Longtime Spokane physician operates independently

Dr. Jeffrey O’Connor has a broad perspective of the medical profession, having worked in public health before launching his own practice and later joining Providence Health Care.

Although still associated with Providence, O’Connor left the region’s largest hospital last year to open a solo office in North Spokane.

During a recent interview, O’Connor offered his insights about the business of medicine, the hotly debated Patient Protection and Affordable Care Act, and the challenges facing America’s health-care system.

S-R: When did you first aspire to a medical career?

O’Connor: As far back as I can remember.

S-R: Did you have a mentor?

O’Connor: I can’t think of one, other than my parents and the way they approached life. We talked about a lot of stuff at dinner. They always encouraged me to do the best job I could.

S-R: You’re a primary-care physician. Is that a specialty?

O’Connor: No, it’s a general grouping: family practice, which is what I do; geriatrics; internal medicine; gynecology; and some pediatrics.

S-R: How much education did you need to become board certified?

O’Connor: The standard medical school, then a three-year family residency. So seven years out of college.

S-R: How much did medical school cost?

O’Connor: It was cheap back in the ‘70s – about $1,500 a year.

S-R: What does that education cost now?

O’Connor: My older daughter went to the University of Washington – she’s been out a couple of years – and four years cost $90,000. That’s a bargain for medical school tuition today.

S-R: How many employees do you have?

O’Connor: Eight. One PA (physician assistant) and three medical assistants. The other four do administrative work, billing and scheduling.

S-R: Is that pyramid hierarchy typical of a small private practice?

O’Connor: It’s becoming that way in primary care because of the administrative overhead we have to deal with. When I started my first practice in 1983, I had two employees, one of which is still with me.

S-R: What did it take to open your own practice?

O’Connor: In ‘83, I was able to put out my shingle, go to the bank and get a startup loan for about $75,000, which took us a couple of years to pay off. It was a lot more complicated in 2011 – a lot more employees and four times as much money.

S-R: Did medical school teach you anything about running a business?

O’Connor: We had one class on how to run an office. I think the AMA (American Medical Association) put it on. It was one day, maybe two.

S-R: What business mistakes have you made?

O’Connor: A lot of them. There’s a tendency to spend more on stuff than you need to – to say I want this toy or I want to try this. The rule of thumb I go by now is that if my manager thinks it’s OK and my wife thinks it’s OK, it’s probably OK.

S-R: Why did you decide to join Providence in 2007?

O’Connor: I saw some opportunities to use the things I had learned over the years to develop an effective medical group.

S-R: Why did you leave?

O’Connor: I’m not a corporate guy.

S-R: What’s your typical work day?

O’Connor: I usually start around 7 a.m. I make sure I get paperwork from the previous day done before I see my first patient. I’m here five days a week, and typically see 20 to 25 patients a day, the last one around 6.

S-R: Who covers when you want to get away?

O’Connor: My PA stays here, and I share calls with the Providence medical group. And there’s urgent care they can be referred to.

S-R: Has the recession affected your practice?

O’Connor: Yes. I was with Providence during the worst of it. Starting a business in the middle of a recession was a lot of work. And patients’ lack of insurance is a big deal.

S-R: Who are your customers?

O’Connor: I have a lot of Medicare patients – I’m board-certified in geriatrics. And a lot of North Side families.

S-R: What do you like most about your job?

O’Connor: Every day is intellectually challenging. I learn stuff all the time. I like my staff, and I enjoy helping people. It’s really fun when someone comes in with a concern or they’re suffering, and I’m able to say, “I think we can do something about that.”

S-R: What do you like least?

O’Connor: Bureaucracy. It’s destroying the system. The ability to help patients is being undermined by the administrative overload.

S-R: How much of your week is devoted to helping patients vs. being a businessman?

O’Connor: There’s a lot of overlap, because if I take good care of people, that helps my business. On the other hand, I have to tend to the dollar or I won’t have a place for patients to come. For me, that (attention to business) typically occurs before the first patient arrives in the morning and after I’ve seen my last patient of the day. But I have more important things to do than fill out forms.

S-R: Do you have an opinion about the Affordable Care Act?

O’Connor: I was relieved when it was ruled constitutional. I have misgivings about it, because the same entity that brought us a lot of bureaucracy is going to bring us even more. On the other hand, I’ve had patients suffer irreparable harm because they didn’t have insurance and wouldn’t come into the office.

S-R: What’s the solution?

O’Connor: We’ve started a direct-care program where patients can pay $49 a month, and everything we do is covered under that flat fee.

S-R: What is not covered by their $49?

O’Connor: Anything outside these doors. Medications, certain tests, emergency room visits and hospitalization are not covered. My hope is that the Affordable Care Act will eliminate the need for this, but people still need to be seen between now and then.

S-R: What’s working in today’s health-care system, and what isn’t?

O’Connor: The science of health care is working. I do stuff every day that we never came close to doing 25 years ago. But the cost and the bureaucracy undermine our ability to do those things.

S-R: What do patients want from their family physician?

O’Connor: They want health. They want someone to listen to them. They want answers. They want a personal connection.

S-R: Can you offer that to 2,500 patients?

O’Connor: We work very hard at it. And fortunately, most of those 2,500 aren’t sick.

S-R: Is there a busiest time of year?

O’Connor: Yes. Once school starts, kids get sick and bringing it home. Usually October through March or April is the busiest time, and July and August tend to be quietest. People who are sick at the lake just live with it. They don’t want to come into town.

S-R: What advice would you offer someone considering a medical career?

O’Connor: It all depends on your expectations. If you want a career where you’re never bored, always challenged, it’s a good place to be.

S-R: Who’s your competition?

O’Connor: Basically, me. I try to do a better job each day, and drive my staff nuts sometimes thinking of new ways to do things.

S-R: How do you relax?

O’Connor: By reading about medicine. I also like being with my wife and getting away from time to time. And I take piano lessons.

S-R: Any favorite client reactions?

O’Connor: During one examination, an elderly patient said, “Thank you,” and I said, “What for?” She said, “My mom died from high blood pressure when she was 25 years younger than I am now. You took care of me and gave me 25 extra years. Thank you.”