House Calls Make a Comeback
While American medicine is coming to the realization that healthcare’s future depends on quality primary care, Bruce Alan Wallstedt , MD, realized that truth years ago, when he chose family medicine as his profession.
“There’s a general consensus now that we need more family physicians, more people who are willing to care for a whole community across the board,” he said. “There’s really some good data that show that in a community where there are more family physicians, no matter how many subspecialists are in the area, the general cost of care goes down and the quality of care goes up.”
A Florida native, Wallstedt is a Brentwood-based family practitioner and president-elect of the Tennessee Academy of Family Physicians (TAFP). In October, he takes the helm of the 2,250-member organization. “We provide an opportunity for like-minded and like-practicing physicians to communicate and try to use each other as resources to take on all of the issues that are facing us,” Wallstedt said of TAFP. And those issues are substantial, he said, especially considering that emerging healthcare models such as accountable care organizations and patient-centered medical homes put family practitioners front and center.
Wallstedt has been on medicine’s front lines for nearly 20 years, but it took a little time to get there. The son of a truck driver and a waitress, Wallstedt moved with his family from Florida to a rural Georgia farm when he was 12. That’s where he graduated from high school and then headed to Davidson College in North Carolina. After a year, however, he went back home, unsure whether medicine was his calling. He became an emergency medical technician and “started riding an ambulance,” he recalled. Then he took a job at an emergency room in the Atlanta area.
Those experiences over two years cemented his resolve, and he returned to college — this time Rhodes College in Memphis. In 1993, he graduated from the University of Tennessee School of Medicine in Memphis and then completed his family practice residency there with Saint Francis Hospital. He was recruited to Nashville in 1996 by George L. “Lanny” Holmes III, MD, the founder of Family Practice Associates of Southern Hills.
While he was committed to primary care, Wallstedt said he also enjoyed emergency medicine. “The first day I had my license as a second-year resident, I actually worked an ER shift in Brownsville, Tenn. I moonlighted a lot in residency, and even though I was in practice with Dr. Holmes, I worked four or five ER shifts a month.”
After 10 years of that, Wallstedt reassessed his career. “I just needed some time with the family. Both my kids were adolescents at that time,” he said. Thus, he left the Southern Hills practice and worked full-time as an emergency physician. “But I just couldn’t leave my family practice roots,” he said. That’s when he made a unique decision. While sticking with emergency medicine, he launched a part-time, home-visit practice.
“Right now I have two wide-open careers,” he said. “I’m the current medical director of the emergency room at StoneCrest Medical Center in Smyrna, and I work about 10 shifts a month there, and I also have a full-time mobile practice.”
Wallstedt’s patients are primarily the elderly and disabled, residing in assisted-living facilities, independent-living facilities and individual homes. His mission is to provide healthcare to those who simply can’t get to an office — and who most likely would forego care as a result.
“We’re actually back to the old-time docs who do home visits,” he said. “We really see this as a solution for a lot of problems we’re facing in healthcare. If I can keep somebody out of the ER and see them early in their disease process, I can save the system a lot.”
At his side in the venture is his wife, Andre, a registered nurse. The home-visit practice began as a part-time enterprise, but malpractice costs alone were more than the practice’s profits. The Wallstedts almost took down the shingle, but their two children nixed that plan. “My kids said, ‘But, Dad, they need you! You aren’t just doing this for money, are you?’ They put me in my place,” Wallstedt recalled.
This year, Wallstedt hired three nurse practitioners to help take the practice to the next level. “I’ve been turning down tons of business for a couple of years now, because to me, I need the right people working with me who understand that this population is vulnerable and needs advocates,” he explained. He called that notion “the Lanny Holmes philosophy.” He explained, “Lanny made it clear that there’s only one business decision to make in medicine, and that is good patient care. I have operated by that, and it brings me more business than I can handle.”
Wallstedt’s practice today covers several Middle Tennessee counties. “The home visit stuff is absolutely fun,” he confided. And he noted that he gleans much more about the patient when in the patient’s environment rather than in a sterile examination room.
Wallstedt called himself a “houspitalist,” a play on words he 0bviously enjoys. “I basically do concierge medicine, but I don’t charge concierge fees,” he said.
And those two children who encouraged their dad to stay on his family medicine path? Jake, 19, is a freshman at Texas Christian University in Fort Worth, and Megan, 18, heads to TCU this fall.