Dr. Mark Barreto '00: The Doctor is over it

Dr. Mark Barreto ’00 always wanted to be a doctor. After working as a primary care physician during the COVID-19 pandemic, Barreto realized the hardships patients experience while trying to receive medical attention through traditional insurance.

Hospital network policies and processes, insurance-driven time constraints on visits, quotas, and excess documentation and coding requirements, made him spend more time on paperwork than caring for patients.

So he opened a private family practice in Otego, New York, with a Direct Primary Care model, in which patients pay a monthly fee similar to a gym membership. While they still carry insurance to cover the big things, like hospitalization, tests, and prescription costs, patients receive direct care, and the monthly fee covers unlimited appointments, extended visits, minor in-office procedures, and home visits without having to go through a complicated insurance process.

What type of patients primarily use this model – older people, families, etc.?
My patient panel includes families and single persons. I have a diverse socioeconomic panel, and all genders are welcome. Barreto Family Medicine is LGBTQ+ friendly! As a family physician, I care for patients of all ages. I have cared for newborns through 100+ years old. While I have chosen to no longer practice obstetrics, I have cared for pregnant patients and delivered many babies during my career.

What about the healthcare system prompted you to change the model of your practice?
At the start of the COVID-19 pandemic, I was an employed primary care physician working for the Department of Veterans Affairs. VA patient appointments were being canceled, medical care was not being received, and patients were unable to access their doctors due to restrictions originating during the pandemic. I was unable to make changes in the manner and policies regarding management of primary care at the VA, even before the pandemic arose, but the COVID-19 pandemic led me to become increasingly disillusioned about my role as a healthcare provider at the VA. So between February 2020 and July 2020, I made preparations to leave the VA and open a Direct Primary Care practice with the vision that I could provide excellent care to my patients and serve my local community amid the pandemic.

I personally greet my patients at the door and provide a face mask if they did not bring one with them. I escort the patient to the washroom, where they perform hand washing. Then they come directly into my office, where my patients sit in comfortable armchairs while they have a relaxed, conversational visit with their doctor. Appointments usually last anywhere from one to two hours or more. There is intentionally no one waiting in the lobby to put pressure on the patient or the doctor to end the visit prematurely as my schedule is set to avoid this.

As I have no office staff or nurse, to establish a successful practice I rely on technology to help facilitate office administration functions, such as patient communication and scheduling appointments. Patients can self-schedule routine appointments online through my website, where they can see my schedule and pick a date and time that works for them. For urgent medical matters, I offer same- or nextday appointments. Technology has allowed me to also offer the options of telemedicine video chat visits and phone call visits.

What is it like being a doctor who patients can access 24-7?

An important benefit to my patients is direct access to me as their doctor. Patients have a special patient-only phone number that rings directly to my personal cellphone. Patients can reach me 24-7 by phone call, text, or email me, and these written communications are linked directly to my Electronic Medical Record for automatic documentation in the patient’s chart. As our doctor-patient relationship is based on mutual respect, my patients do not abuse this privilege and have appreciated its availability.

Do you have a favorite moment of your career as a doctor?
My favorite moment of being a doctor is not a single moment but many small moments and emotions that occur naturally when you have meaningful relationships with people you care about. Together we laugh and cry, grieve and elate, smile and frown, hug, and fist bump. There are so many times when we empathize with each other, and true understanding is acknowledged and appreciated by both parties. We can even lightly chastise each other and/or call each other out on excuses and failures on follow through. This is all acceptable because we know the intention is coming from a place of love.

What inspired you to become a doctor in the first place?
The combination of working on a First Aid merit badge in Boy Scouts and taking biology in high school led me to my decision to become a doctor. At the time, I only personally experienced a few types of doctors: emergency medicine physicians, allergy-immunology, orthopedists, and my pediatrician. Of those, my pediatrician best demonstrated the aspects of practicing medicine that I desired to emulate in my future career. Through college, I desired to be a pediatrician.

It wasn’t until my first year of medical school that I even heard of the specialty of family medicine, which was not a prominent field of medicine in the area I was raised. I did a summer externship with a rural family physician, and I was sold on the virtues of practicing primary care as a family physician.

How did coming to Saint Rose shape you as a doctor?
The College of Saint Rose was the perfect undergraduate institution for me! I met a diverse population of students and faculty with interests and expertise in a wide variety of fields. I benefited from excellent faculty, who cared for their students and created true bonds of friendship. One of my most important lifelong relationships began at Saint Rose in working closely with my mentor, Sister Theresa Wysolmerski (a biology professor), who took me under her wing and fostered in me the drive to pursue my dream to be a medical doctor.

What do you think it will take for the healthcare system to change?
I believe that the system will eventually financially fail – sooner rather than later. From the ashes, a well-timed and effectively led revolution of the poor and middle class can then create a new egalitarian healthcare system. This new healthcare system should be led by medical and public health professionals, who are not beholden to boards of trustees and/ or private shareholders focused on profit.

The new system will need to remain focused on the ideals and recommendations of nonprofit, nonpolitical medical organizations. The new system leadership should consist of persons with high degrees of integrity and empathy and clear guiding moral principles. The direction of the new healthcare system and its policies should be determined by what is good for patients based on evidence-based medicine, with a focus on primary care and communitybased and preventive medicine.

By KASEEM GOMEZ