfortable setting.”
He got the house-call bug from his grandfather, a family physician “who enjoyed treating patients in their homes and passed that on to me,” Forney said.
Forney realizes he would be making more money with a traditional office practice, which is driven by a high volume of patients. The more patients a doctor sees, the more reimbursements a doctor gets. But offsetting that is the lack of overhead from office rent and staff, he said, as well as the fulfillment he gets from his practice,
“I went into to medicine to help people,” Forney said.
Dennis Quick is senior staff writer at the Business Journal. E-mail him at dquick@charlestonbusiness.com.
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