In the 20 years I have owned and operated Advanced Family Medicine, the shape of our Medical practice, our patients, our team members and partners have come and gone. But what has stayed and improved over time is our commitment to our compass and our map. Our compass is the values we live by and our map is the terrain or territory on which we live.
The map has changed frequently and dramatically. When we started our practice in Kuna, there were around 7,000 residents in the city limits. Now there are at least 29,000. In addition, the surrounding area has filled in such that there are fewer farms and dairies and more sprawling subdivisions outside the city.
When I opened my practice in September of 2004 there were two other existing practices, both independently owned and operated. One was started and run by a physician in town who employed a P.A. and N.P. There was another owned and operated by a N.P. who employed a P.A. Now neither of these is in operation: The physician sold his practice to another P.A. in 2006 who was shut down due to inadequate oversight after one year and the N.P. sold her practice to the Family Medicine Residency of Boise a few years later and retired soon after. St. Alphonsus has since opened an Urgent Care and most recently Primary Health came to town in 2021.
Another map change has been our revenue stream. Where before it was entirely fee for service, we now have multiple insurances, especially Medicare Advantage plans, who only pay us a fair amount if we meet quality measures for our patients, including diabetes control, blood pressure control, and annual wellness reviews. Without these quality measures and the bonus payments that go with them, we would be unable to see Medicare insured patients and stay in business.
Even with our best efforts to keep our quality ratings high – and we do as well or better than some local hospitals with teams working on this – our margin of earnings has eroded from 50% when I started to 15% now. As a result, we have to employ and offer more ancillary services in an effort to creep up that margin in an attempt to catch up to inflationary pressures. These are constant, especially in wages. Although many still complain of low wages in Idaho, they have doubled in the last 15 years for both the front office and Medical Assistants while my earnings have gone down.
To that end, we now offer a wide range of services to allow our patients as much care as possible close to home. These include Massage Therapy, Osteopathic Manipulation Therapy, and Cosmetic Injectables treatments – both medical and cosmetic. In addition we provide the full range of Family Medicine services Idahoans have come to expect. Our providers can take care of you from preconception until after death (Dr. Thiros and I both serve as Associate Hospice Directors).
We also offer multiple procedural interventions not typically seen in outpatient clinics as well such as procedural birth control, circumcision after delivery, skin lesion and cyst removal, fracture care, laceration repair, and joint injections, as well as in-hospital OB, EGD and Colonoscopy. One stop provision of healthcare is what our patients prefer since it is at least a 15 minute drive from our office to any specialty care in the valley. But if a patient prefers to access these services elsewhere, there is no push back from us in providing that for them.
Our compass, the values by which we measure whether we are doing it right, have been clarified but remain unchanged. Specifically we cling to the Platinum Law in deciding how to provide healthcare to our patients. I recently coined the phrase “Advancing your health, together” to sum up our purpose in the workplace. We seek to discover what is most important to you, and within the bounds of ethics and quality and financial responsibility to the patient and their insurance, try to make that happen.
When hiring and internally training, we have chosen to emphasize the five following values: responsiveness, flexibility, communicative listening, humble confidence, and boundaries with compassion. This allows us to assemble a team that treats our patients with uniform respect and allows the patient to direct their care more often than they would within the limits of a hospital system or sprawling multispecialty corporation.
When I started my goal was to try independent practice until the drawbacks outweighed the benefits. I admit I feel something of a drive not to fail at this point and wonder to myself what will make things bad enough to wave the white flag and become employed somewhere else or sell out to the highest bidder. For now, I maintain my independent practice to keep my commitments to my employed providers, my patients, and our team – that they know there is a place for them in Kuna, Idaho. Where we are uncompromising in keeping our values – our compass, but where we concurrently look for compromises in the way we meet the changing needs of our patients and travel the landscape in which we practice – our map.
Someone recently said that if we treat the journey through life as the destination, we will enjoy it more. I have to agree that has been true of my 20 years of private practice. And, at least for now, I plan to keep advancing my practice with my map and compass in hand on this journey which is an adventure that has become my dream job.
-Michael Foutz, M.D.