Best Practices: Manhattan Medical Partners
The gastroenterologist whose small practice provides intimate and advanced care
Ron Palmon is a rarity among New York physicians, picking up the telephone and leaving messages for his patients personally, even if the impetus of the call is simply delivering blood test results. Clearly, the approach — along with the excellent care his two-person practice delivers — is working, since the internet is crowded with glowing reviews of this popular gastroenterologist. Here, Dr. Palmon tells us about how running a small practice is like a marriage, and what types of books keep his patients happy in the waiting room.
We’ve heard of the slow food movement; everything I’ve read online indicates you are a proponent of the slow care movement. Tell me about that.
I’ve never practiced in a big group or a hospital or some of the most common settings that exist nowadays, where there is often a lot of bureaucracy or pressure to see or bill a certain amount. My partner and I have a small office, and every new patient on my schedule, even if they’re coming in for a very simple thing — a pre-colonoscopy visit, for example, which doesn’t take a lot of time — still gets 45 minutes. Existing patients are all scheduled for 30 minutes, too, meaning I’ll go a week sometimes and see as many patients as some doctors see in an afternoon. I partially credit my partner, Peter Chang, who was a few years ahead of me, with this approach. When I joined him, this was just the way he did things. There have been a couple of times over the last ten years when I was tempted to book more.
Ultimately, what it comes down to is how would I want to be treated if I were a patient.
On top of that, in this area on the UES, a lot of the patient population is savvy, and they have options and resources — the 10 minute visit is not what they’re looking for. I do think most doctors would like to spend more time with patients, but not everyone has the luxury of setting their own schedule the way private practice affords. I may make a little less money with half hour appointments, but I am happy about the care I’m giving people. In the long term, I think it only helps business, and cramming in a few extra patients doesn’t make me or them happy, anyway.
What sacrifices have you made in order to keep your practice small?
I call all my patients with their results myself — blood tests, biopsies, all of that. Sometimes I just want to go home at end of day, and I know many of those results could probably be communicated by someone other than a physician, but I like doing things this way, and I know that patients appreciate the opportunity to hear from me. That gesture helps to form a bond, and they actually get a chance to respond to me directly about the information and ask any questions they might have.
As for other hurdles to keeping a small practice as healthcare gets more regulated, how we administer certain procedures has had to change. For example, we used to perform procedures like endoscopies and colonoscopies in the office, but then New York State increased the regulatory requirements, and we had to be accredited by the same type of agencies that do this for hospitals. You could argue whether that’s actually necessary, but the result is that we no longer do those things here; we perform our procedures at a very nice center where there are 20 or so other doctors, which is a bit different of an experience for patients. We’re maintaining the same type of care, but that’s just an example of increased pressures that practices have experienced from a regulatory perspective.
What’s it like running a small business? Do they teach you about that in medical school?
They do not! Most physicians who are in medical school now will probably not ever be business owners, whereas 20 years ago the majority were. While it would be nice to see some sort of business training in the curriculum, things are getting so complicated that it’s beyond the scope of medical school. A lot of it is on-the-job learning. I joined an existing practice, so much of the administration was already in place; I didn’t have to hang a shingle up solo.
Unfortunately, I think physicians like me are going to become less and less common, other than in certain fields that can exist outside of the insurance system. Understandably, a lot of doctors just want to see patients, write up their cases, and go home; they don’t want to do double duty as an internet-savvy entrepreneur. For the longest time my partner and I didn’t even have a website — I look at some doctors websites and they look like something that was written for search engines. And there’s a logic there because I will say that, increasingly, my referrals are coming from people who have found me online.
Also, having a practice with one other person is like being married! One of the things that leads to the most job satisfaction for me is the fact that I have a partner whom I truly trust. I really think we complement each other; with regard to the business aspect of things, he’s very detail-oriented and good at things like balancing books, so I don’t have to worry about those. He has certain strengths that I don’t have, and I think I bring things to the table as well. We do make all of our decisions about practice together — staff, new methodologies, medications, moving our procedures to a center. It’s very much a true partnership.
Are there any technologies that help power or build your practice?
Because we’re a small practice, I still use the phone over email, but that’s a decision based not on the value of the technology itself, but on how we want to communicate. Overall, our field is very involved in technology, and we really embrace it. There are minimally invasive procedures done through a scope, for example, and a new type of colonoscope with three lenses that can see around the corners of a colon. I also perform capsule endoscopy, which is a pill with a camera on it. I’m amazed by it, even after having done it for ten years. On the practice management side, we do have online appointments that patients can book themselves, and services such as Capsule, too. I’m always interested in trying to improve the experience for patients.
Vital Signs
Favorite patient amenity: The children’s books that my partner put in the waiting room. The Gas We Pass is what’s sitting in front of me right now.
Way you keep relaxed in the workday: We have a pretty stable group of staff — we have a lot of fun just hanging out together. Everyone’s jumping in and out of my office all the time.
One recommendation to New Yorkers for general GI health: Try not to waste your money on some of these things that I see people come in after having done — juice cleanses or colonics or things that have no actual science behind them. Does it actually sound healthy to you have cayenne pepper and honey for five days?
Favorite or most satisfying procedure to perform: I only perform a limited range of procedures, and do a lot of colon cancer prevention. What that entails is a colonoscopy to remove polyps — we find them 25% of the time, including in some young patients. That’s particularly rewarding because there are very few cancers that can be prevented. We’re taking healthy people and keeping them healthy.
Learn more about Dr. Ron Palmon and his practice here!
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