This position will be standard Primary Care with a good quality of life and the ability to build the type of practice they want. Ralph Castillo, CEO, had this to say; “It would be nice to have somebody who can come in and have a vision for what primary care should look like. I think this is a position that is still coming into a practice that is not fully established. Meaning it's got room for growth. And that is the expectation, to help it grow. We need a family medicine doctor that is well rounded and wants to practice a true full scope of modern medicine.”
Morgan Medical Center has a team consisting of 1 Full Time Family Medicine provider and 1 Full Time Family Nurse Practitioner. The basic schedule will be Monday – Friday, and the clinic is open from 8am – 5pm. The office has a full staff of nurses, PAs, and front office personnel. Currently, the patient panel is predominantly adults and Geriatrics, they we are looking to build out the Pediatrics component.
Dr. Pepper comes in Tuesdays and Thursdays at 10 am and then the rest of the time he's in by 8 am. The clinic usually sees patients up until about 3:45, sometimes 4:15, if they do addon’s for acute stuff. They will do quick add-ons at the end of the day, or just throughout the day, but generally the last new patient or established 30-minute patient is 3:45pm.
The Primary Care practice has a ton of opportunity and room for growth. We are looking for a provider that is forward thinking and wants to engage with patients and expand the practice. It’s very important for a provider to be accessible to patients and will go out to build a relationship with the community & physicians in the area. The organization is willing to get any new equipment necessary and willing to let them build a medical staff as they see fit. The hospital operates with Cerner EMR and has outstanding imaging equipment & labs in the office, so there is every tool necessary to build a practice. Specific areas the clinic is looking to expand into include:
Modern Medicine
Build a Pediatrics component.
In-office procedures
Injections
Biopsies
Vaccine Program
Preventive medicine
Women’s Health
Diabetes & Thyroid management
Hypertension and obesity
Weight loss
He continued; “I'm big on communication. So, I'm constantly talking to the providers, figuring out what we can do to grow things, what are our roadblocks, those kinds of things. So, it'll be nice to have somebody that can say, hey, this is how it's happening. And let's figure out how we make this work because this is something I've experienced and is something that you’ll want to do. That would be nice and very welcomed.”
The hospital and clinic are both set up to provide all the services listed above. Especially the in-office procedures, which would be easy as there is a procedure room, and the staff is comfortable with all procedures. The clinic also has plenty of exam rooms that could be turned anything another procedure room if needed.
Athens is the main referral center for the providers in Madison. It’s about 30 minutes north, so it’s an easy drive and they have all specialties of medicine. Most Cardiology, Gastroenterology, Oncology, Neurology and Psychiatric referrals will be directed up to Athens. High level acuity cases will be sent to Atlanta to the University Hospital. Covington is a city 30-minute west of Madison that has multiple Pediatricians, so some patients will choose to go there. The closest Childrens Hospital is CHOA, the Childrens Hospital of Atlanta.
Dr. Robert Pepper, a Family Medicine physician that has been with the practice since 2019 is retiring in May 2025. He came to Morgan Medical after spending 25-years practicing in Africa as a Missionary and is an incredible human in general. Dr. Pepper truly cares about the patients. He cares about the practice but since he is getting ready to retire, he's not trying to market himself in the community and grow the practice. We are looking for a provider to bring a fresh perspective to medicine and someone that wants to come in and build the program to increase not only the market share, but also the services being offered.
Right now, the clinic is not doing and in-office procedures, injections, biopsies, or vaccines. This dramatically limits the overall market share and has reduced the Pediatric volume to less than 10%. The entire Primary Care market in Madison is very experienced, so anyone with a fresh perspective that is up to date on the latest policies, techniques and literature would be able to build a practice very quickly.
In addition to the other limitations, Dr. Pepper does not really see kids. Danielle will see a few, mostly healthy kids above the age of 5 years old. The main reason for a limited Pediatrics population is the hospital does not offer vaccines, so parents take their kids to facilities in Athens that can do the vaccines and just keep going there for general care.
When I asked the CMO Dr. Rick Brewer about this he said, “Sick kids, we could do all day. We can give some shots to kids. We can do all that stuff all day. Danielle discussed immunizations recently, and we've had the literature on how we start that immunization program with the requirements for Medicaid and all that stuff. So, it's all things that we can do with no problem, we just need a physician to help start it.”
Dr. David Fletcher has his own practice, Madison Medical Associates, and has a team of 4 NPs and is very busy. Morgan Medical gets some rollovers from Fletcher's office, because he is booked out for months and is not accepting new patients. Dr. Fletcher sees patients of all ages, so a lot of families take their kids to him and have them for several years.
Dr. Walter Zant and 2 PAs operate in Madison and are another primary care provider not accepting new patients. He also sees kids and has a large Pediatrics patient panel.
Dr. Ron Boulware has two locations called Main Street Medical, but he’s more of an urgent care kind of Primary Care and doesn’t have a distinct patient panel.
Danielle and Dr. Pepper do call one month at a time, so each takes half the year, and it is anticipated this will remain the same for the incoming provider. There is an answering service that fields all the initial calls and filters the priority ones to the Primary Care team. Stephanie Lunt, the Primary Care clinic Director said this about call:
“Dr. Gallo and Danielle will get all the Women's Health calls so usually Danielle will just answer all the women's health stuff, unless we need to get Dr. Gallo involved. So, she does Women's Health pretty much all the time.
The good thing is there will be months when they're on call and they may only get one or two calls. They're not getting a ton of afterhours calls in general because they're screening those calls for people who want prescription refills, or you know what I mean? So, it's got to be something that kind of goes through that answering service to get to the provider and that’s rare.
And here, the clinical staff triage everything during the day, so rarely does the providers talk to the patients unless it is necessary for them to talk to them. We use the EMR to send messages back and forth to figure out what's going on and the clinical staff handles all that.”
The Primary Care team works Monday through Friday, 8am – 5pm. Both Dr. Pepper and Danielle see about 15 patients per day, though it probably fluctuates between 12 & 18, depending on the no-show rate, which is right at 14%. The clinic started charging this fiscal year for no shows because it was starting to affect overall production. The team is optimistic that it will help get it down to single digits.
The patient breakdown is about 90% Adults & Geriatrics, 10% is Pediatrics. They are doing little to no procedures, injections, and vaccines, if a provider has that skill set, the volume will increase steadily.
For the current Fiscal Year, July to February, Dr. Pepper has seen 2,810 patient visits, so about 300 a month. Danielle has seen 1,285 Family Medicine patient visits and 256 Women’s Health visits for the Fiscal Year. The team has seen 350 new patients so far this year, which is around 40 new patients a month.
For the Family Medicine department, they average 1.5 RVUs per clinic visit, and that’s without doing any procedures in the office. To produce the MGMA median RVUs, 5,516 Total RVUs, you would need 3,677 patient encounters per year which is 306 RVUs per month (204 Patient Encounters).
Stephanie told me this regarding her philosophy as the clinic manager; “I will do everything in my power to help them get there. I don't want to see them fail. I don't want anything in here to fail. We're going to hit goals. We're going to do all the things that we need to do to make sure we get there. And it's the same with the providers. I'm going to do everything in my power that I can do. But there's some things out of my power. I can't build relationships for them. I can't make them want to be involved if they don't want to be involved. So those are the things that are important for someone that wants to grow the business, because that's how it's going to work.”