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Care Package

Medicine is, at its core, the provision of care to patients. But in this country there's a lot of financial and regulatory baggage that goes along with providing care. Here is how one DMS alumnus—with more than a little help from his wife, running a "mom and pop doc shop"—handled that baggage.

Story by Deborah Lee Luskin, Photographs by Max Aguilera-Hellweg & Flying Squirrel Graphics

For 16 years, I managed my husband's medical practice. The "Mom and Pop Doc Shop," I called it, because it was like an old-time general store where the proprietors lived in back and knew who would come in when, what they would buy, and when they would pay, if ever. Our office was never so quaint as to be attached to our house, but that never stopped patients from dropping by after hours for an informal consult. And, like a general store, it took both of us to run the practice.

Tim Shafer and I met in 1984, the year he arrived in Townshend, Vt., as a doctor for the National Health Service Corps (NHSC). The Corps—a program funded through the U.S. Public Health Service—had paid Tim's Dartmouth Medical School tuition in return for a commitment to work for three years in an underserved region. The NHSC's hope was that doctors would decide to stay and practice in the area where they did their service. But the two previous NHSC doctors posted in Townshend had left as soon as their payback period was over.

By the time Tim's three years were up, however, he and I were married and we'd put down roots in Townshend. We decided to stay, so the NHSC turned the practice over to us—lock, stock, and receivables. The only problem was that Tim was too busy doctoring to take care of the books. I, on the other hand, had just completed my doctorate in English literature and was unemployed and pregnant. We consulted a business advisor; started a checking account with $2,000 in it; and, on July 1, 1987, opened for business.

To Tim's patients, the change was seamless. The office location and phone number remained the same, as did the staff. What changed was our need to turn a profit, since the Corps was no longer footing the bill. After paying our

Shafer often had to stay late or go back after dinner to finish up paperwork—as here, in 1994.

employees' wages and benefits, after covering the rent and utilities, after buying the Band-Aids and cotton balls, we needed to have enough money left over to pay ourselves something. For 16 years we succeeded, though sometimes by the skin of our teeth. And then, on July 1, 2003, we gave the practice away.

Again, to Tim's patients, the change was seamless. The biggest changes were a regular paycheck and generous benefits for Tim, and freedom from working in

health care for me. There had been significant changes in the way Tim practiced medicine during those 16 years, but far bigger changes in the operational arena—including debilitating governmental regulations and the health insurance industry's takeover of the delivery of primary care, introducing an excess of paperwork and a reduction in payments, which made staying independent and profitable ever more difficult.

Two other factors also contributed to our

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Luskin is a freelance writer and frequent commentator on Vermont Public Radio. And as a visiting scholar for the Vermont Humanities Council since 1986, she also teaches lifelong learners in libraries, hospitals, and prisons throughout the state. She holds a Ph.D. in English literature from Columbia University and is married to Dr. Timothy Shafer, who earned his M.D. from Dartmouth Medical School in 1981. The black-and-white photos on odd-numbered pages of this article were taken in 1994 by Max Aguilera-Hellweg for a feature in Hippocrates magazine (and colorized for Dartmouth Medicine by Jennifer Durgin); they are used here with permission. The color photos on the even-numbered pages are the work of Flying Squirrel Graphics' John Douglas.

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