Changing Medicine with a Smile
By Edward Araujo, Managing Editor, Arizona Physician
Photography by Ben Scolaro, scolarodesign.com
From Print Issue - Fall 2020
Rajeev Agarwal, MD, is a bundle of energetic joy who moves you after just a few minutes of talking. That positive attitude has helped shape his career as a pediatrician, harnessing the energy to forge long-lasting relationships with parents of his patients.
The Beginning
Growing up New Delhi, Dr. Agarwal was going to follow his relatives and become an engineer. But then his sister bucked the trend and entered medicine. She would encourage him by saying, “I think you would make a great doctor because you really care about people.”
After earning a medical degree from the All India Institute of Medical Sciences, Dr. Agarwal trained in pediatrics at the University of Texas Medical Branch at Galveston Affiliated Hospitals and completed a fellowship in pediatric nephrology from the University of Florida College of Medicine and Children’s Hospital in Columbus, Ohio.
Dr. Agarwal launched a private practice in rural Virginia but soon found city life was calling. Deciding to head west in 2005, Dr. Agarwal interviewed with several pediatric practices in the Phoenix area but found them to be underwhelming in the doctor-patient relationship.
Dr. Agarwal’s vision was to build deeper relationships with more frank discussions amongst patients and doctors. He would merge alternative and traditional medicine to fit the needs of the patients. His model would be based on providing a mix of community healing, prevention, nutrition, meditation, and healthy lifestyle, rather than what he saw as “in and out diagnosis.”
“Having a bigger impact on how people live, what people read, how people see things in life,” Dr. Agarwal states. He believes in learning from patients, so that you can put in place best practices. That approach would lead him to continued success.
At Agave Pediatrics, Dr. Agarwal feels blessed to have built such great chemistry with his fellow providers. They approach medicine with his same fervor. That lead patients in Scottsdale, Goodyear, Chandler, and Glendale to ask why Agave was not in their neighborhoods. After learning some patients were travelling 40 miles to visit the Phoenix office, Dr. Agarwal chose to expand. He says, “We need to go to them. A pediatric office should be easily accessible to parents of children in need.”
Practicing during COVID-19
As the current pandemic has swept across the nation, medical practices have adjusted to the constraints and mitigation measures to prevent the spread of the SARS-CoV-2 virus.
Agave Pediatrics adjusted early on. They increased use of tele-visits, became more aggressive in cleaning office suites, and followed shifting guidance from the state and county. The family-oriented culture focused on clear communication between all stakeholders, including leadership and staff, and allowed Agave Pediatrics to thrive during the chaotic period.
Agave Pediatrics experienced two types of hardships while staying open during the pandemic, one through the lens of their patients and a second from staff.
Dr. Agarwal explains, “Our practice numbers were down 20-30% in revenue of what we would normally see.” Reimbursements from insurance companies weren’t initially consistent and Agave ate the unreimbursed costs.
For staffing, Dr. Agarwal was able to keep all 75 employees on the payroll, although the drop in revenue forced Agave to reduce hours in all locations. He is convinced the positive culture helped to cultivate staff who stayed upbeat and supportive of the changes. Leadership checked on employees to track how the pandemic economy was impacting their families. When a few staff members tested positive for COVID-19, others on the team volunteered to shift locations and cover for their ailing colleagues. Such support and efficiency led to the hiring of five more staff.
A requirement to practice during the pandemic was more personal protective equipment, both for staff and patients. “PPE wasn’t easy to come by in the early stages of the pandemic,” says Dr. Agarwal. He feels blessed Maricopa County Medical Society stepped up to help his practice. He also thanks patients’ mothers who made hundreds of cloth masks to ensure the practices would remain open.
Dr. Agarwal found telehealth to be a mixed bag. Although reimbursement wasn’t a challenge, he found it has been difficult for many patients whose slower Wi-Fi at home hampered the communication. This caused several dropped calls and choppy connections with parents and their children.
Impact of a COVID Vaccine
With several vaccine candidates still in clinical trials, it is difficult to predict when and how well any effective vaccine will impact medicine in 2021. Yet, Dr. Agarwal says, “I always plan on a couple of levels. I plan for tomorrow, I plan for a month, I plan for a year, and I plan for five years.” The most important milestone that will change his planning is release of a vaccine.
Dr. Agarwal understands some people are nervous any vaccine candidate may be rushed to production. That’s why he looks forward to seeing the FDA approve a safe and effective vaccine for use. Whenever that happens, Agave Pediatrics wants to be first in line to distribute a vaccine to its patients and staff.
Thinking of Going on Your Own?
Running his own practice has been difficult, especially during the global pandemic and its recession. But Dr. Agarwal does not mince words. If a physician believes going into private practice will be easy sailing, then they should think twice.
Be ready, he says, for a lot of initial disappointment and be prepared to work very hard. Dr. Agarwal finds being in charge is a challenging lifestyle. If you are not absolutely wedded to the practice, then you are going to find it difficult to run. In the early days of Agave Pediatrics, Dr. Agarwal felt the pull to focus on medicine. He learned it was equally important to take care of the business.
Dr. Agarwal believes physicians need to learn about human resources and managing people. In private practice, this entails hiring the right practitioners and office staff, recruiting and retaining patients, and building core personnel you can trust. It is essential for success. “As a physician, you can’t do it all,” he says. “You need to be able to trust your team to handle their jobs.” Dr. Agarwal also finds that treating medical and office staff fairly goes a long way towards practices flourishing over time.
The Future of Healthcare in Arizona
What a year 2020 has been. Like a rock thrown in a pond, the pandemic’s ripples will last for years to come. Patients are rethinking how they interact with medical offices and seeking options for telehealth services they can access online or through a smartphone. Telehealth, a fledgling market making inroads in some specialties, expanded rapidly and is here to stay.
Dr. Agarwal’s take on telehealth is that insurance companies were initially blind to it, parents were blind to it, and doctors looked at telehealth as subpar care. When physicians were pushed, they found more and better ways to apply the technologies. Dr. Agarwal is convinced telehealth will not replace the human element of a thorough examination, but it can help in other ways.
The decisions of whether the State of Arizona and the Federal government maintain payment parity will greatly impact whether telehealth services remain a strong adjunct to face-to-face visits.
As a pediatrician, Dr. Agarwal hopes the pandemic will encourage more adults and children to receive the flu shot, an essential step to protect individuals and the larger community. Maricopa County Department of Public Health and the Arizona Department of Health Services are moving swiftly to inoculate as many residents as possible this flu season.
Another way Dr. Agarwal sees healthcare interactions shifting is in the patient’s view of cleanliness. Parents of his patients are very conscious of coming into the office. He is convinced private practices, clinics, urgent care facilities, and hospitals will maintain a high level of cleanliness moving forward.
When it comes to the future of pediatric care, Dr. Agarwal predicts more investment in building lasting relationships with parents. Doctors, he believes, will provide touchpoints at the right times and in ways parents can access, helping to keep patients in their care.
Agave Pediatrics has made getting vaccinations easy. The process is very quick and doesn’t require seeing a practitioner. Dr. Agarwal foresees more practices following suit, leading to an increase in vaccination uptake.
Dr. Agarwal also predicts greater separation of patients between sick and wellness visits. Agave Pediatrics believes this method has helped to reduce transmission of disease and allows staff to focus on procedures according to whether they work on sick or wellness visit days.
Regardless of what is around the corner, Rajeev Agarwal, MD, will be ready. From a would-be engineer in New Delhi to owning several pediatric locations in Arizona, Dr. Agarwal has evolved and remains laser-focused on providing high quality care for his patients. We encourage you to meet Dr. Agarwal and feel the joy he exudes for medicine.