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By CHENMAY YEE • mychen@startribune.com

 

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

In the 1990s, the spread of managed care sparked consolidation of medical and clinic groups that left the solo physician a dying breed. That’s especially true in Minnesota. 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.”

She takes home about $60,000 a year, about $20,000 less than she used to.

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 rejoining a big group.

Jon Hallberg, a family physician with University of Minnesota Physicians, is grateful he won’t have to take such personal risks when he opens the Mill City Clinic in November. His task, he said, is to create the “iPod of clinics” — with same-day appointments, email

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.

“I felt like I was running a marathon,” he said. 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.”

Going solo

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.

He’s seeing about 10 urgent care patients and doing about five immigration exams a day. He hopes business picks up.

“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

By Adam Epperson

 

CEDAR ISLES DEAN — A new family-run urgent care clinic recently opened in the Calhoun Village Shopping Center, offering treatment for everything from slivers to bone fractures.

Neighborhood residents Mike and Niki Oldenburg hosted a grand opening for their venture, Twin Cities Medical Clinic, July 9. It’s at 3264 W. Lake Street on the second floor of the mall just above the Blockbuster

video store.

The husband-and-wife team said a main reason for starting the clinic was a lack of urgent care in the area.

“Urgent care is basically a walk-in clinic with same-day service for minor medical problems that don’t require an emergency room, but do require a medical provider to address,” Mike said.

Mike has been in practice for more than 10 years and has medical licenses in the United States, Norway and Sweden, his birth country. Because he was born in a foreign country himself, Mike has become especially interested in providing care to immigrants, helping them achieve the “American dream.”

“I was born in Sweden and I came here when I was 2, so I have a lot of empathy for those immigrants coming for the American dream,” Mike said. “I love the immigration medical exams.

“When you work with the immigrant population, you realize there are people out there who truly believe in the American dream,” he said. “It’s really amazing because I think a lot of us Americans, who grew up here; we kind of lose vision of that because it becomes just a part of your normal life. When you meet these immigrants, you meet people who really believe in hard work and success.”

Growing up in different countries, such as Thailand and Vietnam, in addition to working with the Peace Corp. in Africa spurred Niki’s interest in earning her doctorate in public health. Living around the world has also given her perspective on people from other countries, as well as those trying to enter the U.S.

“There’s some (immigrants) who’ve given up a lot to come over here,” she said. “You see how diverse our community is. It is a diverse group of people who come to see Mike. We just enjoy people who come from different cultures and talking to them about how they lived in their own countries, what food they ate, and what languages they spoke. It’s been really interesting.”

But the new clinic is open to anyone with just about any minor medical issue. Some former patients, such as Alfredo Olarte, showed support for the new clinic at the official grand opening. “(Mike) cares about you, he asks you questions, he makes you feel comfortable. He’s also super gentle, but has no attitude,” Olarte said.

Mike and Niki met at the University of North Carolina at Chapel Hill as Mike worked for his master’s and medical degrees and Niki worked for her master’s and doctorate. They were married in 1996. After earning her doctorate in public health, Niki set off to make her own mark in the medical field, before taking time off to raise the couple’s two daughters, Kirsi, 10, and Aila, 7.

“I used to work in the health department, and I was the director of evaluation. I evaluated HIV and STD prevention programs, and then I took five years off to raise my two daughters,” Niki said. “So I was a full-time mommy and I loved it, and now I am at the School of Public Health at the University of Minnesota. I manage cardiovascular clinical trials and now I am working 25 percent (of the time) because this (new clinic) is such a huge venture for us.”

Niki and Mike have already been hard at work advertising their clinic to neighboring businesses and have already developed a relationship with Walgreens next door. The moment a prescription is written at Twin Cities Medical Clinic, the patient is directed to the Walgreens, where it can be picked up. An electronic system is in the works, so prescription orders will immediately pop up on the list of things to do for the pharmacists.

“I’m very excited for them, I think there’s a big demand for (urgent care) here,” said Walgreens Manager Heidi Corporaal. “They’ll help our customers, and we’ll help them. It’s a good mutual relationship.”

Twin Cities Medical Clinic is physician-staffed from 10 a.m.–8 p.m. Monday–Friday and noon–6 p.m. Saturdays and Sundays. For more information,

visit www.twincitiesmedicalclinic.com or call 612-285-9996.

Urgent Care: 612-285-9996

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