Assembly Line Medicine – Part 1 – The reason Noreta Family Medicine Exists

 One of Noreta’s patients recently brought in an opinion piece written by Devorah Goldman, a visiting fellow at the Ethics and Public Policy Center and senior editor at Mosaic magazine, from the Wall Street Journal titled “The Doctor’s Office Becomes an Assembly Line.” You can read her very thoughtful article HERE. Ms. Goldman laments the decrease in physician-owned practices (aka private practices) from 75% of total practices in 1983 to 46% in 2018. She says:


“Kathleen Blake, AMA’s vice president of healthcare quality, earlier this year cited studies showing that hospital acquisitions of private practices….have led to “modestly worse patient experiences and no significant changes in readmission or mortality rates.”

Wow! I have a funny feeling that there is a reason this fact did not make headline news – hospital systems have a lot of influence! But how is this acceptable? Does this fact make you as mad as it made me?

Ms. Goldman goes on to say:

“Doctors must operate with a clear sense that they are serving the patients in front of them, not the government, data-collection systems, insurance companies or hospital directors.”

Amen to that! Some people wonder why trust in medicine has been lost. It’s because the government, data collectors, hospital administrators, and insurance companies do not take care of you (the patient) — doctors like me take care of you. When a doctor is forced to follow rules that were made by someone who has never met you, you begin to mistrust the system. I saw it happen time and time again in my first 10 years of practicing medicine in a turbulent large hospital system.

I’ve thought about a paraphrased quote from Ghandi a lot over the past 1.5 years — “Be the change you want to see in the world.” I don’t consider myself to be a rebel. I am a rule follower. I like order and get nervous when I consider taking a risk.

However, I also believe in doing the right thing, in practicing ethical medicine, and in trying to find a solution to a problem if I repeatedly come across it. I repeatedly came across the same problems with the healthcare system in my previous practice and was unable to affect meaningful change. Therefore, I decided to strike out on my own, to open Noreta Family Medicine, and to try to be an example of how primary care can improve if you have the freedom to try something different. I hope my story will be a part of showing that small independent practices can survive and thrive and that they are worth fighting for. I believe the trend of physicians selling their practices can be reversed, because it is what is best for you, the patient. I’m biased, but Direct Primary Care (DPC) offices like mine can be a model for how to reverse this trend because the only commitment I have is to directly caring for you.

 I need to acknowledge that I am extremely thankful to have been able to open Noreta Family Medicine during a time when so many other offices have struggled. I am lucky that I am able to pursue my goal, and that I have the support of loyal patients despite being in a national health crisis.

I have a lot more to say on the topic of “Assembly Line Medicine”, so I’m going to use the next four blog posts to discuss other points brought up on this article.

Up next: Assembly Line Medicine Part 2 – The Decline of Private Practices, and why that is a problem

Melissa Boylan MD, FAAFP
Family Physician and Owner of Noreta Family Medicine