10 Questions: Mark Tomasulo, DO, Colorado Family Doctor
July 13, 2014
When asked what one thing he would change about medical practice, Mark Tomasulo, DO, a family physician in Colorado Springs, Colo., named three: middlemen, politicians and government policy. That is one of 10 questions MedPage Today is asking leading clinicians.
After completing his residency in family medicine, Tomasulo served as chief flight surgeon for The Big Red One. Following a deployment in Iraq, Tomasulo took over as the chief of aviation medicine at Evans Army Community Hospital.
He is getting ready to open doors at his direct-pay primary care clinic, PeakMed, in August 2014. Tomasulo has a wife and two kids.
1. What’s the biggest barrier to practicing medicine today?
The biggest barrier to practicing medicine today is navigating the bureaucracy that has been created. Today’s healthcare system places emphasis on metrics, patient satisfaction for reimbursement, EMRs (that have driven further wedges between the doctor-patient relationship), and third-party payers that make profits without accountability or benefit to the health of the patient.
This problem has been around for a long time and is getting worse day by day. However, the new and bigger barrier to practicing primary care is the large conglomerate organizations that are purchasing independent practices and taking autonomy away from the providers, all while attaching facility fees to the visit. This is resulting in higher costs for the patients, higher costs to the overall healthcare system, monopolies in regards to primary care, and limiting the ability for doctors to utilize resources outside of the institution they work for.
2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds or tests, etc.) and how did you respond?
Last month, in the urgent care, I had a 19-year-old female with her mom requesting a refill of albuterol after her acute asthma exacerbation that I just treated. I asked if she had a family doctor, and she said No. “Why?” I asked. “Well, I can’t afford to see the doctor,” she said. “Do you work?” I asked. “Yes, but my employer does not offer benefits for part-time workers, and they will not hire us full time,” she said. “How much do you make working part time?” I asked. “About $200 per week before taxes,” she said. “Have you applied for Obamacare?” I asked. “No, I can work and I don’t want government assistance,” she said.
Mom was starting to cry out of desperation, because they could barely afford albuterol let alone a hospitalization if she did not get her medication.
I told her that I was opening a Direct Primary Care practice in a few months, gave her my information, and told her that I will take care of her free of charge. My heart went out to a young American trying to do the right thing, work hard in life, and get ahead without handouts.
Well, she accepted my offer, mom gave me a hug, and I felt like a doctor that day.
3. What do you most often wish you could say to patients, but don’t?
I think it’s important to tell people they are making foolish decisions when needed; for instance, when they have diabetes, hypertension, smoke, and eat poorly. Now, I say it with tact and respect, but, nonetheless, I tell them what I think needs to be said. I feel it’s our duty to not worry about political correctness, feel good discussions, or gentle conversations when a good hard talk needs to take place. After all, we are their doctors, and it’s our obligation to teach, advise, encourage, and to be HONEST with them about their health!
4. If you could change or eliminate something about the healthcare system, what would it be?
The middleman, politicians, and government policy that has complicated and convoluted has broken healthcare for the greatest nation in the world. The final thing, and probably the most important, is to encourage family, internal, and pediatric doctors to stay independent and avoid the pitfalls of institutional medicine by being employed or selling their practices off.
Corporate health institutions are driving the costs of primary healthcare through the roof for Americans and limiting doctors’ autonomy. The financial effects this will have on our healthcare system long term will devastate future generations and change the face of primary care, and not in a good way.
5. What is the most important piece of advice for med students or doctors just starting out today?
Take ownership of your patients, never let another doctor do what you should have done because you were lazy or tired, stand up for our profession, because at the end of the day you are a doctor … people trust you with more than just their emotions, so don’t screw it up!
6. What is your “elevator” pitch to persuade someone to pursue a career in medicine?
If you love science, responsibility, high pressure situations, making life and death decisions, and someone else telling you how your profession should be run … come on board.
7. What is the most rewarding aspect of being a doctor?
I truly get to help people without an agenda or ulterior motive, and from time to time I actually get to change someone’s life for the better.
8. What is the most memorable research published since you became a physician and why?
I am not one to spit out research publications or studies off the top of my head, but I can say that through my own research, grass roots/national movement of Direct Primary Care, and being the owner of, and a physician at PeakMed, healthcare is actually affordable, personalized, fun, and rewarding again. Oh, and it eliminates all the bureaucracy that never should have been allowed into healthcare in the first place.
9. Do you have a favorite medical-themed book, movie, or TV show?
My favorite medical-themed movies are “Patch Adams” and “Doc Hollywood,” both of which motivated me to pursue family medicine. Favorite TV show was “ER” … man, was I naive!
10. What is your advice to other physicians on how to avoid burnout?
Make time for your family, redefine yourself as a doctor, take back control of our profession by leading and not following, volunteer your time locally if possible … it lets you be a doctor where everyone appreciates you. Believe it or not, I feel a second wind in my career opening PeakMed even though I work more now than ever!