Doctor as renegade—accepts cash, checks, eggs or pie, not insurance
Dr. Susan Rutten Wasson
Doctor as renegade—accepts cash, checks, eggs or pie, not insurance

by Jennifer Vogel, Minnesota Public Radio

Osakis, Minn. — Dr. Susan Rutten Wasson sits on the corner of a bed in the cramped bedroom of Alice Johnson, a 91-year-old Osakis resident everyone calls "Grandma Alice." She's examining Johnson's arm, which is swollen, she's determined, because of a tight sleeve cuff.

Also in the room are Alice's daughter, Ione, and granddaughter, Anne, who lives downstairs in the farmhouse Johnson has occupied for decades. A Rottweiler mix as big as a Shetland licks the face of 18-month-old Sarah, Rutten Wasson's daughter, who sits on the doctor's lap.

It's more a scene from the days of frontier medicine than from the modern health care system. And that's because Rutten Wasson, 42, is a throwback to a time before HMOs, electronic health records and hospitals with fountains in their lobbies. She sees patients the same day they call if she's not booked up, spends at least a half-hour per visit — compared to the more typical 15 minutes — and usually charges only $50 for a consultation. She takes cash or check, but no insurance — and sometimes accepts gratuities of a dozen fresh eggs or a pie.

Video by Vickie Kettlewell

"I have a few bottles of homemade wine in the fridge from patients," says Rutten Wasson. "In summer, I'll get pickles or tomatoes. I've received pork sausage, the kind that would convert a vegetarian."

Rutten Wasson is decidedly not a vegetarian. She and her husband raise sheep and chickens she butchers herself. "Occasionally, I have people pay me more than my fee because they think I've earned it. It's nice. I don't complain."

In an era of high overhead, ever more byzantine regulations and payment models, cuts to Medicaid and Medicare benefits, and large medical systems swallowing independent practices, Rutten Wasson relishes her straight-forward manner of practicing. Since many federal health care reforms — such as those requiring electronic medical records — are tied to Medicare, they tend not to apply to her.

Her practice serves as a critique of the modern health care system, the complexity of which has pushed some providers and clinics to find dramatic work-arounds, despite the fact that it can be tough to make a living outside the mainstream. A small but growing number of physicians practice "concierge medicine," charging patients annual retainers for basic medical care. A 2010 nationwide survey commissioned by a congressional agency pegged the number of concierge doctors at 756, up from 146 in 2005.

Walk-in clinics are another alternative. MinuteClinic, for example, started in Minnesota in 2000 and has spread to 26 states. At these clinics, nurse practitioners and physician assistants treat a menu of common illnesses and injuries and perform physicals for reasonable, stated fees, no appointment necessary. Exams typically run between $79 and $89.

In rural Minnesota, where there are too few doctors to treat a sparse, aging population, being creative is both more possible and an imperative.

Compared to other doctors, says Rutten Wasson, "I don't waste anywhere near as much time on paperwork. Yes, I do other things. I take out my own trash. I clean my own instruments. I clean my own toilets." She prefers this to working within the insurance system. "I'm autonomous. I don't let third-party payers or clinic staff get between me and the patient."

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