I usually spend my winter break planning out vacations and schedules for the year. But this year I spent my winter break planning out a whole new life. A whole new direction for my medical practice, my patients, and my family.
I was 22 years old starting medical school as a freshly minted chemical engineer, my chosen undergraduate degree. Four years of medical school and five years of residency later I joined a primary care practice in Utah. It is now 18 years and I am still working at the same insurance based practice. When I joined this practice, my oldest and only child was two. Now he’s almost twenty and I have four children.
In almost three decades since I started medical school and dedicated my heart and soul to the practice of medicine, a lot has changed… but some things stayed exactly the same:
I love solving problems.
I love helping people.
I love learning new things.
I love seeing patients.
I count them as part of my extended family. I relish the fact that I can be present for some of the most joyful, terrifying and tragic parts of my patients’ lives.
I see my job as a privilege, a calling to which I have dedicated a huge part of my life, my passions, and even my health. Despite the sacrifices made I do not regret my choice. I love watching infants grow bigger, the old folks grow older and the fact that when I go to the office I feel like each visit is time to catch up with an old friend.
Of course when I started, I thought the only two people in the exam room would be me and the patient. Silly me.
The exam room is crowded with a bunch of people. My attention is split between these intruders and the patient in my current insurance based practice.
Who are all these middlemen crowding me in my sacred “safe space”?
We’ve got an insurance company whose goal is to get in the way of spending some of those astronomical premiums on actual care that benefits the patient.
We have the pharmacy benefit manager, who uses opaque pricing and other schemes to pretend that they’re actually saving the patient money on their medications…. All the while collecting legalized kickbacks and funneling billions to their now vertically integrated insurance companies.
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There’s the employer of the patient who picked this insurance company. Not that they had much choice … having to constantly renegotiate plans for employees. Every year less benefits cost more and more dollars, dollars that come right out of my patient’s salary.
There’s the government. The Center for Medicare services bureaucracy creates mountains of paperwork and check boxes and even dictate specific visits that I have to have with my patient every year. Visits with no added clinical value.
There’s the computer. The electronic medical record demands my attention as I struggle to add up to twenty codes per visit, type in carefully worded narratives and check a million boxes. It’s basically a cash register and data collection device for all of these above mentioned exam room intruders. Built to help them … not me or the patient.
Even the state gets involved, because they control Medicaid. Both Medicaid and Medicare have reimbursements that are so low the only way to keep an insurance based practice viable is to maintain a very high volume usually with a non physician, i.e. short appointments with a nurse limited to one or two problems at the most.
We’ve got the pharmaceutical companies wedged in there too. They have created amazing medications for my patients but the price tag is astronomical. The best treatments for diabetes cancer and heart failure can cost over $10,000 a month.
All these third parties drive up the cost and complexity of the system, and provide astonishingly little benefit to my patients considering the average insurance premium is over $1500 per family per month.
It’s getting really crowded in this exam room. I feel like I can hardly see the patient that I’m trying to help. In the insurance model I’m not even a doctor…. I’m a traffic cop on crowd control duty. 15 minutes at a time. All. Day. Long.
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About a year ago after a series of punishing eighteen hour workdays I made my final decision that I could not continue like this. I will get off this train careening towards the land of substandard healthcare.
What is the price of admission for this high speed train? Non consensual compromises for my patients and for me.
I love my patients, I want to provide them with the highest quality personalized attention that I can offer, but I am unable to do that in an insurance based practice.
In 2024 I will open a new practice called Blossom Health. It is a membership based model for patients called direct primary care. I believe this model takes all of the good and eliminates much of the bad in the insurance system.
It is called direct because I will contract directly with the patient and only with the patient. There will be no insurance companies in the way of my ability to care for my extended family for the last eighteen years.
It is called primary because healthcare is of primary importance and I provide the most important, basic head to toe cradle to grave care for patients. It is estimated that a good primary care physician can take care of almost 90% of one’s healthcare needs. In my new practice model I will be doing just that.
The word care is included because I care enough to want to provide the type of care I can only provide with extended appointments times, direct timely access to me and the ability to meet patients where they are at using text, phone call, or video. I can do this because I don’t have an insurance company to tell me I cannot.
Direct primary care, also known as DPC, is a membership based practice. The members of my practice called Blossom Health will pay an affordable monthly fee similar to the cost of a mobile phone bill. No copays, no surprise bills, just an exam room with only two people in it.
Imagine having personalized expert care from your physician when and where you need it.
Imagine feeling confident that your physician will partner with you on health related decisions for you and your loved ones. Imagine if your physician worked for you, not the insurance company.
Join the direct primary care movement and say goodbye to crowded waiting rooms, answering machines and all the runaround.
It’s healthcare; without the hassle.