Can New Offices Change a Group's Practice Style?

Article excerpt

Forced to abandon its cramped, outdated buildings, this group designed its beautiful new digs with managed care in mind.

t's a question that could have appeared on this year's MCATs: If a pediatrician left her department to staff an after-hours urgent-care center at 5 p.m., a plastic surgeon began making his way toward a department-head meeting at 5:01, an orthopedic surgeon left the surgery center for his office at 5:02, an FP began trekking to consult with a staff psychiatrist at 5:03, and all the doctors were members of the same group, where would they meet? The answer, if the group happens to be the Palo Alto (Calif.) Medical Clinic, is in downtown Palo Alto. That's because all the doctors involved would have to walk local streets to reach their destinations.

Some 13 buildings across three city blocks comprise the current home of the Palo Alto Medical Foundation (the clinic is the organization's physician arm). The main building, a three-story rectangle that "looks like the box the rest of the buildings came in," according to one Palo Alto physician, was appended to the group's original Spanish-style clinic in 1962. Over the years, when that setup proved too small, the group branched out.

The clinic's doctors will be united later this year when PAMF unveils its new $100 million main campus. (It will also continue to operate two satellites.) Prodded by California's building codes, which would require tens of millions worth of upgrades for the old buildings to meet earthquake safety standards, Foundation leaders began looking at solutions to their space problems a decade ago. They ultimately settled on a nine-acre site only six blocks from their present home.

PAMF, located about 30 miles south of San Francisco, sits in the vortex of two of the most compelling issues in medicine-managed care and computer technology. The move allows the group to accommodate both in the design and planning of the building. Hundreds of hours of meetings gave Palo Alto doctors a chance to contribute to the building's design. And while the new campus won't revolutionize how the clinic's doctors work, it does represent an evolutionary step toward tomorrow's medical practice.

Who's next to whom stirs debate

For the 150 or so Palo Alto Clinic doctors who will move to the new building, significant changes await. Some departments, such as plastic surgery and sports medicine, will be moving from their private enclaves into a large group setting.

Perhaps no department's physical surroundings will change more than those of the psychiatric department. For now, Palo Alto's mental health practitioners work in a charming Victorian house a block from the main clinic building. The house boasts wood paneling, fireplaces, and a private, cozy feel.

"That house served us well when psychiatry had nothing to do with primary care," says internist David Hooper, a member of the clinic's board of governors. "But under managed care, psychiatry needs to interact more with primary-care physicians. In the new building, mental health will be next to family practice, allowing psychiatrists and counselors to participate in managing common primary-care issues like depression. The trade-off is that they lose their house full of character and move into a more sterile office setting."

Adjacencies-both intra- and interdepart-, mental-were much debated issues among the group's doctors. Family practice leaders, for example, wanted to be next to pediatrics so the two departments could share a kids' play area. Because of various considerations, it didn't work out. "Our patients can't access a play area; that's a real disincentive for parents to have FPs care for their children," says FP Steven Lane.

Family practitioners also wanted to be near the general internists so that all adult primary care would be centralized. Internists, though, had other ideas. "We wanted to remain with the internal medicine subspecialists, because so many of our patients are complex and involve subspecialty care," says Barry Eisenberg, Palo Alto's chair of general IM. …