Brad Bigford still remembers clinging to the furniture as a child in a vain attempt to keep his mom from hauling him into the doctor’s office for stitches. He’d fallen from the bunk in his bedroom and hit his head the night before. The next day, he fought to keep his mom from dragging him to the doctor’s office for treatment to the wound. The way Bigford remembers it, he was parallel with the bedroom floor, clinging to a bookshelf as his mom picked him up.
Despite that childhood terror, he survived the experience. He grew up to become a nurse practitioner, actually.
In January 2015, Bigford started working at the Ada County Jail, after two years in urgent care at another facility. Months later, over Thanksgiving of that year, his visiting family presented him with a litany of health questions.
“Whenever family comes into town, it’s always, ‘What medical issues are we going to address?’” Bigford said.
This time, he started joking about sending them a bill.
And then he started giving some serious thought to the possibility of seeing people for medical appointments in the comfort and safety of their own home. The leap from joke to reality didn’t take long. In April 2016, he went live with Table Rock Mobile Medicine, offering house calls the way doctors used to 100 years ago. It's not at all affiliated with the Ada County Jail — it's his own project.
Back then, Bigford had a truck and no overhead. He had to get approved for Medicare and Medicaid, he needed malpractice insurance, and he needed to work with a medical supply company, but the total startup cost was low. All told, not counting the cost of the vehicle, it took about $5,000. The low risk — and the potentially high gains — were two points he made when convincing his wife to let him start the business.
Still, at first, business was slow. He saw about three people in three months.
“I thought I was a failure and I should close up shop,” he remembered.
Early on, some people thought he was running a scam, he said, despite the fact that he linked to the Board of Nursing’s website where customers could verify his license. Decades ago, doctors used to take house calls often, he said, but that practice went out of style in the 1970s and 1980s. By 1980, only about 1 percent of doctor-patient interactions were house calls, according to a study cited by U.S. News.U.S. News and World Report When he explained his business model to people who called asking where his office was, many of them were skeptical. He still gets those calls sometimes.
Still, friends of friends starting spreading the word about Table Rock Mobile Medicine. It took a few months, but by August 2016, business was getting consistent.
One reason for that consistency, Bigford believes, is the rise of smartphones. Patients can sign up for an in-home appointment with Table Rock Mobile Medicine using the company’s website. They don’t have to schedule far in advance — they can pick a slot hours away. The website uses a Microsoft Office app to schedule appointments. It automatically factors travel time into scheduling. It also considers what type of service the patient needs — anything from a routine checkup or flu treatment, to specialized visits for men and women’s health.
“I could wake up with no one scheduled, and by noon it could be full,” Bigford said.
Bigford said initially he thought the majority of his clientele would be geriatric patients who had difficulty leaving their homes. Instead, the ease of scheduling online — and the fact that he could travel — made the service a good fit for stay-at-home moms, scheduling for their children or spouses. On his busiest days, working 12 hours a day, he might be able to see a maximum of 12 people. He usually averages between seven and 10 people a day, however.
He sees first-time patients and repeat patients, often for things people might normally go to an urgent care clinic for — stitches, the flu, routine checkups, coughs, rashes, testing for urinary tract infections. He's not an ambulance service, nor is he a substitute for emergency services or a surgeon. But there are a great deal of services he can provide for patients while still saving them a trip to a doctor's office.
Moms with multiple children, for instance, don’t have to load all of their kids into the car when just one has to go to the doctor. Children are also more comfortable in their own bedroom than they are in the sterility of a doctor’s office, Bigford said. This is especially important for children who have anxiety or for those who might be autistic, for example.
Those visits are more efficient than going to urgent care too, he said. A parent with multiple children could spend 45 minutes going to see a doctor in a clinic for a call Bigford said he could handle in 10.
The downside, of course, is Bigford can see far fewer patients than the 30 or 40 an urgent care clinic might be able to take on any given day. His coverage area is also, at the moment, largely limited to Ada County. Still, he’s all right with that.
“I get to sit down and talk with people and get to know them,” he said. “People love it. They feel like they actually get heard.”
The cost of a house call from Bigford is "the same as any standard urgent care visit," according to Table Rock Mobile Medicine's website. He accepts public and private health insurance.
For Bigford, balancing a day of work in the jail followed by a round of house calls isn’t especially taxing. The variety of the job helps, he said.
“With two polar ends of the health care spectrum, it breaks it up,” he said.
Still, he has a 10-month-old and a 5-year-old at home, and he pulls 70-hour work weeks. He confessed he’s had to strive for a work-life balance since founding his own company, and added it’s been “mostly work and not a lot of life.” He takes off every other Sunday.
He just hired another nurse practitioner though, a co-worker from the jail. She’s not working for Table Rock Mobile Medicine yet, but he hopes she will be within the next 60 days. They’re considering having her serve the north Nampa area.
“Hopefully that’ll take some of the pressure off of me,” Bigford said.
Table Rock Mobile Medicine’s style of health care makes it difficult to see a large number of patients across a large swath of territory, but for Bigford, the goal isn’t necessarily about numbers. He wants to increase access to health care. He wants to work around whatever obstacles might stand between a patient and their ability to find quality medical treatment.
He thinks back to his nightmare of a visit to the doctor as a child, when he needed six stitches in the head, and he compares it to other cases he’s had where children need stitches.
Sometimes, he said, they’ve been comfortable enough to fall asleep in their own bed afterward.
“That would never happen in urgent care,” he said.