WESTERLO — This summer, a new doctor will be coming to rural Westerlo. 

Dr. Myria Emeny, who currently practices at the Whitney Young Health Center in Albany, will open a micro practice in the building where St. Peter’s Hospital recently closed its charity clinic in the Westerlo hamlet. 

“I went into medicine to serve underserved populations, and rural areas are underserved,” said Emeny.  “Coming here stays within my own ethics of giving back.”

Emeny, 50, got her medical degree from Albany Medical College and completed her residency at St. Clare’s Hospital in Schenectady.

In micro practices, doctors lower overhead costs by also performing the roles of secretary, cashier, nurse, groundskeeper, and janitor.  Patients make appointments through the Internet.  Emeny first heard of micro practices, developed by Gordon Moore of Rochester, while in her residency.  Micro practices emphasize a healing relationship as opposed to an office visit, and doctors spend more time with patients. 

“I feel micro practice is committed to the patient rather than the doctor’s convenience — finding that collaborative care,” said Emeny.  “How do I meet your needs?  How do I respect your beliefs?”

St. Peter’s had run the Perkins center, one of its charity clinics, since shortly after Dr. Anna Perkins died in 1993.  St. Peter’s closed the clinic last month.  According to the hospital, the center was losing money and the number of patients had been dwindling.  There is now only one doctor practicing in the Helderberg Hilltowns. 

Emeny is not deterred by St. Peter’s findings.

“Their numbers were dwindling in terms of their goal was 25 patients per day,” Emeny said.  “They were only getting 11 to 15.  My goal is no more than 12 per day.”

Because the clinic had a full-time nurse and secretary, it needed bigger numbers to pay for overhead, Emeny said. 

When she starts her practice, she will see no more than six patients a day as she gets used to being a “jack of all trades.”

“When you start combining all of those jobs into one, you can’t see patients every 15 minutes,” Emeny said.  “You see patients every half hour.  So, what their numbers dwindled to is my max.”

“A good fit”

Last month, Emeny met with members of the community.  On Sunday, she spoke of fitting in.

“The first thing you have to do for good medical care is make sure the doctor and the community fit,” said Emeny.  “If you don’t have a good fit, you’re not going to have healthy people.” 

Emeny said one of the big questions in the community is: Do I have to go to St. Peter’s?

“No,” she said.  “You pick your hospital.  Make sure the hospital knows my phone number because, when you get into the hospital, I want them to call me.  I don’t want them to wait till Monday morning.  That’s part of the reason why the phone is on 24/7.” 

At her current job at Whitney Young, she doesn’t have to keep her phone on all the time, but she does, she said, because, if her colleagues have a problem with one of her patients, they need to be able to reach her.  “Not hunt me down,” Emeny said, “reach me.”

Emeny had been looking to open her own practice.  Within one week, she had been told of Westerlo by four people. 

She then contacted Westerlo’s supervisor, and, shortly after, spoke with Gaye McCafferty, a nurse who lives in Westerlo.  The two talked about the people’s needs and what people were looking for — urgent, chronic, or long-term care.

“I’m looking to provide long-term care,” Emeny said.  “I think that medicine needs to be not only an office visit, but a healing relationship.”

Emeny said she is a strong proponent of family medicine.

“When someone comes in with a headache and you know that his grandma died two weeks ago,” she said, “you know that grief is playing into the headache and so you don’t go looking into a neurological cause right off the bat. 

“You start treating the pain, but you also treat the emotional pain because you know the whole family,” she said.  One of her greatest joys was taking care of a four-generation family.  “I had a great-grandma, grandma, mom, and the kids.  And it makes it easier to provide that total care because it’s not fragmented,” said Emeny.  “And that’s something that the community is looking for.”

Doctor-patient relationship

Doctors, Emeny said, are the only workers who send out bills for their services with the recipient deciding how much they will pay. 

“If I send a bill for $139 to the insurance company and they decide to pay me $57, I can’t squawk,” Emeny said.  “If I did that to NiMo, or National Grid, how long would I have my lights?”

Emeny said micro practice doctors need patients on board to help get the momentum going.  She said the system is broken. 

“We have a system that pays specialists for doing procedures, but it does not pay primary care well,” she said. 

The only way doctors are going to do medicine their way — being there for their patients all the time, not just for an office visit — is to get rid of overhead, Emeny said.

By doing more themselves, doctors can decrease the overhead.  With the medical system as it now stands, she said, you have to be “on a hamster wheel.”  

“They’re talking about cutting visits from 15 minutes to 10 because the overhead continues to climb,” Emeny said.  “Everything from paying for employees salaries, which are higher, to workmen’s comp. for employees, plus benefits, takes 70 percent of your cost of running an office,” she said.  “Medicare, right now, is threatening a 10 percent cut in what they pay, but we can’t cut our staff’s pay by 10 percent.”

Emeny spoke of her experiences with a number of patients — their differences in beliefs and education.

Some patients, she said, will never talk about end-of-life care.  She cited Native Americans, some of whom believe that if they prepare for a do-not-resuscitate order, they will bring about their own death.

“And you have to respect those kinds of differences,” Emeny said.  “At the same time, primary care needs to be very alert for: Is there child abuse?  Is there spouse abuse?  And is that contributing to the office visits that I’m seeing here?

“I can’t tell you the number of patients who are embarrassed because they can’t read,” Emeny said.  “Then, I need to be able to say, ‘OK, let’s find another way for you to know your pills.  Bring your pills in.’” 

She has labeled medicines with small yellow and red dots so that her patients know which ones they should take in the morning and which ones they should take at night. 

“Now, their meds are right.  Now, all of a sudden I have somebody who has mild mental retardation but…they can still live on their own.  But they can’t read,” Emeny said.  “And their sugar’s dropped from 600 to 200 because now they know what to do with their medicines.”

Is it overwhelming to keep up with so many kinds of patients and their needs?

Emeny said it’s not. 

“I changed careers from a special-ed. teacher/sign language interpreter, so I have always been aware of differences,” she said.  “And, then, my experience at Whitney Young has really honed my ability to be aware of ethnic differences.” 

She knows of patients who place suction cups along their backs to try to draw out illnesses and of patients who don’t take their medicines regularly because their ethnic beliefs permit them to only take them when they need them. 

She uses a metaphor to teach diabetes patients about how taking their medicine is like shoveling the sidewalk to prevent someone from slipping. 

“Now,” Emeny said, “when they hear about shoveling the sidewalk before they fall down, they’re like, ‘Oh, so my medicine is like shoveling the sidewalk?’”

For some patients, she may need to look at alternatives — changing daily doses to weekly doses, and using patches rather than pills.

Some patients cannot remember to take their blood pressure pill but will remember to put a patch on every week.

Technology and scheduling

For her new Westerlo practice, Emeny said she’s “pretty well settled” on office hours being from 8 a.m. to 2 p.m. Tuesday through Friday, and from 8 a.m. to 8 p.m. on Saturdays.  She hopes Saturdays she’ll see kids in school and people who work, and Tuesday through Friday she’ll see those who are retired.

On June 1, she will open her website to take patients. 

“There’s only two weeks a year that I’m anticipating I won’t be available to answer phone calls myself,” Emeny said.  “And that will be vacation.  And we’ve already talked to some local docs who are going to help me out with that.”

For those who do not have a computer, she’s working to find out whether a voice-activated system is available in which patients speak into their phone and a computer makes the appointment.  If a system is not available, she will open the phone lines for patients to leave messages and then she will schedule them.  She will have a mixture of pre-booked appointments and open-access scheduling, with half of her appointment slots open each day.

“This allows people who don’t know when they’re going to be off work or when they’re going to have time to get there,” Emeny said.  “They can call and say, ‘I’m off today, do you have any openings?’”

All of her medical records will be electronic. 

“Electronic medical records means that, when you call me at home, I’m going to have your record in front of me,” Emeny said.  “Then I’ll know exactly what you’re on.  I’ll know exactly how to help you over the phone.”

Emeny lives in Albany. 

“One of the big concerns is the doctor is going to be so far away,” she said.  “But I won’t be because it will be a phone call, and I can turn on the computer and there’s your record and I can help.”

Emeny said “one of the big things” she has patients do is call her every three to five days when she changes their insulin medicines because she doesn’t need to drag patients into the office all the time. 

Emeny on Perkins

Asked if she has heard stories of the revered Dr. Perkins and whether she feels she lines up with Perkins’s philosophies, Emeny said, “Amazingly so.  I mean, the whole fact that I’m going to handle my own call.  The fact that…I want to be a part of the community, not a doctor who travels in and leaves.”

Emeny said she will attend town meetings, go to some baseball games, and perform physical exams of students at schools. 

“Because that’s part of being part of the community,” she said.  “I don’t think somebody coming in and just treating this as just a job is going to be as effective as being part of the community.”

Emeny said it has been interesting to read newspaper articles about Perkins and spoke of possibly framing the articles and getting them back up on the wall.

“Because those are just amazing stories of her commitment.  And my commitment to people and caring for people is the same,” Emeny said.  “Will I be able to match the things that she did in terms of four-, five-, and six-dollar office visits?  No.  The reality is that insurance makes it difficult for doctors to make a living.”

Transition to Westerlo

Eight months ago, Emeny bought a house in Albany. 

“If I’d known about this opportunity,” she said, “I’m not sure I would have bought the house.”

Emeny said she wants to make the doctor’s building more teacher-friendly, insulate the walls, and get rid of some shelving. 

A kitchen will be added and Emeny will hold classes after-hours on diabetes, chronic obstructive pulmonary disease, and hypertension. 

Her daughter is a special-needs young adult, Emeny said, and the blessing of working at Whitney Young was that she was seven minutes away. 

If her daughter needed any kind of assistance, she said, she could run home, help her, and return to work.  A 45-minute drive won’t allow that, Emeny said, so her daughter will, at times, stay in the apartment behind the medical building. 

“One of major things was: I wanted to see how people treat her because if people aren’t going to accept that she comes with the doc, the doc’s not coming,” Emeny said. 

People have been very warm and very supportive of her, she said, and talked to her about NASCAR, which is her biggest thing. 

“And,” she concluded, “it has worked out very, very well.”