I spent the first 12 years of my medical career taking care of poor people in a teaching hospital in Providence, R.I. In the early 1990s health care was rather different than it is now. If a person had private insurance, they generally had ready access to both primary care doctors and specialists. For my clinic patients, it was another matter. Many had no insurance or Medicaid, were disabled, homeless, poorly educated or didn’t speak English. Working there required tremendous patience and a level of dogged determination that I did not realize I possessed. Health care access was very challenging.

As much as possible, I addressed the patients’ care myself, even learning to speak somewhat mangled medical Spanish. However, if a patient of mine needed medication, tests, or specialty care, the challenges were greatly magnified. I would then resort to what I’ll call creative patient advocacy. This involved finding free medications wherever possible, calling repeatedly, walking patients to other clinics and at times utterly obnoxious persistence. It became a sort of game, and if my patient got the care they needed I felt like I had won that match.

Eventually I became the director of those clinics and was given the opportunity to improve the system. It was a bit like trying to clean up a teenager’s bedroom, requiring finding the walls and floor and building it back up to a sense of order. There is now a centralized phone system for all clinics with Spanish-speaking staff, clear appointment times and communication between specialties. Not perfect but no longer chaos.

I describe this because access to health care for all Americans is becoming more like the clinics and less like the private world of the past. But I can’t clean up this mess. There is a growing shortage of primary care doctors both here and everywhere. There are many specialties with impending shortages. Hospitals are being encouraged to work with physicians to coordinate patient care. There is much talk about changing the payment system to move away from fee-for-service models. These are worthy goals but will take time to achieve. Meanwhile we are left a broken system. Many doctors are scheduling patient appointments every 15 minutes and rushing through issues, an unsatisfactory situation for providers and patients alike.

In an effort to offer an option for people which would allow for more time, I decided to open a small private practice based on the concierge model. My goals are to provide primary care that is unhurried, personalized and easier for patients. I offer longer appointment times and work with people to communicate with them in ways that work for them. Many people own or work in busy businesses or travel frequently. They often find it easier to be able to communicate electronically, or make a quick call instead of coming to the office.

Today’s health care system can be overwhelming. Some people see me because they have very complex situations and need help in navigating the maze and coordinating their care. Oftentimes family members become very involved in a person’s care, and I work with them in coordinating services and planning for future needs.

Some come to my practice because they want to focus on wellness concerns such as weight loss, fitness or nutrition. They want the opportunity to discuss their options with a physician who can get to know them and help them to achieve their goals. There is little time for this in a typical primary care practice nowadays.

The goal of primary care doctors is to provide both preventive care and care in times of illness, care ideally of the highest quality. There are many ways to achieve this goal, and no one way is the right way. I believe people should have choices, and should choose the doctor who they feel is best for them. I am offering an option for those who want to take a more active role in their health care, and want a doctor who will help them to do that.


Dr. Gail O’Brien is an internist whose private medical practice is Alliance Internal Medicine in Edgartown.