Can doctors become chefs?

When a doctor is running several PAs and RNs they are no longer tapping chests and writing prescriptions. They're management.

The model for today's small medical practice is

a law office.

The support staff works to maximize the time value of the lawyer. The lawyer only has so many hours in a day. The staff's job is to off-load as much of the work as possible so the lawyer can maximize the value of that time.

Check out the dance next time you visit your doctor. All questions of money are handled by staff. Basic tests like blood pressure are taken by nurses.

Once the doctor comes in for your eight-minute talk, all the scut work has been done. Your condition is known, the prescription pad comes out quickly, and you're done.

The hot topic in primary care is the "medical home." From the system's point of view, the idea is that a medical practice gets a fixed fee for keeping people well. From the patient's point of view you're far more likely to see a registered nurse (RN) or physician's assistant (PA) than the doctor.

But what is the medical home concept from the doctor's point of view?

It's a restaurant. (Here, with this publicity photo of Emeril Lagasse at the Superchef blog, is a good illustration of why doctors don't like that idea.)

Most chefs don't spend their time behind a grill or making salads. If they are in the kitchen at all they are expediting -- calling out the tickets as they come in, checking the plates as they go out. Or they're out on the floor schmoozing the customers.

When a doctor is running several PAs and RNs, that's their job. They supervise. If they talk to patients it's mainly in a marketing or executive capacity. They are no longer tapping chests and writing prescriptions. They're management.

This can be a good thing. A doctor's time is incredibly valuable. A medical home extends the reach of that time. It's good for patients as well, as the cost of each visit goes down and they have a practice caring about keeping them well, not just selling them services.

But what happens next? In the restaurant trade the chef becomes a celebrity. He gets several restaurants. He goes on TV. You don't think Emeril Lagasse or Mario Batali actually cooked that chicken, do you? They designed it, supervised the staff, and their reputation stands behind the result.

This is what happens when you start a business around what you do. You no longer do it. You're in business.

This is what many doctors fear. But the only way to greater productivity and an easier life is through multiplication. That's what a restaurant gives to a chef and his recipes. That's what the medical home offers doctors.

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