09/09/2024
The Reality Behind My Decision to Close
Hands On Medicine has been a steadfast presence in N/NE Portland and the lives of thousands of individuals and families for nearly twenty years. I founded Hands On Medicine with the mission to provide high-quality personalized healthcare to individuals and families in my neighborhood, create jobs that value quality of life, and to make a substantial contribution to the overall health of our Portland communities. I can proudly state Hands On Medicine has successfully met this mission and more. However, this has come at a great cost.
The US Corporate Health Industrial Complex is a deeply flawed system full of mismanaged resources and exceptionally high stakes. Despite these tremendous obstacles, Hands On Medicine has managed to provide care that exceeds standards of practice and common expectations. Over the years we have insulated patients from the challenges of providing care everyone deserves and that we can be proud of as providers of care, not providers of insurance. I have decided that to continue providing such high-quality care with ridiculously low compensation and high liability and conflict is not fair to myself or my employees. I have come to see that subsidizing the broken system does not improve it. In fact, buttressing the broken healthcare system only serves the system itself, hiding its flaws and misleading patients.
Staff spend countless hours answering questions insurers have artfully evaded. Providers spend disproportionate clinical hours hunting down medications in short supply because corporate pharmacy staff cannot be bothered. The hours staff spend in prior authorization purgatory to get patients the care we know they need begins to add up to days, weeks and years. But the inefficiencies do not stop with private corporate healthcare. The State of Oregon’s Medicaid system is as unsupportive now to the clinicians and small clinics that make up its backbone as it was when I started Hands On Medicine nearly twenty years ago.
The entire time I have owned Hands On Medicine, I have fought on many fronts: as a primary care provider in a hierarchy wherein specialists are kings, as a nurse practitioner in a physician-dominated field, and as a small business owner surrounded by big box medicine. Primary care that is preventative and holistic is completely taken for granted. Nurse practitioners continue to be viewed as “less than” by the medical establishment that sees licensure before credentials and experience. There are fewer and fewer small family practices and true neighborhood clinics in our country, and for clear reasons. The road to here and now was full of obstacles and the forecast is worse: more private equity purchases, huge system mergers, and an exponential squeeze on the little gal.
I write these truths because people should know, our patients should know, and we all need to be doing something about it. This broken healthcare system does not afford people the high-quality services patients have come to expect at Hands On Medicine: 30 and 45-minute appointments, less than 3-day notice medication refills, insurance plan education, 24/7 access to clinicians or a front desk staffer that knows your name and recognizes your smile. What Hands On Medicine has provided is beautiful and authentic, but unfortunately it is completely unsustainable.
Though I have chosen to close Hands On Medicine, I did attempt to sell the practice in hopes that staff and patients would have a choice as to where to obtain employment and healthcare, respectively. I quickly learned that there are fewer individuals and small groups going into family practice then when I began this lonely two decades ago. Most mergers, acquisitions and expansions are among the usual suspects- large hospitals, urgent care chains, huge insurance companies, private equity firms and other big box or online retailers. I refused to sell to an agency that would dramatically change the care our patients receive and soil the legacy of the hard-working employees that made Hands On Medicine the clinic it is today.
As I step off this soapbox, I would like to conclude with a request. If you care about the value of your healthcare and tax dollars, and care about the health of yourself and your loved ones and neighbors, let’s have a dialogue about really big changes like universal healthcare, decentralizing corporate healthcare and insurance, and supporting hands-on care where we all need it- within our families and communities.
- Shelda Holmes, FNP
Medical Director and Owner, Hands On Medicine
