Many of us remember a family doctor being a part of the fabric of our lives as we were growing up. He, or rarely she, was the one who might visit sick kids at home. They got to know families: parents, children, and sometimes grandparents. They also worked in a private practice.
Solo practitioners have been dwindling in numbers in recent years but a few are still scattered around Snohomish County. While they may no longer make house calls their offices make for medical homes for many patients.
Dr. Mark Swyer at North Creek Medicine, 210 128th St. SW, Everett, has just celebrated his 20th anniversary as a solo practitioner at this location.
“There is a shortage but it’s projected to be an increasing shortage over the next 10 years,” Swyer said.
Swyer says that there are fewer doctors going into primary care, partly because reimbursements have not been as high as for people who go into procedural specialties.
Swyer is hoping that there will be emphasis nationally on primary care and a more equally distributed financial system to doctors practicing internal medicine and family practice.
“I think that doctors in training will get that sense and hopefully (there will) be an increase in those doctors,” Swyer said.
Swyer, 56, came to the Pacific Northwest in the mid-1980s. He graduated from Rutgers, now Robert Wood Johnson Medical School, in New Jersey.
When he graduated he decided to try surgery. He did a year at Emory University in Atlanta, Georgia, and found that it wasn’t a good fit for him.
Swyer went to work in some emergency rooms but began to look west when he thought about joining the United States Navy. He came to Seattle to stay with a friend while interviewing and met, Jackie, the woman who would become his wife.
Swyer decided to move here but not join the Navy. Instead he headed for the University of Washington then Massachusetts to train in internal medicine.
The goal for the Swyers was to move to Snohomish County to live. During that time, Swyer found his practice and bought it. He made a home for his family in Snohomish and a medical one for his patients in Everett.
The clinic was a family practice with an emphasis on women’s health care. Swyer wanted to keep it that way, and did.
His nurse practitioner, Jenny Nyman, has been at the clinic since 1996. He also employs two medical assistants and one full-time and one part-time receptionist.
In his 20 years in Everett Swyer has seen a progressive improvement in the quality of drugs and the targeting of drugs to treat patients in a preventative manner, especially when it comes to treating diseases such as hypertension and diabetes.
“I think the drugs are very important in terms of getting the right drugs to the right patient early and ideally preventing the progression of disease,” Swyer said. “And that’s specifically to prevent heart disease, strokes, and other vascular disease.”
Screening has also greatly improved with tests to pick up prostate and colon cancer being great tools.
“I think that’s the key to early detection,” Swyer said.
When it comes to prevention Swyer thinks that patients have definitely picked up on the idea that prevention is the priority and the key to good health.
“That didn’t exist, I would say, 10 or 15 years ago,” he said.
Whether a solo practitioner or in a big clinic a doctor is responsible for only a certain number of patients.
“It’s basically a finite number,” Swyer said. “We can only take care of up to a certain number in terms of being efficient, effective.”
The patients who visit Swyer’s office have already made the decision that they want someone who they can establish a personal care relationship with. People who don’t have medical problems rarely need a doctor and opt for treatments at a walk-in clinic when they occasionally get sick.
But if a person develops a chronic illness such as hypertension, diabetes or heart disease then Swyer believes that is the time when awareness comes and those patients make more informed decisions about who they want as their personal care physician.
According to Swyer, our health care system has made it more difficult from an overhead point of view, just to exist in a single setting.
“In terms of what we do, whether we are in a single or multiple setting we’re all trying to practice with the same ideal, the same basic concept,” Swyer said.
Swyer is able to manage funds efficiently and subcontract out non-medical practices that doctors offices have to keep on top of.
Patients at North Creek Medicine can go online to the website and make appointments to see Swyer or Nyman. They can also pay their bills online saving both patient and doctor’s staff time and money.
What is important to Swyer is that he and his patients want a sense of being independent and to establish a relationship.
“I think that some doctors have had to give up some of that independence,” Swyer said.
He believes that some doctors have to compromise a lot more than solo practitioners because they have to work with a group that is a little bit more administrative, more controlling, and they sometimes have to follow formularies.
“Certain big clinics have their own formulary and doctors have to stay within that,” Swyer said. “To me that limits my own independence to select different drugs and to also select different specialists.”
Swyer is hopeful that President Elect Barack Obama’s new administration will be interested in preventative care and will push an agenda this is primary care and patient first oriented and less toward big interests.
“At the table I’m sure they are going to be compromising with all the different players in the room who represent various segments of the health industry,” Swyer said. “But I’m hoping that he’ll make the primary care doctor and their patients the priority in his plan.”
Talk to us
> Give us your news tips.
> Send us a letter to the editor.
> More Herald contact information.
