Combination of primary care and specialty practice helps balance finances

SANTA ROSA - Dr. Ty Affleck is admittedly one of a dying breed. As other medical professionals flock to the fiscal shelter and insurance clout of a larger group, he wants to preserve the tradition of the one-doctor, "personalized" practice.

The Palo Alto native opened his practice in Santa Rosa about 16 years ago alongside his wife, Dione Affleck. Trained as a family doctor and sports medicine specialist, he has long run a unique, integrated practice providing both primary care and orthopedic and other sports-related treatments.

Over the years, he shifted from splitting his time about evenly between the two sides of the practices to primarily sports medicine. But with a recent move to a new building, he hopes to balance the practice once more and open the door to local patients still looking for that intimate care setting. Dr. Affleck said he is confident the specialist side of the practice, which is traditionally better reimbursed, will help sustain finances to remain independent.

"A decade ago the independent practice was thriving in this area, but now it has almost disappeared. It used to be that your doctor was your doctor your entire life. They knew your history, your family and there was this real sense that someone is looking after you," he said.

In recent years North Bay primary care doctors have made it clear that the single-physician office is quickly becoming a fiscal impossibility. The cost of care continues to increase, and insurance carriers negotiate reimbursement rates far below larger groups that can guarantee a sizable patient load.

Nearly every local doctor has folded into Kaiser, the Sutter Medical Foundation, Northern California Medical Associates or others, and even the area's hospitals have launched medical group-type models that have become the home to once independent providers. Those who have tried to make it on their own often must rush patients in and out just to cover the cost of running the office.

Dr. Affleck said though he understands some patients like the convenience of the larger practices, with on-site pharmacies, specialists and even hospitals, others miss the intimate relationship between doctor and patient that in some cases is lost. Now in a new building, the primary care physician/specialist hopes he has found a model to keep the tradition alive.

The office, called Santa Rosa Sports & Family Medicine, recently moved from its original home on College Avenue to a larger location at 1255 N. Dutton Ave., providing space for two additional treatment rooms. The doctor purchased the 5,000-square-foot facility last November, gutted it, remodeled and moved in this February. He also added a nurse practitioner to grow the primary care side of the practice, and he hopes to add at least two more.

"Honestly it has been difficult, but we are just trying to be as cost-effective as possible and keep our heads enough above water to keep the option for an independent office open," he said.

In addition to his practice, Dr. Affleck has also worked as a team physician for Sonoma State University and Santa Rosa Junior College, and he provides training for the Santa Rosa Family Medicine Residency Program.