From Banking to Family Medicine

It was in an exam room with his wife that Jeffrey Geier’s life would change. It wasn’t the fact that he and his wife were expecting babies four and five (twins)—rather, it was during a conversation with the physician that the community bank president and CEO would learn of the opportunity to run a medical practice.

The practice needed a medical manager, not necessarily someone from the medical world, but someone who understood management and finance. Armed with an economics degree, banking background, and his own experience as a consumer of medicine, he took the challenge to manage his first medical group. Fourteen years later, Geier is administrator of Moscow Family Medicine, which serves a variety of patient needs at four facilities.

Upon entering medicine, Geier was most surprised by the complexity of managing a medical group. Accomplishing organizational goals in the medical world requires more teamwork than in the banking world. He says, “In medicine, every customer walking in the door is a unique individual with unique needs, wanting different things. It takes a lot more people moving in the same direction to meet those needs.” And getting those people—a diverse range of employees from the highly trained and scientifically educated to the first-job workers—moving in the same
direction is a challenge Geier relishes.

What makes it more challenging is the wide mix of patients they serve at their four locations. Although Moscow is a modest-sized town, its catchment area includes a varied population of 250,000. Farming, logging, and ranching are common vocations for many of their clients—and they have a desire for traditional family medicine. At the Main Street and West Side Clinics, their longtime patients expect to see the same physician they’ve come to trust and think of as their own, and they want this physician to care for their whole family. Moscow is the kind of setting where “we run into our patients all the time outside the clinic—at the store, out on Main Street. Our kids go to school with their kids.

Many of our patients appreciate and have come to expect a friendlier relationship with their doctor.” In contrast, their QuickCARE Walk-In Clinic serves more emergent patient needs, promising through extended hours “the kind of care you need, when you need it.” Those patients want to see anyone who can help them and are not attached to seeing a specific doctor. “We never know who—or what ailments—will walk in. The challenge there is that you staff for what you think you’ll need, but it can be hard to get the staffing levels just right in that setting.”

And still in yet another health care setting Moscow Family Medicine operates, the University of Idaho Student Health Clinic cares for students and their dependents. In this situation “most of the patients are managing their own health for the first time, so the physicians get to spend a lot of time educating patients,” says Geier. However, in the university setting patients are accustomed to a more institutional approach to their care and don’t assume they’ll see the same physician from visit to visit.

Across the spectrum of locations and ways patients can get care, one of the most unusual things at Moscow Family Medicine is their longtime use of EMR. Having used EMR for more than 13 years, Geier feels that each system upgrade gives them new efficiencies—which is critical to helping them deliver high-quality care, as well as continuity of care, across their locations. “One of our longtime patients might need to be seen at the QuickCARE clinic over the weekend, and the staff there will have access to the patient’s medical record.” Plus, the EMR helps lift administrative burden by providing information physicians need before they examine a patient—triage detail, test results, previous office visits—and allows them to anticipate the care that might be needed, while making their time with the patient more connected and focused.

Regardless of the setting, one of the biggest challenges facing Moscow Family Medicine is finding family medicine physicians. Notes Geier, “More are retiring than are being trained. The current system doesn’t financially entice them.” Plus, given the downward trend on reimbursement levels, it is becoming harder to meet the special expectations patients have of family practitioners. Geier says, “It is time-consuming to have a strong one-to-one relationship with patients and to care for the whole family; each appointment might need to be longer to address multiple issues.” And that’s where Moscow Family Medicine distinguishes itself. “They use different words to say it, but all of our physicians just want to care for people,” says Geier. “For them, it is not ‘let’s get paid’ first, but ‘let’s
take care of people.’”

That’s why Geier believes there is an art to practicing medicine. “It requires strong relationships—between the patient and the physician, as well as the nurses, the schedulers, the receptionists, and everyone involved in caring for our patients.” Moscow Family Medicine has been caring for patients for 30 years. In fact, two of their founding physicians are still on staff, Dr. Ruby and Dr. Spain. “We joke that they delivered the babies of the babies they’ve delivered,” says Geier—which means they must be doing something right.