While the sites have generally served upscale gentrified neighborhoods, the practice has recently expanded to less affluent areas and accepts Medicaid. Dr. Cohen’s dream is to expand his network nationally as a nonprofit in which low-income sites would be subsidized by the more profitable offices. A previous attempt at expansion with two offices in Southern California did not work out because the time zone difference didn’t mesh well with the Internet portal.
Wanting to hear a firsthand account from a family on how the Tribeca Pediatric system works, I contacted a neighbor who has recently moved his young family here to Brunswick. His impression was generally positive. He gave high marks to the patient portal for the ability to get school and camp forms and vaccination records quickly. Appointments made electronically was a plus, although the after-hours response time sometimes took an hour or two. He would have preferred to see their assigned provider for a higher percentage of visits, but this seems to be a common complaint even in systems with the greatest availability. Care was dispensed efficiently but didn’t seem to be overly rushed.
In the NY Times article there is one complaint by a former provider who felt she was getting burned out by the system and leaned on 10 minutes for sick visits and 20 minutes for well visits. Personally, I don’t see this as a problem. The length of a visit and the quality of the care are not always related. Given good support services and an efficiently run office, those slot guidelines seem very reasonable, realizing that a skilled clinician must have already learned to adjust his or her pace to the realities of the patient mix. However, as the pediatric sick population has leaned more toward behavioral and mental health problems, a primary care practice should be offering some option for these patients either in-house or with reliable referral relationships. Although the NY Times article doesn’t provide any numbers, it does mention that the providers are generally young and there is some turnover, possibly as providers use the practice as a “stepping stone.”
To some extent Dr. Cohen’s success seems to be the result of his real estate acumen and business sense. Because the majority of recent medical school graduates enter the work force with a substantial debt, it is difficult to imagine that a young physician would have Dr. Cohen’s entrepreneurial passion. However, clearly his success, at least in the short term, demonstrates that there is a substantial percentage of both patients and providers who prefer small personalized offices if given the option. It will be interesting to see if and how Tribeca Pediatrics expands and whether any of the larger existing networks attempt to imitate it.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at pdnews@mdedge.com.