Physician Practice Too Small for a PCMH? Think Again

Mambu was lucky in some respects. Having spent 22 years in a group practice environment, he despaired of ever being able to care for his patients with chronic conditions properly.

"My interest in chronic care began back in medical school," he says. "It's a very tough part of medicine and I never thought we did a great job with chronic care, even though it's been my career-long ambition."

But it was an ambition that lay dormant for years, as technology and payment incentives never encouraged the creation of a true patient-centered medical home. Even in a large health system, which bought the practice where Mambu spent 22 years. 

"I thought being part of a large health system would be a model to help patients get this type of coordinated care," he says, explaining the sale.

He complains that the health system wasn't interested in the medical home, only the profitability of the practice.

10 years ago, at the age of 52, he thought, "if I don't do it now, it'll never happen."

"It," was starting his own practice by hanging a shingle, putting an ad in the paper, hiring a scheduler and a nurse practitioner, and doing house calls. That happened in 2005.

He got involved with the American Academy of Family Physicians, which was planning a demonstration project on how to revamp primary care as a way to show the viability and value of the primary care physician in an era in which most young doctors were eschewing that career track in favor of specialization.