Chestnut Hill resident Dr. Paul Wallace is a rare medical doctor who makes house calls. It took innovation and tenacity to build an economically feasible practice dedicated to underserved patients.  

Wallace trained to be a hospitalist, which is a primary care physician who takes care of hospitalized patients, at the Medical School of the University of California, San Francisco. Many patients there are elderly with a plethora of medical problems like diabetes and emphysema, congestive heart failure, and other forms of heart disease, Wallace explained. 

After practicing as a hospitalist in San Francisco for 16 years, Wallace, his wife and two children moved to Philadelphia, where he became a hospitalist at the University of Pennsylvania Hospital from 2016 to 2020. In both San Francisco and Philadelphia, he became concerned about a trend in hospitalization of his low-income patients. 

“A lot of older people with multiple medical problems get fixed up [in the hospital],” he said, “and they go home and they don't have access to medical care because they have a hard time getting out of the house. For example, some patients cannot afford to have a ramp constructed or a doorway widened to accommodate their wheelchairs. The only way they have access to health care is through emergency calls for ambulances.”

Wallace found that when he discharged some underserved patients from the hospital, they would go home and wait until they got sick enough to go back into the hospital. When he looked into home health care, he discovered that only 15% of homebound patients get the proper care they need, according to statistics on the website of the Home Centered Care Institute, a national organization of home health professionals. 

As a result, Wallace dedicated himself to patients who have no access to medical care after they leave the hospital. But how could he treat patients inside their homes as effectively as he had in the hospital?

Enter new technology. In his last year in San Francisco and throughout his years at Penn, Wallace learned to use a handheld ultrasound. Small and sleek, these ultrasounds can project images on the screens of phones. 

Many of Wallace's patients have congestive heart failure caused by an excess of fluid. Sonograms from the handheld ultrasounds have revealed grave underlying conditions he would not have discovered if he were not able to peer inside their bodies. The sonogram of one patient's stomach, for example, revealed that there were about eight liters of fluid in her belly. And the reason why she couldn't breathe was that all the fluid was pushing up against her diaphragm.

A sonogram of another patient's heart revealed that there was too much fluid around the heart that was squeezing it so much, it wouldn't function properly. In both instances Wallace sent his patients to a hospital, where their fluids were drained. In other cases, a sonogram enabled him to determine how much of a diuretic to prescribe without causing kidney failure. 

Wallace believes that a handheld ultrasound is a vital tool for primary care physicians. In fact, he started a fellowship at Penn in portable ultrasound for internal medicine, has written several articles about it and teaches it to medical providers in the region and nationally. 

Before Wallace left Penn, he took courses from the Home Centered Care Institute and learned what he could from doctors who were home-based. He was told he would have a hard time making a living as a home-based doctor.

“The way our health system is set up,” he said, “reimbursement is based on the number of patients you see or the number of procedures you do, so if you're doing house calls, you can only see six or eight patients a day. Most primary care doctors, on the other hand, see 20 to 40 patients in one day.”

Wallace was not deterred. In May, 2020, he bought a portable ultrasound for about $2,000 and a subscription for cloud storage for $400 a year and formed his company, Insight Home Physicians. 

“The first year and a half was difficult,” said Wallace. “It took me that long to find a billing company that could effectively collect fees from insurance companies. One saving grace with house calls is that there is low overhead. There are few administrative layers between doctor and patient.” 

About a year ago, to make ends meet, Wallace took a job at Einstein Hospital Montgomery County in East Norriton one week a month as a hospitalist. His tenure at Einstein will end this month when he will start working in home-based healthcare two days a week at Holy Redeemer Hospital in Meadowbrook, located eastern Montgomery County.

Wallace's house-call practice focuses on patients, mostly from Northwest and Northeast Philadelphia who are truly homebound. Most patients come via referrals from home health agencies, and there is currently a waiting list to become a long-term Wallace patient. 

“When you see patients in their homes,” he said, “you are getting a much better picture of the whole person (because) you're meeting their family and it's a more intimate relationship with the patient.”

For more information, visit insighthomephysicians.com. Barbara Winkelman is a Chestnut Hill resident, author of many children's books and freelance writer.