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."