Saturday, October 27, 2007

Physician Business Ideas - Why Not More Office Procedures? An Analysis of the Obvious

“It takes an unusual mind to undertake the analysis of the obvious.”’

Alfred North Whitehead (1861-1947), Science and the Modern World

John L. Pfenninger, MD, a Michigan family physician, passionately believes his compatriots in their offices can do more procedures and do them well with more convenience for patients with less cost to the health care system.

That’s why he founded the National Procedures Institute (NPI) in 1989 to teach procedural and surgical skills to primary care physicians. NPI has trained over 15.000 clinicians to perform appropriate procedures in their offices.

Saith John:

Doing procedures makes so much sense. Many things can be performed in office as opposed to the hospital. Surgeons are trained to do everything in the operating room but this markedly increases costs. Sebaceous cysts, lipomas, hemorrhoids, and many other conditions can be treated in the office setting. Patients appreciate this, as do the insurers, because costs are kept to the minimum.”

“Other advantages of doing procedures include a reduction in the delay of diagnosis. In other words, if a skin lesion looks atypical and the clinician is comfortable doing a skin biopsy, it is biopsied on the spot. The alterative is sending the patient away. This may take 6 to 8 weeks before another evaluation. In the case of melanoma, this puts the patient at increased risk.”

“If the clinician becomes more involved with seeing, feeling, and exploring the innuendos of a disease process, the diagnostic acumen become more accurate. Doing procedures can break up the monotony of the day-to-day practice.”

“In addition, reimbursements still are greater for surgeries and procedures, versus nonsurgical areas. Numerous studies are available showing that those who perform procedures have a significantly higher net income. For most family physicians, they chose the specialty not to be case managers or paper pushers, but rather, to provide comprehensive care. Doing procedures makes this more likely.”
To back up his argument and to give it obvious educational validity, NPI offers CME credits and has produced a mammoth 2080 page textbook Pfenningers &Fowler’s Procedures for Primary Care, Second Edition (Mosby, 2004) and code books for procedures. NPI can be accessed at

For publications related to this topic, see Sailing the Seven “Cs” of Hospital Physician Relationships, The Voices of Health Reform, Innovation-Driven Health Care, And Who Shall Care for the Sick?

1 comment:

Dr. Val said...

I met John Pfenninger at the recent AAFP meeting in Chicago. He's a gem of a person - friendly and good natured. I agree that family physicians should do more simple office procedures.