When she was only 8 years old, Sarah Heiner knew she wanted to practice medicine. She was a sick little girl in suburban Chicago who, along with her older brother, suffered from acute asthma. It was her pediatrician who inspired her career choice.
“He was just a really good role model,” Dr. Heiner says of the physician. She recalls how he sympathized with the unique difficulties her single mother faced raising two sick children in the ’60s. She remembers how he would make house calls whenever necessary. “He made it possible for my mother to keep her job.”
Heiner got her start early. As a high school student, she was accepted into Northwestern University’s Honors Program in Medical Education in Chicago, an accelerated track that had her complete four years of pre-med in just two. It was a little intense, she says — “They had enough kids crack up that now it’s a three-year program” — but it was worth it for the two expensive years it shaved off her tuition.
By the time she was 20, she was in med school. She completed her residency at University of California, San Francisco and Mt. Zion Hospital, then opened a private adult care practice on Rancho Drive in Las Vegas in 1986.
“A lot of us came in the mid-’80s. Vegas was bustling. It was supposed to be a great place to practice medicine,” she says. Then, by the mid-’90s, local insurances started cutting reimbursements, prompting the rise of group practices. According to Heiner, medicine became less about the quality of care than the quantity of care.
“We all thought we were going to get paid to think, which is what primary care doctors are really supposed to be doing, but the system is completely stacked in reverse. The more time you spend with a patient and think about what’s best for the patient, the less you get paid.”
In 2007, having trouble making ends meet — “No one wanted to pay me” — she closed her office, joining the masses in group practice, where she lasted only a year. Frustrated by what she refers to as “sweatshops for doctors,” she quit.
Heiner was headed back to Illinois when she was asked to be the founding medical director for Volunteers in Medicine of Southern Nevada, a free clinic for the uninsured in Las Vegas. During the year and a half that she treated the uninsured, Heiner met and married her second husband and began again. Using money from her savings, she opened a small private practice in Henderson in 2012 ( drheiner.com).
“But the only way to do it, because the insurances don’t pay enough to open the front door and turn on the lights, was to do cash,” she explains. Her experience treating patients at the free clinic led her also to accept Medicare.
While Heiner admits that some of the only 20 patients she’ll see in a day balk at her $100 fee for a 15-minute visit, the business model suits her. It allows her to take the time to properly care for patients. “And if they’re having hard times or are going to need a bunch of follow-up appointments, it’s my luxury to say, ‘I’ll give you a 50 percent discount’ or, ‘This visit’s on me.’”
Taking time to properly treat her patients is important to Heiner. In 2006, she had a patient suffering a viral illness of the heart. She sent him to a cardiologist, where he was diagnosed and prescribed antibiotics thought to have healed him. A year later, he collapsed. The man’s wife called Heiner from the emergency room, where the doctors could find nothing wrong with him. They were preparing to release him the next morning, but before they did, Heiner decided, “I’m just going to take a minute and examine him.”
It was when she placed her stethoscope to his neck that she heard the swishing sound in his carotid artery. A CAT scan revealed that the infection of the previous year had not gone away but had, in fact, eaten at the main outflow valve of his heart; the valve was splitting open. Heiner’s patient would likely have died within the following 12 hours. Instead, for the time she took to re-examine him, he was rushed into the eight-hour surgery that saved his life.