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HOME > ABOUT > PRESS > STILL MAKING HOUSE CALLS
Article published - March 21, 2008
Credit: NAPA VALLEY REGISTER
Still making house calls in the age of HMOs, PPOs
Friday, March 21, 2008
By NATALIE HOFFMAN
Register Staff Writer
Large health care facilities are getting a lot of foot traffic these days, but Napa County is also home to a handful of old-fashioned independent family doctors. One of these physicians, Dr. Jonathan Wheeler, said the numbers of independent family doctors may be dwindling, but he finds the rewards of remaining in private practice outweigh the challenges.
Wheeler, an Angwin resident and one of eight independent physicians at St. Helena’s Napa Valley Family Medical Group, said he averages four to five house calls each month — mostly for frail, elderly patients who live at home, in nursing homes or who are staying in area hospitals.
“It’s one of the most rewarding things I do,” said Wheeler, who totes his black bag filled with oral and injectable antibiotics, a blood pressure cuff, reflex hammer and other diagnostic tools. “There’s a mission of being a family doctor and taking care of the whole family from birth to death, wherever that may be. I think (house calls are) an important part of the family doctor’s mission statement.
“In med school, I was so excited to get that (black bag). Some of the other people made fun of me and said, ‘Oh, you’ll never use that,’” said Wheeler, who fits in house calls after office hours or on his lunchtime.
Wheeler started practicing in St. Helena 14 years ago, taking over for then-retiring family physician Dr. John Ford. He said although the pleasures of caring for his extensive family of patients are plentiful, remaining in private practice also brings its share of financial challenges.
“In the upper Napa Valley, health insurance plans are pulling out and more patients are using the larger health organizations like Kaiser Permanente,” he said, adding that shrinking reimbursements from private insurance companies, Medi-Cal and Medicare are incompatible with independent physicians’ increasing overhead costs.
“That’s probably the reason why I joined the (Napa Valley Family Medical Group). They had better contracts with the health plans than I could get on my own,” he said.
Independent family physicians’ rewards can come in unexpected forms. Dr. Francis Mueller — also in independent family practice at St. Helena’s Napa Valley Medical Group — said he has heard of rural family doctors accepting wine, abalone or other goods in return for medical services.
A dying breed
In 1987 and 1988, there were 25 independent family doctors in Napa County, according to Maryann Eckhout, executive director of the Napa County Medical Society. Today — excluding solo family physicians who work at Kaiser and Clinic Ole — there are just 13. Three retired or left the area just since January of 2007, according to Eckhout.
A case in point is Dr. Andrew Alexander, who had a family practice at Calistoga’s Vermeil Clinic for more than 15 years. Alexander, who also was Calistoga’s mayor for two terms, recently moved his medical practice to Washington state.
Wilhelmina Grader-Stephens, one of Alexander’s former longtime patients, said Alexander is sorely missed.
“It was rather upsetting. ... You go to one doctor and they know everything about you. It’s kind of hard because I have to start all over again. ... (Alexander) was very supportive and understands all of the family dynamics, which I feel is important,” she said.
Tricia Williams, vice president of business development and marketing at St. Helena Hospital, said local physician Dr. Beverly Benson began caring for Alexander’s patients in January, adding that St. Helena Hospital is now running the clinic where Alexander practiced.
As Benson gets acquainted with her new patients in Calistoga, Mueller continues caring for the surviving members of four generations of a local brood. Mueller, who makes house calls about once a month, said effective family physicians must be acutely tuned into their patients.
“People are frequently there for reasons other than what they tell the receptionist. For example, they didn’t want to say the visit was for depression, so they say it’s a cold instead,” he said.
“You get to know a family. It’s the opportunity to get to know them over a period of time that’s rewarding,” said Mueller, who began practicing in 1979 in Calistoga, where he spent 22 years before moving his practice to St. Helena.
“I really enjoy what I do and like being part of the community. My grandparents moved here in the ’20s and I have a lot of roots in this community and that’s what makes it fun — having friends, family and my grandparents’ friends. For me, what makes being a family doc rewarding is that now I have a big family,” Wheeler said.
Calistogan Editor John Waters Jr. contributed to this story.
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