www.peacefulpractice.org

1. The Attending
Model of
Medicine
Jerry Hizon, MD,FAAFP,CAQSM
Founder & CEO, Motion Medical Group
Family/Sports Medicine Physician
Assistant Clinical Professor, U.C. Riverside
School of Medicine

2. •CEO, Motion Medical Group (two offices)
lMurrieta and Temecula
•Board of Governors; Temecula Valley Hospital
•Past President; Riverside County Medical Association
lLeader of work group: Lessening the EHR Burden
•Future Physician Leadership Program
• UCRSOM/TVH/City of Temecula
•Mission Statement
•“Treat every patient with respect using the best
•medical practices to improve access to quality
•healthcare in a culturally sensitive manner. “
Other Involvements

3. UC Riverside Medical School Temecula Valley
Hospital

4. David & Goliath

5. David & Goliath
Disadvantages Can Be Advantages

6. Goliath’s Advantages
Size, Strength, Power
9’9” height
But….
“Am I a dog that you come against me
with Sticks”……Diplopia?
“COME HERE and I will give your flesh
to the birds and the wild animals !”
Goliath required a shield bearer who
went ahead of him…..poor vision?

7. Goliath’s Disadvantages…. What’s the Diagnosis
Acromegaly Syndrome
with Pituitary Tumor
Acromegaly is a syndrome that results when the
anterior pituitary gland produces excess growth
hormone (GH) after epiphyseal plate closure at
puberty; is often associated with gigantism

8. David’s Advantages/Disadvantages
He was a nimble slinger

9. Models of Medicine
Large Group
•Military
•Academic
–UCR, Loma Linda, Mayo Clinic
•Kaiser Permanente
•Hospitals
–Scripps, Sharps
Proactive Care Physician
Lead- HealthConnect
“Train your Dragon…voice
recognition for EHR
Mark F. Eastman, MD

10. Models of Medicine
Medium Group
•Riverside Medical Group
•Rancho Family Practice, Temecula

11. Models of Medicine
Solo/Small Group
•Single Physician
–HMO – Managed Care
–PPO – Blue Cross, Blue Shield, Aetna
–Membership – Eisenhower 265
–Concierge – MD VIP
–Direct Care – cash only, no insurance
–Functional Medicine Micropractice

12. Timely Books

13. Playing In The Sandbox

14. Physician Burn Out

15. Why Doctors Kill Themselves
Dr. Pamela Wible - TEDMED
Physician Suicide
300 to 400 physicians die from suicide —. Female
physicians are 2.3 times more likely to die by suicide
than those in the general population; male physicians,
1.4 times more likely. Stat News, 2016

16. Physician Challenge
Number of patients seen per day Family Medicine

17. 2013 report by RAND corporation for the American Medical
Association, stated that “aspects of current EHRs that were
particularly common sources of dissatisfaction included poor
usability, time-consuming data entry, interference with face-
to-face patient care inefficient and less fulfilling work content,
inability to exchange health information, and degradation of
clinical documentation.”

18. 2014 research in the International
Journal of Medical Informatics found
physicians who use a technology-
centered approach have the longest
patient encounter times, but they also
have the lowest patient satisfaction
scores.

19. The Martian Movie's Recommendation

20. Inspiration

21. Translational Medicine Through Technology
Eric Topol, MD

22. Medical Authors - Audible
•Eric Topol, MD
•Atul Gawande, MD
•Malcom Gladwell
•Steven Covey

23. Stephen R. Covey

24. HdoggMD meets ZdoggMD
Zubin Damania, MD

25. Three Keys to Attending Model of Medicine
Technology, Team and
Touch

26. Electronic Health Records
Practice Fusion EHR

27. Intraphysician Communication Technologies
Tiger Text

28. The Ability to Connect
IEHIE- Inland Empire Health Information Exchange
Peaceful Practice Website (pending)
Thank-You:
Tarek Mahdi, MD –Riverside Family Physicians
Joe Scherger, MD – Eisenhower Med Center
Dolores Green, MBA - Executive director RCMA

29. Solo/Small Group Practice Technologies
Chocolate and Nurses

30. Atul Guande,MD
Lone Ranger Cowboy vs. Pitcrew

31. Curtis Combs, MD
Medical Assistant/Medical Scribe Combination

32. The Attending Model of Medicine
Helen Ranney, MD

33. What Makes a Great Attending ?
Helen Ranney, MD
What they do:
1) Make decisions
2) Educate
3)Procedures
4) Responsible for ultimate care of patient
5) Edit the EHR note
6) Send/write the prescriptions
What they do NOT do:
1) Scut....Scribing
2) Find Labs
3) Find old records/consult notes
4) Find Images (xrays, ultrasound,MRI)
5) Take initial patient intake
6) Details of disposition

34. Advantages of the Attending Model of Medicine
Helen Ranney, MD
1) Complete Medical History Taking by sending
in “the clones”
2) 30 minutes now presented in 30 seconds
3) I GIVE the patient their medical history to
their satisfaction (the patient is MY
ATTENDING).
4) Patients have second chance to answer the
various questions
5) Laser focus on patient a la Sherlock Holmes
6) “Court reporter-like” documentation
7) Chart notes/billing completed before next
patient
8) Excellent work/life balance for physician
9) Patients get excellent/timely care
10) Staff gets excellent job/opportunity

36. Gaze Study Result (Practice Improvement Project)
Efficient Care
•Medical Assistant /Medical Scribe
Direct/Shared Gaze = 93% time
vs. 45% w/o MA/S.
Avg. 8.3 min/patient w 5 Star
Rating......SCALEABLE
“The Key to good EHR is not
touching many keys”

37. 2013 prospective studies of the usage
of scribes in a clinic setting that found a
59% increase in patients seen per hour
and a 57% increase in work relative
value units per hour with a $205,740
total additional revenue.

38. Peaceful Medical Practice
ical Assistant/Scribe/Health Coach/Navigator

39. Bert ( “a cockney of all trades” ) VS Radar

40. Medical Assistant / Scribe / Health Coach / Navigator

41. Staff Development Technologies
Course
Speed reading
Test Taking
Time Management
Memory

42. Resources for my “pit-crew” (CME for MA/Scribe/HealthCoach/Navigator)

43. Practice Fusion Academy in San Francisco

44. Practice Technologies
Present Case in front of
Stand Up Desk
Computer
Can look over prelim note
Check List
Propose Eval & Plan
72% correct dx via hx
Tsukamoto, 2012

45. “If you stay on time you only have to be average to get good patient reviews”
Goal:
1) Answer phone on first ring by a
Human with nickname,”Sunshine”
2) Scaleable so sameday appointments
3) Reception area (no waiting room)
4) Attempt to see them BEFORE appt
5) All patients over 20 yrs- Last Name
6) Vital Signs Vital
7) Timer #1 started when pt roomed
8) Timer #2 started when doctor enters
9) Timex Vibrating Watch
8 minutes to 5 star rating(PIP Project)

46. The Ritual of the Physical Exam- Pearls from Ted Talks
Dr. Abraham Verghese,MD
Allan Pease
Hand Shake
Hand Position
Tim Ferriss
Eye Gazing
Parties

47. Dr. Hizon VS Dr. Google

48. Effective Patient Education via Large Wall Mounted Computer Screens
Four Slide Patient Education
1
2
3
4

49. Asynchronous Patient Education Technologies
Down load E book prior to
annual physical exam
Patient Education YouTubes- Pre/Post Visit

50. Chronic Disease Practice Technologies
Diet Doctor

51. Telemedicine and Primary Care Research Projects(PIP)
Wearable(Fitbit) engaging patients on their
smartphones in a HIPPA compliant phone app.
l Student run research project
Thank-You:
l Deborah Deas, MD, MPH
l Dean, UCR School of Med
l Dr. Michael Nduati, M.D., M.B.A, M.P.H,C.E.O.

52. Primary Care is now SCALEABLE
Average MA/Scribe can see 10 patients per day
(Range is 8 to 12 per day)
8 hour day = 48 minutes per patient
Average hourly wage = $14/hour
Average daily wage = $112/hour
Average patient visit = $103 + procedures
So one patient seen essentially pays for a MA/S.
If hire 4 MA/S should see 40 to 48 patients per
day
With 40 pts average per day x 22 d/m x $103/pt =
Gross Monthly Billing per doctor = $90,640.00
50% overhead doctor nets = $45,320.00/month
Annual salary potentially = $ 543,840.00
Limiting Factor is number of MA/Scribes

53. Patient Satisfaction
s
778 review 4.9 stars
HeathGrades 40 reviews| 4.8 stars
Google 17 reviews 4.8 stars
YELP 14 reviews 4.5 stars

54. Disadvantages of Attending Model of Medicine
Not enough well trained MA/Scribes
Steep learning curve for novice MA/Scribes
Good ones advance to graduate school
Easy to get frustrated with novice Ma/Scribes
Physically large number staff member
Staff dynamics amplified
Physician MUST read and edit every word

55. Qualities of a MA/Scribe (Proposed)
1.College/University,(HS graduate with some college/med terminology preferred ).
2.Proficient in English reading, grammar, and comprehension, and excellent verbal skills
3.Possess strong computer and keyboarding skills, a high level of concentration
4.Possess solid hand-eye coordination, and keen listening skills, passion to work in
healthcare.
5.Must be able to stand or sit for long periods. Ideal candidates are confident, mature,
and able to multi-task, self motivated, punctual, and cooperative.

56. Medical Scribe Programs
l www.ScribeAmerica.com
l www.EliteMedicalScribes.com
l www.theACMSS.com The Medical Scribe Certification and Aptitude Test (MSCAT)
l www.MedicalScribeTraining.net
l www.ahdpg.com American Healthcare Documentation Professionals Group
l www.PhysicianAngels.com
l www.MedicalAssistantca.com Efficient Care Medical Assistant & Scribe Training Program
l www.ScribeSolutions.com
l “Medical scribes lack consensus on training, certification” Conn, 2013 Modern Healthcare

57. Future Technologies

58. MA's can improve logarithmically
Physicians
Medical Assistants

59. Tools to Treat
• MA check list app
• Khan academy videos
• Treatment Terraces
• MA Bootcamp
• MA CME's
• MA/S Twitter
• YouTube Library
• Billing and Coding
• Risk Management
• Communication
• Interview skills
• Presenting to an attending
• Online Presence – 5 Star Rating

60. HealthCoach/Scribes from UC Riverside Pre Med Students and CBU Pre Med
Students
Barry Bittman, MD

61. Physicians need Pit Crews

62. Solo/Small Group Practice Technologies
Cycling is surgery

63. Solo/Small Group Practice Technologies
Motion effects emotion
•Either Take Prozac or Ride Prozac

64. Solo/Small Group Practice Technologies
The Pilates Company

65. Solo/Small Group Practice Technologies
C-Arm Radiographs (Xray)

66. Solo/Small Group Practice Technologies
SonoSite Ultrasound

67. Solo/Small Group Practice Technologies
Sideline M.D.

68. Solo/Small Group Practice Technologies
Coach’s Eye
•iPad Gait Analysis

69. Solo/Small Group Practice Technologies
HikeBikeTemecula.org

70. Solo/Small Group Practice Technologies
Temecula Virtual Half Marathon
•MapMyWalk.com

71. Solo/Small Group Practice Technologies
POSH Exercise Group
•“Professionals Out of Shape”

72. Solo/Small Group Practice Technologies
Summer Solstice Century
•MapMyRide.com

73. Future Technologies
Pharmacogenomics
Travel Medicine
Telemedicine Options

74. Solo/Small Group Practice Technologies
Acne-Trac
•Remote Acne Treatment via
iPhone

75. Physician Touch
Ted Talks for Doctors:
Allan Pease - Body Language: The art of shaking hands.
Eye Gazing - Tim Ferris
The Jarvis Reflex - prior to entering a room
Abraham Verghese - Doctor’s Touch
l Allan Pease
Tim Ferris

76. Contact Me
Dr. Jerry Hizon
Telephone: (951) 760-0107
Fax: (951) 667-1933
25495 Medical Center Dr.
Suite 305
Murrieta, CA 92562
JerryHizonMD.com
Jerry@MotionSportsMD.com

77. Follow On Twitter
•Eric Topol
–@EricTopol
•David Chao
–Pro Football Doctor for 17 years
–@ProFootballDoc

78. TEMECULA/MURRIETA SINCE 1986

79. Prepare to Care
l Plan Pearls and pitfalls of the day.
l Make time up in the air