UO > Feature > Make it Happen

By ten in the morning, it was already sweltering outside when Thomas Devlin (not his real name) was wheeled into Sherif Osman’s medical practice in late July. The sixty-two-year-old white male had undergone coronary artery bypass and graft surgery six months prior to his first visit to Dr. Osman’s Bel Air, Maryland, office.

Devlin’s cardiologist had referred him to Osman for non-healing leg wounds at his venous graft site. Overweight and suffering from diabetes and congestive heart failure, Devlin presented with significant generalized edema. The infected, open sores at Devlin’s venous graft sites oozed pus, and he ran a low-grade fever.

Devlin’s cardiologist had tried multiple antibiotics, both intravenous and oral, as well as topical antibiotic creams and ointments in his attempts to heal Devlin’s wounds. When his best efforts failed, he turned his patient over to Osman, the “go-to” wound-care specialist in Harford County, Maryland.

Wound care was not always Osman’s specialty. After a residency in internal medicine, Osman developed a successful general medical practice, eventually growing it to three full-time physicians, four nurses, and two technicians over a 15-year period. But the pleasure he gets from constantly challenging his medical skills gradually led him to appreciate the unique issues involved in wound care.

“I discovered that I really liked wound care,” Osman says. “It had a bit of medicine, a bit of surgery. It was a new field at that time, and it’s one where new technology is emerging constantly. I started to go to wound-care conferences. The more I learned about it the more interesting it became. Eventually I started a wound-care center within my practice and hired a couple of wound-care nurses.”

Osman’s efforts led to increasing success caring for his patients’ wounds, and referrals began to pour in. By 2004, Osman had developed a larger vision for his practice and his patients. He would create a self-standing wound-care facility dedicated to state-of-the-art treatments, essentially reinventing his chosen profession.

As he explored the logistics of a stand-alone wound-care facility, Osman was approached by the regional hospital about jointly developing a wound-care center. As a former president of the medical staff for the hospital, Osman was already well respected for his medical skills, smoothing the negotiations process. Each side quickly determined that there were enough wins to make the partnership viable. Osman would be able to lower his overhead and increase his marketing budget by virtue of the hospital’s involvement. The hospital would gain critically needed fees and would also expand its patient pool.

Over the ensuing months, each side drafted a vision of what the center would be like. Finally, in the summer of 2005, the hospital began the build-out of a 1,150 square-foot wound-care facility within its walls, with Osman as its director. For Osman, now 47, it is a dream come true and a picture-perfect model of how physicians can create new opportunities for themselves that are both satisfying and rewarding.

Diverging paths

While the manner in which Osman seized the day is hardly unique in American medicine, it occurs more often today than it did in the past, according to those in the health-care industry. A generation ago, a physician could count on a long and lucrative practice in his community simply by doing what he was trained to do. However, the evolution over the past 20 years of the American health-care system to its current mega-business model has changed that quaint view. Newly-minted physicians face hurdles in earning a fair living that would have been inconceivable to previous generations of doctors. That, plus the frenetic pace of medicine today, the burdensome paperwork, and the ever-present legal dangers, have made many physicians question whether they want to ride what they perceive to be a runaway train.

From hospital administrators to physician recruiters, medical lore today is rich with stories of physicians giving up lucrative practices to sail around the world or of moving out of profitable urban practices to serve rural communities in idyllic settings that allow them to have more time with their families or to enjoy leisure pursuits.

Michael Duffy, MD, is one of those physicians. Now 35 years old, Duffy made lifestyle and service his key priorities in deliberately and proactively choosing a medical practice. After growing up in Boston, Duffy was lured by the rugged western lifestyle he experienced during his college travels and knew he wanted to practice near the mountains and be able to pursue the outdoor activities he loves. He chose a family practice residency in Casper, Wyoming for the range of skills it taught but also for its immediate proximity to fly fishing, bicycling, camping, and canoeing.

“Those three years in Casper were my best ever,” Duffy says. “The program had everything I wanted, including lots of obstetrics, which I knew I’d eventually need to be able to practice in the rural areas I wanted to live in. After residency, I wanted to stay as close to Wyoming as possible. The outdoors and open space is so valued in this part of the country. The priority everyone attaches to the outdoors is something I respect.”

But location was only one of Duffy’s requirements. Ever since he was a child he has wanted to serve a disadvantaged population, one where his skills would literally be life-saving. That opportunity appeared when he was offered a position in Twin Falls, Idaho, in a community health center, providing services primarily to migrant Hispanics who labor in the region’s agricultural industry. Twin Falls is a federally-designated health professional shortage area and since Duffy received his medical training under a National Health Service Corps scholarship, the choice of Twin Falls also repaid his service requirement.

Duffy’s community health center is involved in an innovative partnership with the internationally renowned Children’s Health Fund (CHF), founded in 1987 in New York City by Dr. Irwin Redlener and Paul Simon, the singer-songwriter. CHF provided the community health center, one of its 17 sites nationwide, with a fully equipped medical van, complete with both medical and dental examination rooms, along with continuing training for Duffy.

“I love working with CHF,” Duffy says. “They’re an advocacy group that is actively trying to change policy, so no child in this country goes without excellent health care. They are respected in Washington. I feel like we are trying to get to a better place through constructive change rather than just trying to temporarily fill a gap.”

Like most physicians who have created their own opportunities, Duffy was able to prioritize clearly what was most important to him, and not just professionally. He candidly assessed his entire lifestyle. “For me, priority number one is my love of the outdoors. That’s what drew me west to begin with. My next priority is caring for underserved populations. That’s my kind of medicine. That turned me toward a community health center and The Children’s Health Fund.”