Surah Grumet used to be a family doctor at a clinic in the Bronx. "It always felt like I was trying to catch up," she said. "I was always falling behind, and it was so stressful. And it was really hard to bring up my two girls, to be there for them, and still be able to practice medicine the way that I wanted to."
Now, she lives in a suburb of Raleigh, N.C. She still practices medicine, but has no office or clinic. Instead, she works with a Durham-based practice called Doctors Making House Calls.
Grumet puts her girls on the school bus and gets in the car just before nine. Her patients are frail elderly people with multiple chronic illnesses: memory loss, heart and blood pressure problems, arthritis that makes mobility difficult.
Grumet works full time, but on her own schedule. She can spend 15 minutes with a patient, or nearly two hours. She's home before the school bus and completes her patient notes and paperwork while her girls do homework. She makes $70,000 more than she did when she worked in the Bronx.
How is this possible? In a world where many doctors struggle to make money seeing four patients an hour, how can they run a successful practice driving to patients' homes and spending all the time their patients need?
Before 1950, nearly half of all doctors' visits in America were house calls. But then the country began building big hospitals and luxurious doctors' offices, and doctors acquired sophisticated equipment they couldn't put in a medical bag. Medicare and Medicaid reimbursement systems made home visits untenable.
But the house call is now a better idea than ever.
To cut America's health care costs, it helps to look at the most expensive patients. Medicare spends a third of its budget caring for chronically ill people in their last two years of life. This group is growing fast, and growth will accelerate; the first baby boomers are now turning 70.