Yeah, I know I used that line once before, but it’s a special day for me today. Humor me. Five years ago today I earned my last money from an insurance company. Yep, today is my five year sobriety date.
That was before the Affordable Care Act, before the Cubs won the World Series. Before anyone knelt for the national anthem, and if they had, people would’ve probably not minded. It was before the election of a reality TV star to our highest office, before “fake news” became a thing (there was plenty of it, but nobody called it that). It was before half of the rock legends died, before Anthony Wiener went to jail, back when Hamilton was a guy nobody knew much about who was on the 10 dollar bill, when the world wasn’t quite this warm, when Oprah hated me. Actually she still does. I’m not sure why.
I left my old practice because of “irreconcilable differences” with my ex-partners. Instead of going to the VA, joining another practice, or moving to New Zealand, I started a different kind of practice. My Yoda, Dave Chase (who wrote a book that you MUST read) told me about “Direct Primary Care,” where doctors don’t charge a lot, but are able to see a lot of people and give good care because they are paid by their patients. It made sense to me. There were a few folks doing it, and I talked to a couple (I’m looking at you, Ryan) who made it sound possible.
So I did it. I dumped all insurance and started charging people a flat monthly fee. People were skeptical and only my most loyal patients followed me (about 200). It took a while, but we figured out how to make it work, and my patients figured out that this was the best experience they ever had in healthcare.
And we grew.
I added a second nurse, went through several medical record systems (even built my own) before finding one that actually focused on patients over billing. Had some squirrels in my attic (some of them dead), went through an ice storm, a couple of earthquakes, and a hurricane. I also got socks with llamas on them.
And here we are. I have over 700 patients and still have room to grow. My busiest day was when I saw (gasp) 15 patients in the office. I still average between 9 and 10 (although much of the care we give is done via messaging or over the phone, so that number’s a bit deceiving). I still take Monday mornings off, still get home around 5:30 most days, and still seldom get bothered on weekends. My life is still much better than it ever was.
And there is still room to grow.
So what of my critics? What of the people who said I was shirking my duty to Medicare, abandoning my patients, and putting myself over what was best for others? They are idiots. Was it truly better when I was unable to give good care to any of my 3000 (give or take) patients, or is it better when I can give excellent care to 700? Am I truly abandoning my duty to the system by keeping people healthy, taking people off of medications, and keeping them away from ER’s and hospitals? Have I truly put myself above others by taking a huge cut in pay and spending my retirement money? Yeah, that last bit is finally changing, but I’ve got 700+ people who say I made the right choice (and I am still seeing old patients who finally come back to me from my old practice).
What about the criticism that says that this model can’t work in the big picture? What about the argument that if all docs convert to practices like mine, they would not be able to meet the care needs in our country? Again, I am actually giving excellent care to 700 patients. That’s 700 more than I was giving good care to before switching, and 700 more than most doctors give. And there is room to grow that number beyond 700 through increased system efficiency, use of midlevel providers, and improved technology enabling better care, automation, and better communication.
This model works. It is able to give truly good care to people, decreasing their use of the system and dropping the overall cost of care. Do I have proof of these claims? No, but direct primary care has dramatically grown in popularity with both patients and doctors over the past 5 years, to nearly 1000 practices around the country. Patients and doctors chose it because it’s better. It makes sense. I don’t have to waste people’s time, force them to wait in my office (my wait time still averages about 30 seconds), or spend most of my time staring at a computer screen.
So I will pick up my medal for 5 years’ sobriety. There is no temptation to go back to my old life. I hit rock bottom and have been actually enjoying the job of doctor. My future is bright. My income is growing. My schedule still has plenty of room. My patients are happy. How many doctors can say that?
And we are growing.
And I am happy.