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A spirit that is not afraid

Auburn grad takes a direct approach to primary care

<p>Dr. Efe Sahinoglu outside his clinic, Birmingham Direct Primary Care, on July 16, 2020 in Homewood, Ala.</p>

Dr. Efe Sahinoglu outside his clinic, Birmingham Direct Primary Care, on July 16, 2020 in Homewood, Ala.

Dr. Efe Sahinoglu has always done things his own way, a theme consistent with both his education and career.

Growing up in a family of engineers and with a love for math and science made a college decision relatively easy for the Turkish-born Montgomery native: chemical engineering at Auburn University.

After graduating in 2008 with a bachelor’s in chemical engineering, most people would call that enough. Following a brief stint in the industry, Sahinoglu decided it wasn’t, and he went back to medical school at the University of Alabama at Birmingham.

“Starting at Auburn, I did know that eventually I wanted to go to med school, and one thing that appealed to me was how Auburn’s chemical engineering department had a pre-med specialty in which you pretty much already had all the prerequisites for medical school in there,” Sahinoglu said. “I wanted to go into a major that would give me a very strong background to fall back on, in case medical school [didn’t] work right away.”

Sahinoglu put this thinking in action as soon as he graduated from Auburn, entering into an industry job for Kimberly-Clark Corporation as a process engineer, where he was stationed near Augusta, Georgia, on the South Carolina side of the Savannah River.

“I got to use the degree, and I got to work as an engineer for a year,” Sahinoglu said. “Even though I didn’t necessarily like the work I was doing, I think it gave me experience in general. And in the meantime, I got to study for the Medical College Admission Test and pay all of my undergrad loans in that one year I worked.”

Sahinoglu said he attributes the work ethic tested extensively in medical school to his time as a chemical engineer at Auburn, when he believed that work ethic was formed and strengthened.

“I liked chemical engineering, but it was very difficult,” he said. "It’s one of those things that, if it wasn’t for going through all those challenges with the same group of people, as like your colleagues, it’d be less bearable. Chemical engineering definitely gave me a discipline of hard work … to keep trying. It definitely fell in line with my personality.”

At around the halfway point through medical school, Sahinoglu said that he began interviewing with hospitals and clinics around the South for jobs after finishing school. Almost none of them excited him.

“The hospital administrator would meet me and say, ‘Hey, that’s great, so you’ll probably have to see 25, 30 patients a day just to break even for us,’” Sahinoglu said. “You know, you’re doing all that hard work, those years of training to get orders from a hospital administrator to 'break even' for them; it’s like you’re a workhorse for insurance, not to mention all the paperwork, the coding: all the stuff you didn’t go to medical school for.”

After finishing medical school in 2014, Sahinoglu moved to Tuscaloosa to participate in the University of Alabama's Family Residency Program. As a senior resident in the program, just seeing 17 to 18 patients in a full clinic day was a lot, Sahinoglu said. However, around the same time, a family physician from North Carolina came to speak to his class of residents about the format of medicine they practiced: direct primary care.

“The physician [from North Carolina] gave us a three [or] four hour lecture on this, and it just made so much sense,” Sahinoglu said. “I was like, ‘Wow, this is what I went into medicine for.’"

Direct primary care is primary care that is strictly between the physician and the patient, meaning no third parties are involved. This means that patients and physicians bypass insurance altogether, which brings many benefits, according to Sahinoglu — especially the reduced cost.

Instead of paying per visit through insurance, the direct primary care model has patients pay something similar to a membership, a monthly fee that encompasses all of the benefits and services seen in a traditional primary care model. Direct primary care also allows for greater communication between physicians and patients. For adults, it’s $75 dollars per month.

The large reduction in price can be attributed to the removal of insurance, Sahinoglu said.

"[Health] insurance is for catastrophic or very expensive events … it’s not meant to be used for primary care, for your everyday things,” he said. “If you used your [car insurance] for oil changes and tire rotations, then your car insurance prices would go up.”

A big reason why Sahinoglu went into this type of model, he said, is the increased accessibility between him and his patients — something that a more traditional model of primary care is unable to provide. This increase is again due to the removal of insurance from the equation, a removal that brings down many of the barriers between patients and physicians.

For Sahinoglu, this means he can spend more time with his patients. Instead of seeing upwards of 30 patients a day in five to 10 minute visits, he is able to spend an hour or so with each patient, seeing only six to seven for the entire day. 

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It also means that Sahinoglu can communicate with his patients outside of his office; patients are able to text, call or video chat him about issues from their home, possibly alleviating the need to come in for a physical check-up.

“I love being there for the patients when they’re actually needing my help,” Sahinoglu said. “They can text me if something happens after hours … if they’re about to go to the ER, I want them to call me, ‘cause it might be something we can take care of and save an expensive ER visit. Being accessible, I think, is really important.”

After graduating from UAB's medical school in 2014, Sahinoglu took some time to organize his plans and rotated in with several direct primary care clinics in Alabama.

Sahinoglu opted to create his own practice from the ground up instead of joining an existing clinic. After finishing with his residency, he opened Birmingham Direct Primary Care in October 2018.

“Since I was going to build a clinic from scratch with zero patients in the patient panel, I said to myself, ‘Why work for anyone but myself?’” Sahinoglu said. “I’m going through all this training, [amassing] these huge, huge medical debts. I don’t want to be told at the end of the day by someone else how to treat my patients.”

Essentially, the direct approach to primary care allows Sahinoglu to focus much more on the patient and their relationship, he said, and less on insurance and all of the paperwork that comes with it. 

In most traditional primary care clinics, doctors are very focused on keeping detailed records of their patients and are constantly updating information on their devices during visits. Sahinoglu emphasizes this is through no fault of their own, but merely that of the institution and environment that they work in.

If doctors do not accurately fill out insurance information, they risk problems when it comes to getting paid. For Sahinoglu, all the “paperwork” that he does during visits is the occasional sticky note.

“I put a little note at the end of every patient visit, but that’s for me," Sahinoglu said with a laugh. "I’m not going to send that to any insurance ... I don’t care what the insurance thing says. It’s only for me to go back to if I do have a question. It doesn’t have to have all these coding requirements that the insurance determines is necessary so [one] can be paid.”

Another strength of the direct approach to primary care, according to Sahinoglu, is its adaptability to change, a strength that has been tested in the past few months. While some traditional primary care practices struggled with the coronavirus, Sahinoglu took it in stride.

“With this model, we were already set up for telemedicine. My patients have been texting me and calling me since we opened in the fall, so that wasn’t anything new,” he said. “We just continued doing that for most visits, and my patients already know that if they don’t need to come in, I won’t make them come in.”

Eventually, most traditional primary care clinics made the transition to telemedicine, but only after they received permission from insurance companies. Sahinoglu doesn’t have to deal with that. 

“Even though a lot of practices kind of caught up now with telemedicine as the insurance [companies] gave permission for temporary billing, I didn’t need to wait for [insurance] codes for telemedicine to continue seeing patients,” he said.

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