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Growing pains

Growing pains

The Pastoral and Program Models as Seen From a Physicians Perspective.

by Brian Stork

Our local Episcopal church is going through an identity exploration. Currently, we have too many members for a single parish priest to provide individual pastoral care and expand the spiritual and educational programs expected by some of our parishioners. On the other hand, we don’t yet have enough members, or funds, to hire additional support staff such as a full time youth director. Our membership and financial “plateau” has caused considerable discussion and even some tension within our congregation. Some parishioners like the historic “Pastoral Model” of our church. They are concerned, appropriately, that hiring a youth director at this time would threaten the financial health of our historic parish. Others argue that if we don’t take a calculated financial risk and employ a youth director we might jeopardize the future of our parish. The issue is important to me personally because, as a community physician, I not only care about my Church but also share Communion with many of my patients on Sunday.

A few years ago our clinical practice found itself at a similar crossroad. Up until that time, whatever the medical problem might be, we saw each of our patients personally. It was a “Pastoral Model” of patient care if you will. As community physicians we derived a great amount of personal satisfaction practicing in the “Pastoral Model”. I would like to believe that our patients benefited from that model as well.

However, over the past few years our practice has had to adapt to the rapid changes occurring in the health care industry. The identity exploration in our practice began with the realization that we did not have enough urologists in our community to take care of our rapidly growing patient population. At the same time we began to realize that, for basic problems in our specialty, patients probably didn’t need to see a physician provider at every visit.

Our practice took the financial risk and added both a nurse practitioner and a physician assistant to our clinical staff. As a result, patients in our community don’t have to wait as long to be seen and treated. Not only have patients benefited from this transition but our physicians now have more time to spend with the patients who need the most clinical attention. This transition in the organization of our clinical practice has given our physicians more time to sub specialize in the conditions in which they are most passionate about and skilled in treating. We are now treating more patients in our office and providing a wider variety of specialized services then ever before.

The transition from a “Pastoral Model” to a “Program Model” in our practice has not occurred without its share of difficulties. Supervising mid level providers is initially frustrating for physicians who are used to a direct interaction with every patient at every visit. Patients, previously accustom to seeing a physician at each visit, needed time to transition to the new model. Partners used to working side by side started to see each other less as they began to focus on their own specialty interests. Fortunately, our group can now can utilize a wide variety of low cost tools such as e-mail, texting, FaceTime, and Vsnap to stay connected.

Change in an organization tends to occur when the discomfort of doing nothing is greater then the discomfort of changing. There is no question that change can be painful. In our practice, we now embrace change as a challenge and an opportunity. With imagination, hard work, and communication it is possible for organizations as diverse as Churches or physician practices to make the transition from one model of operation to another.

Changes in health care are affecting physician practices rapidly, often by forces from outside of the physician office. Changes in the Church tend to occur much more slowly and perhaps from processes that are more from within the parish. I pray for our church as we work together to discern the correct path and take the next step. I pray for our practice that we can maintain our new course, direction, and speed.

Dr. Brian Stork is an active member of St. John’s Episcopal Church in Grand Haven, MI, and a private practice urologist ( He has a passion for physician leadership, patient education, and community building using emerging technology and social networking. His reflections on life, medicine, and spirituality can be found on Twitter @storkbrian


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Nurya Parish

Thanks for posting these reflections. I’m glad St. John’s is asking these big questions. It’s never easy, but it is necessary to avoid the inevitable drift toward irrelevance that occurs when parishes avoid difficult conversations.

I think the comparison between physician practices and parish ministry is apt, but you are also wise to point out that cultural changes seem to force change more quickly in organizations focused on physical care than on soul care. The church offers the illusion of stability, but it is only an illusion: our stability is found in God. To stay faithful to God’s mission in the midst of a changing world, the church must also change, or risk idolizing our current form over our core purpose.

None of this is simple. You are in my prayers.

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