From the Front Lines – Primary Care

Today Kate from PredictionHealth is chatting with Drs. Aspen Calkins and Scott Marquard, family medicine physicians at Thunderbird Family Medicine in Glendale Arizona to hear their insights on the current state of medical practice.

Kate: Thanks so much for taking the time to answer some questions with us. We really look forward to learning from you and sharing your thoughts with our community.


To get started, I’m really curious about what has changed in your medical practice over the past 5 years?

Dr. M: We have expanded from 1 to 4 providers in the last 5 years and we’ve changed EMRs from Caretracker to Athenahealth. Also, we now use PredictionHealth (PH) daily for our clinic documentation. It was actually PH that allowed us to hire physician assistants. Having PredictionHealth create all of our notes has been huge because without the burden of documentation hanging over me, I can take extra time to teach our PAs. I can teach them like I would residents.

Over the past year we’ve also been doing a lot more telehealth because of COVID. We’ve found that [telehealth technology] hasn’t been hard for our staff, but it has been difficult getting some of our patient base to adapt to [telehealth]. 

Dr. C: We bought and fully renovated a building and moved in the same month we switched EMRs (!!!) And, five years ago exactly, Scott was seeing many patients daily to keep the new business afloat and that meant struggling with charting to keep up. PredictionHealth has changed our time in and outside of the clinic. In the clinic we are more efficient, able to see more patients, and able to deal with more issues with each patient. Outside of the clinic we spend so much less time charting but still end up with highly detailed, accurate, and comprehensive notes. 

How about COVID-19? What has the pandemic changed about your practice? 

Dr. M: The pandemic has completely changed the way we provide care, but also has allowed us to reach more people who find it difficult to make it into the office for an in-person evaluation, all due to telehealth. And, the fact that I can use PredictionHealth with telehealth changes things dramatically. I can just press play, talk to the patient and actually still listen.

Dr. C: Obviously through telehealth our practice has changed drastically, but overall I think being able to do telehealth and even regular telephone visit calls (which used to be untenable due to lack of reimbursement) has expanded our reach and allowed us to give better, more timely, more accessible care to our patients.

Hopefully after the pandemic has eased up, we will have more time to focus on improving healthcare in the US, but how do you see the medical profession changing (for better or worse) in the next 10 years?

Dr. M:  Programs like Medicare and Medicaid want us to do lots of quality measures, which are very good, but sometimes can be frustrating. In the long run, it’s good to have a system to keep clinicians accountable, but it is a lot of work to make sure you’re doing certain things in order to not lose your revenue.

I think telehealth is going to become an even bigger part of regular medical care. I think a lot of patient education could be done with telehealth. We don’t take enough time to do this right now, and telehealth gives us a good opportunity to do more.

One approach we may see more of (that would also curb burnout) would be using mid-level help to take a team approach (PAs, etc.) This is what we’ve done, our patients have accepted it, and bringing on other providers has helped tremendously

Dr. C: I think care will become more value-based and metric driven, moving towards a capitation payment type system. This, in combination with the declining health of the US population, poor education, and decreased trust in healthcare providers may put medical professionals and patients in a difficult situation. 

What’s one message you wish you could get across to all of your patients?

Dr. M: We as individuals have a big part to play in staying healthy, but we just lack motivation a lot of the time. If patients could focus more on eating well and moderate exercise they wouldn’t have to see me as much. Obesity is one of the biggest things I talk to people on a daily basis. Food itself can be an addiction, and we sometimes have to treat it as such.

I would also love for patients to understand more about how much goes into their care behind the scenes (creating referrals, making sure we send in the right meds, making sure we have the right medical history). There is such a huge amount of work behind the scenes that doesn’t provide any revenue. The only thing that creates revenue is seeing patients, but there is an entire support staff that goes unnoticed. 

Dr. C: We went to school for almost our entire young adult lives. We have dedicated ourselves to lifelong learning, the study of medicine, review of evidence, and making sure we are giving the best care possible. Please please believe and trust what we say. 

We would never prescribe a drug just because a pharmaceutical company told us to do so.

At first visits with patients who verbalize they don't trust medical providers I try to reassure them that I wont tell them to do anything (take a medication, get a test, undergo a procedure) unless there is strong evidence that it will benefit them in a clinically significant way. I want patients to understand that my job is to prevent diseases with simple and reasonable screenings and interventions, but sometimes patients think we recommend things for no particular reason. 

You mentioned that people would be surprised how much work goes on in the background of your clinic. How many people does it take to run your medical practice?

• 15 total
• 4 providers (2 physicians and 2 PAs)
• 4 front office staff (handle referrals, do scheduling, give call backs, order diagnostics)
• 3 back office (medical assistants who get histories, take vitals, etc.)
• Biller 
• Office manager
• Medical records person
• Quality measures coordinator

We estimate that PredictionHealth helps primary care providers gain an extra two to three hours per day because of less documentation. How are you spending the extra hours?

Dr. M: As a business owner, using PredictionHealth has freed up more time to look into other revenue streams and focus on clinic expansion (adding more providers, taking more of a managerial role looking at revenue, becoming more efficient in front office/back office, etc.). This has been especially helpful during the pandemic when other clinics may be struggling.

In terms of personal time, I used to spend Saturdays and Sundays doing my charting. Now I can play golf again! I’m also working out again, too. Two years ago I was maybe doing once a week, now it’s more like 4-5 times a week.

Dr. C: Evenings and weekends are no longer dominated by charting, and like Scott, I used to only work out a few times a week, but now I work out consistently. I’m also cooking more, rather than always getting takeout, I’m gardening, and just in general living a more well-rounded life. 

Kate: Thank you so much for taking the time out of your busy schedules to give us a peek into private practice. I think this will be really informative for a lot of people and relatable for our future customers. Next time, we'll dive into what it's like running a clinic as a married team! 

We’ll be catching up with more clinicians in the future. To keep up with the latests,  subscribe to the blog below. 

Get in touch with us to learn more about using PredictionHealth in your clinic. We’d love to hear from you.