On his first day on the job, David Carrozzino found a note on his desk to make a house call on his way home.
More than two decades and thousands of visits later, Carrozzino, a podiatrist, still makes house calls to homebound patients in South Jersey.
Carrozzino is among a rare breed in health care these days. A prevalent practice decades ago, home visits by physicians have declined drastically and are more often made today in rural areas.
By his count, Carrozzino has made more than 15,700 house calls since that first visit in 1991. He also maintains a busy office practice in downtown Woodbury.
"I said 'I'll give it a try,' " he recalled in an interview last week of that first home visit. "I never looked back."
According to the American Academy of Family Physicians, the average family physician makes fewer than one home visit a week, mostly to elderly and chronically ill patients. In the 1930s, about 40 percent of all health care occurred in the home, experts say.
"It takes a lot more time to do a house call," said Wanda D. Filer, a family physician in York, Pa., and president of the academy. "It is used as part of the bigger picture of people who really need it."
The Affordable Care Act, which has enabled more people to be insured and to seek routine care, has increased pressure on primary care physicians, leaving little time for house calls, she said. A physician can treat several patients in the time it takes to make a single house call.
Carrozzino, 53, of Swedesboro, usually makes house calls on Mondays, Wednesdays, and Fridays, and some Saturdays. He sees patients in the office the remaining days.
On a recent Wednesday, he began making his rounds around 10 a.m., crisscrossing Gloucester County in his new bright-red Fiat. His patients jokingly call it "the popemobile." By day's end, he had made 12 house calls.
House calls, Carrozzino says "are my favorite part of the practice." The visits are as much social as they are medicinal.
Toting a black bag of supplies, Carrozzino warmly greeted Ethel Pizzutillo, 79, with a hug at her Westville apartment. While he examined her feet and clipped her toenails, she gave him an update on a recent hospital stay.
Carrozzino was her only visitor in recent weeks and his short time with her seemed like just what the doctor ordered. They talked about the Philadelphia Eagles as a Jerry Springer segment blared in the background.
"His personality is fabulous. Always on time," Pizzutillo said. "He's a gem."
Like Pizzutillo, most of Carrozzino's patients are elderly, live alone, and have chronic conditions that make it difficult for them to visit his office.
Carrozzino routinely checks on their overall health and well being, and if necessary refers them to their primary-care physician for follow-up care.
"There are things you don't talk about in the office," he said. "In the house calls you learn a lot of interesting information."
Experts say home visits improve quality of life and can help cut health-care costs - as much as $3,700 per person annually - by reducing expensive emergency room visits and hospital readmissions.
First-year medical students at the University of Pennsylvania Perelman School of Medicine get field training to learn how to make house calls, making about 180 visits annually. The training is part of Penn Medicine's Truman G. Schnabel In-Home Primary Care Program, which has made about 4,000 house calls since the program began 20 years ago.
"We cannot afford not to do it, not to give these people better care in the home," said Tom Cornwell, a nationally renowned family-care physician in suburban Chicago who founded a practice that has made 90,000 house calls. Cornwell alone has made 32,000 home visits in the past 20 years.
Cornwell, former president of the American Academy of Home Care Medicine, believes house calls will become more common as technology advances and health-care savings increase.
"We are definitely already seeing more house calls," Cornwell said.
For Carrozzino, a typical house call lasts about 15 minutes. He recently spent more than an hour with Patricia Allen, 80, and her sister, Arlene Augustin, 74, at their Williamstown trailer, mostly chatting.
"We look forward to his visits," said Allen, a retired Philadelphia police officer. "He's easy to get along with. Nothing stuffy."
Carrozzino looks forward to the visits, too. It is not unusual for him to take out the trash or vacuum or even put up a Christmas tree for a patient. He offers solutions to problems such as purchasing absorbent carpet pads for a patient who can no longer walk her cherished Pug, Bridget.
"If I could do it six days a week, I would," Carrozzino said. "I get the most gratification out of house calls."
Growing up in Gibbstown, Carrozzino decided at a young age he wanted to become a doctor and chose treating feet disorders as his specialty. He attended Temple University's School of Podiatric Medicine and took over the practice from a retiring podiatrist in Woodbury in 1991.
Patients treat Carrozzino like a beloved adopted son. They invite him to family gatherings and give him vegetables and herbs from the garden. On his way out the door, he told Lucy Wurst, 99, of Mantua, to water a dying plant.
"He's a godsend," said Joan Carite, 80, of Woodbury, during a visit at her high rise in Woodbury. "This is a great service."
Some visits are bittersweet and occasionally tragic. Several years ago, Carrozzino found a house-call patient dead in her home.
Recently, Carrozzino received a package of candy in the mail from a patient's daughter. Carrozzino always took a few pieces from the patient's candy jar during every visit.
Before dying from a massive heart attack, the woman told her daughter, "Make sure you send Dr. Carrozzino the rest of the candy."
"I would be wrong to tell you I didn't have a tear or two in my eyes," he admitted. "This is the type of relationships you build. This is why I am glad I make house calls."