Todd County, Minn. — Dr. Susan Rutten's office is in a small farmhouse in rural Todd County, about 10 miles northwest of Sauk Centre. It's from this homebase that Rutten,33, makes house calls to the surrounding community.
On a blustery winter day, she's driven about 10 miles of country roads to check up on James Larson, 72, who suffered a stroke last summer. Rutten spends a half an hour with Larson. She takes a blood sample and checks his blood pressure. It's all done in an easy chair in Larson's living room.
"That's a wonderful thing," Larson says. "It makes all the difference in the world, not having to suit up and go over to her place. I've never even been in her office."
Rutten says the idea behind her six-month-old practice is to provide patients with quality care.
"It's very hard to have a patient-focused practice in an environment where the real focus is not patients -- it's money," Rutten says.
Dr. Rutten grew up in Michigan and went to medical school in Detroit. Her residency was at the University of Minnesota. Then she spent two-and-a-half years at a clinic in the Twin Cities. Rutten was working within a system she didn't believe in.
"I knew that for what a patient was billed, I would maybe get paid 20 to 30 percent of that. Where was all the rest going? It was supporting hierarchies of decision-makers who didn't make choices that were good for me, or my patients, a lot of the time," Rutten says.
That's what drove her to start her own practice. Along with making house calls, Rutten also sees patients in her office at home.
She has a minimum charge of $20 per visit. If patients need more than about 15 minutes of time, it costs $1.50 for every extra minute. House calls cost $10 extra.
Dr. Rutten's patients must pay her on the spot. She'll send in forms for her Medicare patents so they can be reimbursed, but she doesn't take any form of insurance. That would be too time-consuming, and raise her overhead. Her low costs are what keeps her services affordable.
Dr. Paul Saunders, executive officer of the Minnesota Medical Association, says Rutten is living out the dream every physician has -- to treat patients and charge them a reasonable amount of money. But Saunders says Rutten's style of old-fashioned health care is rare in Minnesota. And he says it's impossible for most doctors to do what she does.
"The reality is, if you've got an office that you're running, you've got to pay the overhead for your office whether you're in the office seeing patients, or if you're seeing them in the home," Saunders says.
Back in Todd County, Dr. Susan Rutten doesn't run an office with nurses and other employees. She pays one person part-time to handle her books. And her parents helped her pay for medical school, so she doesn't have thousands of dollars in student loans hanging over her.
Rutten says she hopes her work inspires other doctors to challenge the system they work in, and to think about what it means to be a physician.
"I dreamed of doing something that I thought was good for the health care system, and good for patients, and which suited my own personal philosophy about practicing medicine -- it's for the patients, it's not for me, it's not for my pocketbook -- it's for the patient," Rutten says.
Rutten has picked a good location for a cash-based operation. The Amish population in the area doesn't use insurance. The local communities of Long Prairie and Melrose are home to a lot of Mexican immigrants who don't have insurance. In addition, an estimated 10 to 15 percent of rural residents don't have health insurance.
Rutten's practice is slowly building. And in between house calls, Dr. Susan Rutten is working on a book about her experience as a new, old-fashioned doctor.