Better Health Care

Back to Basics: New Trends in Medicine

No-frills space gives docs luxury of time

From the September ACP Observer, copyright © 2007 by the American College of Physicians.

By Ryan DuBosar

Patients walking into general internist Soma Mandal, MD’s, Manhattan office in New York City see her immediately—she’s the only person in the practice. She relies on patients to complete their histories before their visit and she verifies insurance in advance. With all the paperwork addressed, she can then devote anywhere from 20 minutes for a routine visit to 40 minutes for a new patient—all of it clinical time.

The luxury of such long visits is a welcome shift from her previous work at a hurried Lower East Side community health clinic. Treating the underserved was rewarding, but the overhead of a large facility demanded she fit patients into 15-minute slots, leaving only five to seven minutes for clinical work. She moved to a large Brooklyn medical practice, but 40- to 50-hour weeks were similarly frenzied. So she began plotting how to strike out on her own.

“I realized that the only way I could take control would be to start my own practice,” she said. Unable to get a bank loan, she covered the $20,000 in startup costs herself and opened her scaled-down practice in September 2006.

By moving to a tiny office with no staff and minimal equipment, she lowered her overhead costs to an income-to-overhead ratio of 8:1. This allows her to restrict her patient load per week to about 20 patients in four half-day sessions, even while continuing to practice in New York’s Gramercy Park neighborhood.


*****
Shreya Mandal's picture

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One thing that I've found unsettling, though, in listening to coverage about the protests thusfar, is this "good immigrant/bad immigrant" rhetoric that's present in what some people are saying, protesters and organizers alike. This morning, while listening to NPR, I heard one woman speak about how Latino immigrants aren't doing anything to harm this country, that they "love America" and just want to become good, hard-working Americans. Then I heard one organizer, speaking at one of the rallies, say something like this: "Nineteen people hijacked planes and participated in the 9/11 attacks, and not one of them were named Gonzales, Rodriguez, or Santiago. But you can bet that many of the people dying serving their country in Iraq are named Gonzales, Rodriguez, and Santiago" so on and so forth.

I understand that much of this is in response to the whole immigration debate getting wrapped up in worries about "national security" - how the specter of terrorism seems to make allowances for all manner of discrimination, racism and xenophobia, and how countless immigrants are nonsensically made to suffer because of it. However, it definitely seems like a very bad, very problematic move to buy into this sort of dichotomy that pits "good" immigrants or "good" brown folks (here, Latinos) against "bad" ones (apparently people of Arab or Middle Eastern descent - because, you know, the actions of individuals become the responsibility, the fault, the burden of their entire race and religion.) Latinos, like all other immigrants to the United States, deserve to be treated with respect and dignity and are entitled to certain rights and protections because they are human beings, not because they're good, flag-waving*, American-loving immigrants. No one is illegal, no matter whether your name is Juan or Mohammed, Gonzales or Atta.


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