Dr. John Decker, an otolaryngologist (or ear, nose and throat specialist), poses in his new offices Friday at Adirondack Medical Center in Saranac Lake. (Enterprise photo — Jesse Adcock)

SARANAC LAKE — Dr. John Decker, an ear, nose and throat specialist who has been practicing here since the 1990s, started working for Adirondack Medical Center Jan. 1.

He and his wife Martha previously operated a private practice on Old Lake Colby Road, just behind AMC, for 15 years.

“The main thing is that running a private practice is very difficult for two people,” John said. “There are a lot of administrative aspects unrelated to taking care of patients that had become more and more burdensome, and as a result, it started to wear on us.”

Physicians moving away from private practices and toward hospital employment is a national trend. John said it’s too onerous to handle the administrative and regulatory sides of things alone anymore. Now, when young health care professionals look to enter the industry, they’re eyeing salaried jobs.

Since 2003 the Deckers operated with John as physician and Martha doing almost everything else.

“She was answering the phone, scheduling the patients, doing all the nursing,” John said.” Doing all the billing — there was no time. All night. All weekends. So the hospital will take over many of those burdens. … She’ll be my nurse now; she won’t be my receptionist and my biller and all of those sorts of things.”

Martha said she often worked 10-hour days on the weekend to get caught up on business from the work week.

“The problem was our office didn’t run like others,” Martha said. “It was just him and me. … The hospital will unburden us from that.”

John said he doesn’t see his practice changing at AMC, as he’ll continue to do what he’s always done — see patients.

“The fancy term is otolaryngology,” John said. “My practice involves general ears, nose and throat problems, including, basically, tonsillectomy and ear tubes and head and neck surgery. I do a lot of thyroid surgery, thyroidectomies, cancer surgeries, salivary gland surgery, sinus surgery, including the endoscopic sinus surgery.”

Three or four times a week, John said he’ll see people with skin cancer they need removed from their cheeks, their noses, ears and necks — something that may be thought of as plastic surgery but falls under ear nose and throat instead.

John also said he handles a lot of trauma-related surgeries, from broken jaws to noses and cheekbones.

He said all that’s likely to change is Martha’s role in their partnership.

“She has been remarkable,” John said. “A couple years ago, we had our granddaughter with us from birth to 18 months. And she managed to do all the things I described plus the day care for the child, during the day, in our office.”

He said that in large part, people had come to depend on her more than him for service. This included working with people who needed care to solve insurance issues.

“Someone can say, ‘Well, I have a billing problem.’ Well, instead of ‘Press 4 for billing,’ she’ll say, ‘Oh I know about that problem, and yes, you’re alright. We’ve sent that off to the insurance company, and they’ll come back and you don’t have to worry about that,'” John said.

In the Enterprise’s Best of the Mountains contest run each year, John said he didn’t used to win the best physician category “until my wife joined my practice 15 years ago, and then I started winning. So it wasn’t anything I was doing different. It was how she was helping people, and that made my practice better.”

Part of the challenge for a private-practice ENT to operate up here, John said, is there wouldn’t be anyone to pass the baton to each day. A physician can’t take a day to go skiing or risk going out to a bar and being unavailable. That’s because there aren’t enough patients to support two or three ENTs.

“I’m hoping that we can develop an ENT service within the hospital so that when my exit comes in future years, whenever that happens, that they will have an attractive place to offer a young person that’s interested,” John said.

He said their phone would ring constantly at the Latour building — that people had been coming from St. Lawrence, to Champlain, to north of Glens Falls to see them.

“I think it’s because, you know, they get treated more personally and warmly,” John said.

Working out of a private practice, he said insurance caused many headaches. As a physician he wants to take care of the someone’s problem — do the procedure, get a patient checked — but it’s sometimes hard to know what a patient will be able to afford, what their insurance situation is, whether it’s all coming out of their pocket.

“Unlike the days when my father was a surgeon here and the patient, say, didn’t have a lot of money or something, they’d say, ‘I got a nice block of trout I caught this morning, you know,'” John said. “And that’d be fine. Fifty cents or whatever. That was literally the way it was practiced.”

John is a second-generation doctor in the Tri-Lakes. His father, Dr. Alfred “Fritz” Decker, practiced here for more than 40 years.

“My father was a thoracic and vascular and general surgeon,” John said. “So he was trained very broadly and excellently, and he came to Sunmount when it was a veterans hospital in Tupper Lake.” He accepted that position in 1951, according to the Historic Saranac Lake Wiki.

“He came up here to get his chest boards in thoracic surgery involving tuberculosis, and he was at heart a hunter and fisherman,” John said. “You know that’s what he liked to do when he wasn’t doing surgery. … So he was extremely, you might say, over-trained for a rural practice, but his heart was up here in the Adirondacks, in fishing and hunting.”

After about a year’s stint in Richmond, Virginia, working the Medical College of Virginia, Alfred Decker returned to the area and joined the Adirondack Surgical Group in 1957.

“Which was Carl Merkel and Warriner Woodruff, back then,” John said, and they covered “the three hospitals, Lake Placid, Mercy in Tupper Lake, and Saranac Lake. … More doctors were attracted because there was this nucleus of well-trained people in a beautiful area. … Dr. Merkel’s son came up and practiced as a surgeon in the area. And Dr. Decker’s son came up and practiced as a head and neck surgeon in the area. And so there was this family tradition.”

John said his original practice opened up here in July 1990 with the Adirondack Surgical Group. Then in 2002 and 2003 he undertook a sabbatical at Albany Medical Center while Martha did day care for their first granddaughter there.

“And then we came back in the end of 2003,” John said. “2004, I think, is when we opened up the practice in the Latour building and had been there since.”

John’s had an unique career as an otolaryngologist. In addition to doing ENT for nearby prisons, he’s also helped deliver children — in one case, all four children in one family. Because he was a solo ENT, Dr. Denise Ferrando would often help out at the Latour building when John needed extra hands for processes like thyroidectomies.

“She’s an OB-GYN doctor, and sort of tit-for-tat, I helped with the C-sections,” John said, “and some of the gynecological surgeries that required an extra pair of hands. And so it’s kind of unique that up here, an ears, nose and throat specialist has delivered in one family, all four children by C-section — as an assistant, not as the primary physician.”

John said that compared to their old space, his new offices are more sterile, which is good and bad.

“It’s less folksy and more hospital-ly,” John said.

He said nowadays a patient will often go into a check-up and see a doctor who is working on a computer rather than looking at the person. During their time in private practice, the Deckers did almost everything by hand — prescriptions were written, insurance forms were mailed. People would come straight to Martha, and then to John. But he said their new partnership with the hospital will have mutual benefit.

“The mission of Adirondack Health is to provide ‘excellent health care close to home,'” John said. “So we’re on the same side. We’re both working in the same direction. … We hope to bring some of that family aspect to the institution, and I’m sure the institution will bring some of its excellence to us.”