At the moment, we are only offering house calls on a limited basis with priority to established patients and prescheduled visit times.
This has become a necessity with the surge in venture subsidized care being delivered by dozens of startups chasing the success of Uber and the rapid growth of the shared economy. When a health tech start up has a plan that includes delivering a Stanford trained doctor and an assistant that helps with parking to your door within 1 hour for $99 then there is no point in doing house calls until they run out of money, and fortunately that won't take very long.
Many of these services focus on the easiest and simplest house call visits and restrict the services they provide. In reality, people requiring the discretion and privacy of a house call physician are often looking for higher levels of service and often are complex cases that require advanced skills you only learn through working with mentors and can't be packaged into an orientation manual as part of a go to market plan.
I know they insist they can make money and that is the story they are sticking to. But we know that to make money like that, you would need to see at least 2 - 3 patients every hour and who would want to do that? Certainly nobody who has done a thousand house calls before. That means that you would have to get the notification or request for a visit while being on call. Then you need to communicate with the potential patient about their condition to confirm and coordinate the house call. Then one has to plan out how to get to the patient and what transportation you will use, which is often Uber these days at a cost of $15 to $30 there and back. Then you need to drive to their home and find the correct door, you might need to park if you drove, and often you will speak with their neighbor or a doorman briefly. It is important to have the skill of getting let in to the buildings without having to call up to the patients to buzz you in since so often people are failing to answer their phones anyway. There isn't a bigger nightmare for a house call doctor than being stuck outside a patients condo not being able to reach them. Once you get to the apartment or hotel room you will often remove your shoes, say hi to the friend or family member in the room, maybe you have to meet the dog or cat, then you can take their vitals, do a review of symptoms for several minutes, hopefully examine the patient, and then you will discuss the likely diagnosis and address any of their concerns while coordinating a treatment plan. You then need to prepare their documentation and supplies from your bag before finally getting ready to leave. Just navigating the way out of a building can be confusing after having been in so many hotel rooms and condos over the years. They tend to blur together into bizarre similar looking hallways where we attempt to remember the direction we came to the door while asking ourselves out loud, "where am I now."
If a physician can do all that in under 30 minutes, not accounting for Murphy's Law, then they would be track stars and no doubt hate house calls more than their normal clinics seeing patients every 15 or 20 minutes. At least in the clinic they would have more time to spend actually seeing patients. What makes house calls special is the intimacy and time that one gives with each patient. You learn more about your patients in their homes than you can ever learn seeing them in the clinic, but that requires a physician to not be out of breath from zigzagging back and forth across the city all night long. Our house calls rarely take under 2 hours to complete and we don't intend to change this philosophy anytime soon. For now we will wait until subsidized care runs out of money.