A family practitioner who sees two patients an hour finds herself struggling to make ends meet.
By KRIS HUNDLEY
Published March 11, 2004
Dr. Gigi Lefebvre, a solo family doctor in St. Petersburg, decided in January that her life had to change.
After 14 years of running a busy practice with devoted patients, she found herself unable to pay her office rent. Despite having $90,000 in accounts receivable, Lefebvre, 44, faced the prospect of having to get a bank loan to keep her practice going.
"That does not do a whole lot for your ego," she said. "I feel like the nice guy who finishes last."
So Lefebvre (pronounced Le-feb) sat down and wrote an alternately anguished and angry letter to her 1,100 patients, telling them it was time to ante up. In February, her office started charging $20 for phone consultations and $10 for ordering drug refills by phone.
"I recently calculated my hourly pay at about $23 per hour," wrote the doctor, who said she routinely works 15-hour days yet has no savings. "I am at a crossroads and the options are few. I have enjoyed providing care for all of you, but at this point, I must also begin to take better care of myself and my staff."
Caryn Caldwell, executive director of the Pinellas County Medical Society, said it is not unusual for doctors to charge for administrative work that takes away from patient time.
"Physicians will get overwhelmed as they get more requests, say, for filling out forms," she said, adding that she has heard few patient complaints about such fees. "They need to make up for low reimbursements."
Lefebvre, who graduated from Louisiana State University Medical School and did her residency at Bayfront Medical Center, has never run a traditional practice.
From the day she opened her office a stone's throw from Bayfront, she has refused to deal with HMOs, limiting her practice to Medicare, private pay and a few insurance plans.
She books only two exams an hour, spending a full half-hour with patients, who know her as Gigi. And if one of her patients is hospitalized, Lefebvre is at the bedside at least once a day.
"You'll see her in the hospital at 10, 11 p.m., always visiting the patient, not just looking at the chart," said Carole Crane, a registered nurse at Bayfront who has been a patient of Lefebvre's for a dozen years. "I chose Gigi because of the way she treats her patients: She listens. But now because of insurance, it's all about the numbers. And Gigi's hurting because she doesn't do it that way."
Chris Almvig, director of health care services for St. Petersburg's Free Clinic, knows Lefebvre from the doctor's years of volunteering one evening monthly with the nonprofit group. And as a former employee of Blue Cross and Blue Shield, she understands that insurers want doctors to see an ever-increasing number of patients.
"Dr. Lefebvre insists on caring for patients in a holistic kind of way, but that takes time," Almvig said. "She's an extraordinary physician who's trying to find a way to practice medicine without compromising her principles."
Lefebvre makes no apologies for her recent letter, which she said resulted in several letters of support and one call from a man who said he no longer wanted to be her patient.
"I don't care," she said with characteristic candor. "He can go somewhere else."
One month after the new fee policy went into effect, Lefebvre said patients have responded by becoming more responsible and thoughtful in their dealings with her office, which includes two full-time assistants and a part-time billing person.
"People are now bringing their medicines in when they have an appointment and getting refills then," she said. "And we're getting fewer phone calls, which makes our days a lot more manageable. In fact, I haven't charged a person yet. People know I'm fair."
George Richardson, a 61-year-old public health adviser for the Centers for Disease Control in Pinellas County, has seen plenty of physicians in action. He has been a patient of Lefebvre's for more than 10 years.
"I wasn't bothered at all by her letter," he said. "She's such a patient-friendly doctor that she's allowed people to take advantage of her. She's just trying to set things straight."
Bonnie Robarts-Gay is one of those patients who thinks she might have asked too much of Lefebvre.
"I wrote her an apology after getting that letter," the 58-year-old St. Petersburg resident said. "She's kept me alive for seven years, giving me drug samples when I couldn't afford (the drugs). I don't have another confidante like her."
Allison Butler, a St. Petersburg pharmacist and Lefebvre patient, said she understands the doctor's frustration.
"We're in big trouble as a society," Butler said. "Insurance reimbursements are so low, most doctors run patients in and out in two minutes and never put their hands on you. We need more people like Gigi, and I'm afraid we're going to lose her."
Lefebvre, who is single and lives in a partially renovated house with paper on the windows, is considering other options.
The drug reps who visit her office work fewer hours and make more money than she does. "The most money I ever made was $119,000 seven years ago," said Lefebvre, who has seen her malpractice coverage jump to $11,000 from $4,000 over the past decade despite having no claims. "Most general practitioners make $120,000 to $130,000 a year."
In her limited free time, Lefebvre and a neighbor who is an engineer have designed, patented and manufactured a stethoscope holder that clips onto a belt. She's now selling it through a promotional items company and hopes drug companies or medical schools will show some interest.
"We've sold about 6,000," she said of the horseshoe-shaped device called Scope-ster. "But we've given away as many as we've sold."
While she waits to hit gold on her invention, Lefebvre is also considering phasing in a concierge-type practice. Under this model, she would charge patients a flat fee for unlimited visits. Though typically viewed as a health care model only for the wealthy, it's a service Lefebvre thinks even lower income patients could afford.
"You could pay me $80 or so a month and walk around with a primary care doctor in your back pocket," she said. "And there would be no bills."
Lefebvre, who dresses for the office in jeans, sweatshirt and sneakers, wants to return to the days when she had some free time to play softball. She wants to get enough rest so she can resist colds, like one that has plagued her this winter.
Lefebvre finds it ironic that she has received numerous awards for her work and is so busy she only occasionally accepts new patients.
"When you're a good doc, and you try hard, this system doesn't reward you," she said. "But I cannot see six patients an hour. I will not participate in that system."
