I gave a TED talk. Okay, it was really a TEDx talk, done right here in Augusta, GA (the garden city...which sounds good until you realize New Jersey is the garden state) on February 3. The talk was entitled "Hi, I'm Rob and I'm a Recovering Doctor," and it focused on how two basic changes in how doctors are paid can totally change the patient experience
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Direct Primary Care
I could say the cliche' things about it seeming like yesterday, yet like it has been forever since I worked anywhere else. I guess I just did…so there’s that. But more to the point is the reality that I actually survived. Many expressed confidence in me when I started doing this, while many others expressed supreme skepticism over whether or not this type of practice could actually work. To both of those groups of people I say: keep waiting to make your final judgment. The practice, while profitable and now growing steadily, is still not near to the point I need it to be. It’s heading in that direction, but there are no guarantees; I still could mess this thing up.
Since my model of practice (a monthly fee without copay or other profitable procedures/products) benefits most from people paying for my service without heavy use of those services, this seemed to be prudent. It seems that I was right about this, when comparing experiences with my colleague. People are much less likely to pay $50 per month (or more) unless they have significant need, so a higher price essentially selects for more complex and/or demanding patients.
This is why I can reasonably handle 640 patients today with only two nurses (one of whom is away on vacation). Yes, I don't get as much money as I would for 640 patients at a higher monthly rate, but I wonder if I could actually handle that number of patients with only two nurses if I selected out for more demanding patients with that higher rate. I doubt it. The longer I consider this, the more I'm convinced of its truth, and the less I am inclined to raise my rates (much to the chagrin of my accountant).
Like my practice, membership medicine is still in its early phases. Like my practice, the future of membership medicine depends on a lot of things beyond our control. But the excitement I hear regularly from physicians, residents, medical students, patients, business owners, and even politicians about its potential is quite remarkable. Both of these conferences were full of something that I once thought no longer existed: doctors who were excited about medicine and cautiously optimistic about the future.
It's been a very slow week in my office. Today we almost pitched a no-hitter, having only one patient come in toward the end of the day. Overall, we've been quiet in nearly every way - few phone calls, few patients stopping by, few appointments, few secure messages.
It's been two years since I first started my new practice. I have successfully avoided driving my business into the ground because I am a dumb-ass doctor. Don't get me wrong: I am not a dumb-ass when it comes to being a doctor. I am pretty comfortable on that, but the future will hold many opportunities to change that verdict. No, I am talking about being a dumb-ass running the business because I am a doctor.
It's a big job, but it's sure a lot easier when I have my nurses and my patients rooting for me and helping me achieve this goal. Really. I cannot express just how much better life is in this practice than it was in my old one. From what I've heard, things are just getting worse in that world.
It's my mission to help pave a road to a better way. I am grateful to have not only nurses on my side, but patients joining in this mission.
Yeah, I am still here. Sorry I left you with Bob the Llamaturkey as my last post to see. That is very thoughtless of me.
Many who have been reading my blog adventure as I build my new practice have noted a bit of a down mood in my writing. Yes, that has been there (not Bob the Llamaturkey, other stuff). The past two years have been quite a but more than I expected. They have definitely been more rewarding and fulfilling than I could have hoped, but they have also been far more anxiety provoking and exhausting than my worries could have conjured. The medical side of things has been wonderful, but the burden of starting a business from scratch is heavy.
Hence the absence of recent blog posts.
I had a very great yesterday.
I saw three patients who had recent diagnoses of cancer. Yeah, those two statements seem to contradict. They don't. Each person I saw gave me a clear view of how the practice I've been building over the past 18 months is making a difference. A big, big difference.
Why do patients feel like they are treated like cows, not humans? Why does our system produce more sick people getting more procedures? Why are things so different for the patients in my new practice? It all comes down to one thing: the basic financial transaction of the healthcare system. From it flow all of the bad things doctors and patients experience. From my rejection of it flow all of the wonderful changes to the care I can now give. There is no meaningful reform that can happen without changing this basic transaction.