Dr Padma Sripada on Providing Personalized, High-Quality Primary Care Amid Workforce Shortages

Padma Sripada, MD, board-certified internist and the sole physician at her independent practice, Columbia Internal Medicine, discusses the strategies she employs to consistently provide high-quality care for patients amid well-documented workforce shortages in primary care.

Sripada received from Capital District Physicians' Health Plan a Top Doctors Peabody Award—a recognition that requires nomination from patients, peers, and the public—for providing exceptional care at her practice in 2023.

Transcript

How do you manage the balance between providing personalized care and meeting the demands of a busy practice, especially with recent workforce shortages?

I've had a primary care solo practice since 2006. Workforce shortages have always been a concern, because I have to do my own administration, as well. And if there's a shortage of office staff, I have to pick up the slack.

The pandemic created a huge upheaval in my practice, as well, and at one point, I was in a big crisis because of the employee shortage. Luckily for me, my daughter moved back home when college went online, and she brought 2 of her friends over and another child who had worked in our office since high school, they all jumped in and kept me afloat, and they were a godsend. They did a lot of the tasks in the office until I could find more experienced staff, and that was a huge blessing.

I feel like because I'm independent, I was able to come up with creative solutions on the fly without having to wait for a board meeting to approve hiring and changes and things like that. For me, I have a steady stream of premed students who look for shadowing opportunities. They're very smart, they have a great attitude, and they enjoy learning. They enjoy interacting with patients. I pay them and give them a terrific letter of recommendation when they leave, so it helps out their application process, as well. And then I have a couple of medical assistants, and I recently got an online scribe service that has completely changed my life, because I have the peace of mind knowing that my notes are done in a timely manner.

I can't answer for other physicians who are in groups, but these are the strategies that I have employed to mitigate my workflow shortages.

How do you prioritize preventive care and overall health promotion for patients at your practice?

I try to keep my new patient appointment time and my annual wellness visits a little bit longer than most practices do. They're about 40 minutes long, and that gives me time to understand the patient's physical, emotional and social needs by talking to them and listening to them and drawing them out.

It's very important to understand what is going on in the background in their lives, because all of that affects how they feel and how they engage with their own health care. For example, I can't make migraines go away with any medication if they are in distress from a situation at home or work or their child is not doing well. So, I have to create an atmosphere in the room where they feel safe to come out with these problems to me. Then, I can work around those issues and give them suggestions that better fit what is going on with them so that they're able to take care of themselves and so medications actually are effective.

I don't force my solutions on them, I give them options for treating the problems. I tell them what I think would be better and what might be—if that doesn't work for them, then we come up with a secondary solution and plan of care. I see that they are more likely to actually follow recommendations if they know that I'm willing to work with them, and they get less anxious as a result.

I give out a lot of pamphlets on diet, blood pressure, medication, problems related to medications, and meditation, healthy relationships, and try to coordinate other aspects of their emotional lives and their mental health issues, as well, in most visits because I don't think we can work in isolation. I think that allows me to build better relationships with the patients. I think a large part of primary care depends on building a relationship with the patient—understanding them, their family, their past, what traumas they've had in their past. Because a lot of times, patients who have difficulties engaging with their care generally have faced some trauma in their lives, childhood or otherwise. So, I think it's important to get all of that out before we really are able to treat them.