Member of the Month: Aaron Segal, M.D.
“Family practice” holds extra meaning for Plano physician
Aaron Segal, M.D., is a family physician at Segal Family Medicine Center in Plano, Texas, where he practices with his father Irwin and wife Stephanie. He was awarded his medical degree by the University of Texas Medical School in San Antonio, and completed his family medicine residency at John Peter Smith Hospital in Fort Worth.
The tradition of “family practice” started 30 years ago when his father opened the practice as a solo practitioner. His mother managed the office. Once he and his wife joined on, the practice grew tremendously: they quadrupled the office space, fully implemented an electronic medical record, and grew the staff four-fold. “There were growing pains along the way, and I think we’ve handled them very well,” Segal says.
Originally interested in a technology-oriented career, it’s no surprise that Segal has been instrumental in the practice’s implementation of their EHR and remains the primary contact for all office health information technology needs including maintenance of the office network, servers, workstations, and database.
Tell us a little about yourself and your career. Despite growing up in the presence of my father, a highly respected family doctor, I really thought I’d become an engineer. At Texas A&M University, I studied Computer Science with every intent of a technology-oriented career. Rather fortuitously, one of my roommates invited me to spend an evening on the campus ambulance. That was one of those “life-changing” nights for me. To be honest, I’m not sure if it was more the blood and adrenalin, or the amazement of seeing one human literally rescue another from the brink of death, but the next day, I enrolled in paramedic school and joined the campus 911 service. I maintained the Computer Science degree, but headed toward medical school without ever looking back.
Why did you choose family medicine, and what’s your favorite aspect of it? My father never tried to influence my decision, but he has been a strong role model, and the thought of working alongside him definitely was a factor. I met David Schneider, M.D., about a month before starting medical school in San Antonio, and he mentored me through my four years in school. Dr. Schneider sent me to my first TAFP event soon after. Through my last two years of medical school, I wavered a lot about what I wanted to do. Like many family doctors, I enjoyed nearly all of the specialties I was exposed to. My wife and family patiently humored me when I waffled between family medicine, emergency medicine, family medicine, neurology, family medicine, ophthalmology, and so on.
In the end, though, my decision was made for the same reasons that I still love family medicine today: I wanted a long-term relationship with my patients and a broad skill set to deal with most of their problems on my own.
What’s the best thing about practicing with your family? There are plenty of attractions to a family practice. For starters, it makes the business and bookkeeping much simpler because we’re not territorial and we don’t “keep score.” If one of my patients wants to see Stephanie, or if one of my father’s patients decides to see me, it doesn’t matter.
The most obvious thrill is the multigenerational patient base. My father has patients who brought their newborns to him 30 years ago. Now Stephanie and I are taking care of their babies. Seeing these families grow within our practice is fun, and also a real testament to the reputation that my father has earned over his career. On the flip side, it’s still a bit weird when I’m taking care of one of his patients and they remember me as a little kid.
Each of us has areas of interest, and it’s not unusual that I’ll excuse myself from a room to “bounce this off my dad,” or that he’ll bring me or Stephanie in for a second opinion on an unusual case. I realize that this happens in any group practice, but I think our patients feel very comforted knowing that we are all a “Dr. Segal.”
The Segal name is our “brand,” and many of our new patients admit that they were drawn to our practice because we are all family.
If you could change one thing in your field or in health care as a whole, what would it be? The current reimbursement model is terrible. Not only does it undervalue the most important cognitive work that we do, and not only does it neglect all of the non-face-to-face services that we spend so much time on, but the system promotes overuse and wastefulness by rewarding costly procedures and tests which often add little to a clinical plan.
When a payment model disincentivizes physicians to practice evidence-based medicine, then the health care system is doomed at every level: patient, physician, public, and payer. Patients expect prescriptions and tests, and they often leave disappointed if we recommend a more conservative plan. To combat this, we must spend extra time counseling and educating.
But counseling doesn’t pay well, so it’s easy to understand why so many doctors and urgent care clinics just send everybody out with a steroid shot and an antibiotic. This not only compromises the patient, but also leads to drug resistance, a recognized threat to public health.
The current E&M codes don’t reflect a primary care thought process, and thus we don’t even have an adequate foundation to more accurately code and bill for what we really do every day. I wish we could code each problem individually — so a stable diabetic, with poorly controlled hypertension and an acute urinary tract infection would be reflected with three separate E&M codes. (Chronic stable, chronic unstable, and acute problem). The coding and reimbursement methods need to be redesigned — from the ground up.
How large of a role does HIT play in your practice? HIT is still in its infancy and I don’t think most of us do a great job of using these technologies to our benefit. Nevertheless, we fully implemented eClinicalWorks in the summer of 2005. All of my father’s paper charts were scanned in (over 140,000 pages), and we use computers extensively in our practice. The physicians all carry tablets, the assistants use notebooks, and there’s a desktop workstation for each front office staff. We host our own server, and I maintain the office network.
Our practice has evolved to better use these technologies. Patients all have access to a robust Web portal which allows real-time access to a personal health record including lab results, vaccine records, vital signs, and medical summaries. We use secure e-mail frequently to correspond with our patients. We use electronic prescribing whenever possible, and faxes are digitally integrated into the EMR. All of our imaging orders and referrals go through the iRefer system, and this has improved patient compliance and greatly reduced the labors and liabilities involved in getting our patients where we send them. Also, I’ve developed an office Intranet which includes clinical decision algorithms, references, and medical calculators, as well as coding flowcharts and other useful tools. Many of these tools integrate directly into our EMR so we can generate very customized reports with a single mouse click.
What one-sentence advice would you give a new family physician just starting out in private practice? “Do what’s best for your patient.” There will always be turf wars and payment issues, but I want to make sure we are always seen as the most ethical, compassionate, and responsible doctors around. Actually, I’ll revise the advice: “Do what’s best for your patient — and have fun doing it.”
It is important for me to be a member of AAFP and TAFP because: I know and trust that whether I’m serving on a commission, or even if I’ve never attended a TAFP meeting in my life, the Texas Academy of Family Physicians is working hard to protect my reputation, my career, and my profession. We have incredible leadership, both physician and non-physician. These people have a crystal ball, and they are many steps ahead of deflecting problems and preparing us for the ones that make it through. There are numerous benefits to TAFP/AAFP membership, from CME and camaraderie, to legislative policies. But the bottom line is that the TAFP is looking out for us in a way that nobody else ever will.
TAFP’s Member of the Month program highlights Texas family physicians in QuickInfo and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month, nominate the physician by sending his or her name, phone number, and e-mail address to firstname.lastname@example.org. View past Members of the Month here.