by Monica Parker Willis mory Healthcare seeks to provide comprehensive health care for all patients in a manner consistent with our reputation for the highest quality. Meeting that objective has never been harder, as anyone who works in our system or in health care in general well knows. To maintain financial viability, we have to do more for less while increasing the volume of patients and services. To those ends, Emory has expanded into the community. We have discovered a competitive market with many high-quality providers - a market where patients' choice of provider often boils down to service, characterized by accessibility, courtesy, and professional respect. While we physicians try to adapt to external changes in health care, we need to look internally as well - to examine our own relationships with each other and how they affect our patients and our reputation. Primary care physicians (PCPs) at Emory health centers serve as gatekeepers within the system. We are expected to direct the care of our patients by judicious use of laboratory and radiologic services and appropriate referrals to subspecialists. However, within the Emory system, the primary care/subspecialist relationship frequently flounders. PCPs within the system have difficulty obtaining appointments with subspecialists or even an opportunity to discuss a patient who may not need a referral. First consultations are sometimes delayed for weeks, phone calls for follow-up are unheeded, discharge summaries from hospitalizations are not sent routinely. This breakdown in service could have serious ramifications for every Emory clinician, regardless of discipline. In metro Atlanta, plenty of hospitals and physicians outside the Emory system do respond quickly to patients, whether they live within a short distance of Emory and Crawford Long hospitals or in the exurbs. In Fayetteville, Social Circle, Cobb and Gwinnett counties, Emory's reputation for excellence is an impetus for patients to drive into the city where they expect exemplary service. They do not always receive it. When they have a negative experience within our subspecialty system, local care seems much more attractive. The solution might be as simple - or as complex - as an attitude adjustment. Just as Emory broke from tradition several years ago by launching health centers off campus to broaden its share of the patient market, perhaps it is time that we recognize that the Emory name, while synonymous with the highest quality, does not constitute an entitlement. Many physicians in the Emory system - myself included - did not build The Emory Clinic's reputation but benefit greatly from their Emory association. By dint of training and credentials, we are qualified to carry on the Emory mission. However, ability and degrees are not enough. Despite the fact that newly minted primary care and subspecialty physicians have not yet established a patient following or professional reputation here, many seem to want to pick and choose patients and tasks, sometimes at the expense of service. Does an Emory affiliation mean that an Emory physician only needs to be present when the clinic opens, review a schedule with names that magically appear, see a few patients, and leave at 5 pm? This is not the case outside Emory, where building a practice depends on accessible and courteous service to patients, collaboration with referring physicians, and involvement in community. Treating illness does not work on a schedule of convenience. Building a practice requires time, effort, and referrals from persons familiar with you. It requires timely collaboration and follow-up at all levels. Yes, it helps the patient and our system to respond to a colleague asking for your help. If you cannot do it, someone outside this system will. Many experienced primary care physicians came to Emory Healthcare from successful practices. These physicians have valuable knowledge to share with both primary care and Emory Healthcare administrators that will help Emory capture the market in their communities.

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Unfortunately, their expertise is underutilized. Many Emory primary care physicians have expended considerable effort to promote Emory, maintain revenue, and increase patient volume. They have built practices by being available at health fairs, consulting with businesses, conducting sports fitness assessments, speaking to groups, and making their faces and names known throughout the communities in which they work. Those efforts need to be acknowledged and supported. To maintain and build Emory's position in the community and increase revenues, the team concept must be practiced by all. Physicians and administrators must mutually respect each other and our patients. Our clinics are not "numbers" factories. Real people work there, and real people entrust us with their lives. Physicians must communicate with each other about the best way to treat without overutilizing resources. We must be accessible to each other. Emory administrators need to visit our different sites to help staffers feel a part of the system and praise their work. A positive note will promote a sense of corporate community, a feeling that "my job is important." We are all privileged to be a part of the world that is Emory, but are we committed to maintaining what we have inherited? Primary care physician Monica Willis Parker is medical director of The Emory Clinic at Social Circle.