Birmingham News interviews Dr. Bruce Irwin

February 22, 2011

While working as an emergency room physician at Brookwood Medical Center in 1979, Dr. Bruce Irwin recognized a gap in the nation's health care system. The chief executive of Birmingham-based American Family Care Inc. recalls that, at the time, there were no freestanding clinics available for people to visit for acute primary care or urgent health problems. "Many people were coming to the emergency room with problems which could have been cared for in a less expensive and more convenient manner," Irwin says.

To fill this need, Irwin envisioned a stand-alone facility equipped and staffed like an emergency room, with on-site laboratory services and X-ray machines.
"It would be more like an emergency room than a typical physician's office," he said.
Such facilities would be capable of caring for a wide range of urgent health care problems more quickly and economically than an ER. They would be located in neighborhoods close to the patients and have extended days and hours of operation.

"Patients would be seen on a walk-in basis," Irwin said. "They would be seen when and where they wanted."
Thus American Family Care was born. Today, his company employs more than 600 people in 27 clinics from Nashville to Orange Beach, including 13 in metro Birmingham.
In an interview, Irwin described how he came up with what he says was one of the first such facilities in the country. It is a model that led Irwin in 2008 to win the Birmingham Regional Chamber of Commerce's Small Business Person of the Year award.


Title: Founder and CEO

Hometown: Center Point

Education: Bachelor's degree from Birmingham-Southern College and obtained doctorate in 1977 from UAB Medical School. Interned at University of South Alabama and UAB in family practice and had a fellowship at Michigan State University from February 1987 to June 1988 in primary care development.

Work history: Has been a physician for more than 35 years, including stints on the staff of Brookwood Medical Center, Baptist Medical Center and what was then known as Medical Center East. Owner of American Family Care since founding the company in May 1982.

Current books being read: "Harmony" by the Prince of Wales; "The Four Obsessions of an Extraordinary Executive" by Patrick Lencioni; "The Confession" by John Grisham.

On his iPod: Exclectic mix from Jimmy Buffet to Lady Gaga

Family: Wife, Carla; children, Donald III, Ian and China

Q. Give me your take from a doctor's perspective on the controversy brewing over health care reform.

Health care reform as currently envisioned addresses only the demand side of the health care equation. It does not address the supply side. It does nothing to increase either the number of health care providers or the efficiency of our system.
There is no money for training programs, for example. More people will have insurance coverage for health care but there will not be enough providers. There will be more patients but no more health care providers.
The new laws make delivery of health care even more complicated. Most importantly it does not address the primary cause of our soaring health care cost which is our American lifestyle.
We make poor lifestyle choices. We eat too much, do not exercise and abuse various substances. We abuse our bodies to the point of failure and then turn to the health care system to save us. We have such a technologically advanced system that in many cases we can save them only to have the cycle start over.
Obesity is the No. 1 health problem in this country and, in many cases, is the root cause of other health care problems such as diabetes, hypertension, heart disease, kidney failure. Patients must learn to take responsibility for their own health and make wiser lifestyle choices. Any meaningful discussion of health care reform must address these issues.

Q. What are the biggest challenges in the health care industry and why?

The biggest challenge in the health care industry is to maintain the quality and consistency of care expected by the American public. We cannot be expected to do more and more with less and less.

Q. What do you feel must be done to fix our national health care system?

We must increase awareness in the public of their responsibility for their own health care. We need to fight obesity with public awareness programs like we did with litter and tobacco. We must increase and improve training programs for health care providers.
We have to streamline the administrative and payment aspects of medical practices so more dollars will be spent on actual health service instead of administrative cost.

Q. For those unfamiliar, describe a typical American Family Care clinic.

AFC facilities are approximately 5,000 square feet, staffed at all times by at least one physician and other qualified nursing, X-ray and laboratory personnel, eight to 15 exam rooms, and additional trauma bays for acute injuries.
We have full-service laboratories and digital X-ray. We are capable of taking care of a wide range of health problems from sore throats to broken bones. Many offices have full-service, open to the public, U-Save Pharmacies, LLC.
We have electronic medical records, and, to the greatest extent, we are paperless. All of our facilities are open at least from 8 a.m. to 6 p.m. Some are open to 8 p.m. We are open every day of the year except for Christmas.

Q. When you first opened American Family Care, did you ever imagine it would be such a success?

Yes, I did. From day one, American Family Care was envisioned as a network of such facilities. The first one in Hoover was so successful we opened six facilities in the first three years of operation.
My real surprise is that it has taken so many years for the concept of acute care/urgent care to be widely developed and accepted by other health care providers and insurance companies.
We were one of the first health care facilities to link all offices by computers. Since the second clinic was opened, our clinics have been linked online via computers and telephone lines to health care providers and insurance companies.

Q. On a given day, how many patients do your clinics see?

It's difficult to say how many patients we see on a given day as our facilities, especially the newer ones, continue to grow in patient visits, and patient numbers vary from season to season. American Family Care will see over 450,000 patients this year.

Q. How have you been able to expand into new markets despite the fact the economy remains shaky?

The reasons for expansion are: The demand for health care is basically stable in spite of the economy; there is a shortage of primary care; demand for primary care services will only increase as our Baby Boomer population ages; and there will be a increased number of insured lives with health care reform.
On the economic side, commercial real estate prices and construction costs are down. We have high unemployment. All of these factors facilitate growth for American Family Care. The current situation is one of great opportunity.


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