Dr. Barry Smith, 43, is president-elect of the District of Columbia chapter of the American Academy of Family Physicians. He practices in Greater Southeast Community Hospital's medical office building.
I'll tell you how I got to medical school. I studied biology at Virginia Union University in Richmond. Then I had various jobs, including detail man -- salesman to doctors -- for a pharmaceutical firm. I was sitting in a doctor's office, talking about his lab work, and he said, "You're in the wrong occupation. You ought to go to medical school."
I talked it over with my wife -- a schoolteacher -- and she was willing to help me with the expenses. So we made that bold step. I was accepted by several medical schools, but I chose Howard.
Family practice is a patient-oriented as opposed to disease-oriented specialty. One has to get to know the patient, the family, not just the disease process. I think of a lady in her late forties who came in with some medical problems -- diabetes, hypertension, overweight. I realized she was suffering from some heavy underlying emotional problems -- family problems. She wasn't complying with her treatment and couldn't get better unless these things got better.
I said I wanted to talk to her husband, too. Eventually her husband and children came in and became part of my practice. Her hypertension began to come under control, she began to lose weight, her diabetes became better controlled. The family is still together.
Do I fear all the new competition between doctors and health plans? No. My practice has grown by leaps and bounds since I started in this office in 1980. I see 15 to 20 patients a day, from pediatric to geriatric. I usually have several more in the hospital. I get patients from Maryland, the District and Virginia, too. My main source of patients is other patients, satisfied patients. I thank the Lord for what's happened.
About 18 percent of my patients are Medicare, and I am bothered by the Medicare freeze on my fees. For example, Medicare now pays about $27 for an office visit. My usual fee, not including tests, is $35. Also, 10 or 12 percent of my patients are Medicaid. D.C. Medicaid pays only about a third of my usual charge.
I spend much of my time with these patients, but what worries me is that with reimbursement constantly being attacked, some services might have to be curtailed. My costs keep going up, but if there is further reduction in fees, can I continue to offer the level of service I want to offer? I sit on committees at the hospital -- utilization and quality assurance -- and I give time to the American Cancer Society. We had a campaign last year that said, "If you're black and live in D.C., you're a high cancer risk. Get a checkup." We were criticized for singling out blacks. But the facts and figures show that blacks are at higher risk. I think the campaign did some good. People began to ask, "What can I do to reduce my risk?"
Am I doing what I'd like to do? Am I satisfied? Yes and no. I like doing what I do. It is rewarding -- personally, financially, even socially.
The part that's one of the biggest "no's" is that I'm so busy I don't have enough time for my family, my wife and my two daughters. I didn't think that would ever happen.