I\’m Rob and I am a recovering doctor.  Yeah, I am recovering…doing a lot better, actually.  Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies.  I\’ve had to learn how to manage my own money (now that I can\’t count on them to bail me out any more), but things are looking a lot better.  I am beginning to see how much better it will be to be on my own.

The key was when I realized that the system wasn\’t going to change no matter how much I accommodated its unreasonable requests.  I felt that if I only did what it asked of me, however unreasonable, it would stop hurting me and, more importantly, my patients.  But I\’ve come to see that all the promises to take care of me and my patients were written in sand, and that it couldn\’t resist the temptation to cheat on me.  I tried to do what it asked of me, but as time went by I couldn\’t take how dirty it made me feel.

I want to believe it was sincere when it told me it wanted to change.  I think at its core, it wants to help patients and doesn\’t want to go on those spending binges.  But no matter how sincere the promises sounded, I was always left alone as it threw its money at every sexy treatment, procedure, or drug that walked by.  Then it would go off on tirades about how much I spent and that I didn\’t do enough to keep to our budget.  It was always my fault.  I think it\’s just easier to pass blame on others than it is to do the hard things necessary to really change.  To be honest, I think it was terrified at how much real change would hurt.

But I can\’t sit around and wait for the system to change any more.  My patients were getting less and less of my time, and I was getting to the breaking point.  I know there are a lot of other doctors who are willing to do whatever the system asks, but I can\’t sit around and watch it self-destruct.  It\’s not what\’s best for the system, for us doctors, and for our patients.  Sometimes the best thing you can do for someone is to let them self-destruct and pray that they finally take responsibility and learn the hard lessons.  I just hope that happens soon.

So what of my life?  Rebuilding everything from scratch has taken all of my energy, but I have much more of that energy when I know it will do good.  I can spend more time with my patients, answer their questions, and focus on them, not the system.  Even though I see how much more I could give my patients, how far their care is from where I want it to be, they are delighted with my attention and availability.  They are used to doctors giving them the leftover scraps of attention, not the bulk of it.  I hope they believe me when I say that my plans for them are much, much bigger than what I am giving at this time.

I\’ve resisted the temptation to run to the arms of another for the sake of financial security.  My experience with the system shows that nobody pays you without expecting more in return.  Then I\’d just end up compromising to keep the money flowing, and that is a kind of relationship I just got out of.  Instead, I am trying to do it the right way, keeping my focus on what is important: giving my patients the best care possible.  It\’s not been real exciting – there hasn\’t been much to write about, spending my creative energy on a building system that will actually improve care, not hinder it.  I\’ve also had to pay much more attention to the little details: tracking where the money comes from and where it goes.  I\’m not real good at that, so it\’s been a steep learning curve, but it\’s given me a sense of control I\’ve not had for a very long time.

I can\’t tell you how different it is, working in a job that actually rewards me for doing the right thing.  I am no longer penalized for healthy patients or an empty waiting room.  I am no longer paid less to spend more time with people or to handle their problems without forcing them to come in.  I don\’t have to live in fear of the Medicare audit.  I can spend my time with my patients as they need it.  I had a guy come in wanting me to help him with his struggle over a decision about his elderly father.  We talked for nearly an hour, and I realized that I wasn\’t at all frustrated by that fact.  There\’s no CPT or E/M code for this kind of thing, but it was what my patient needed, and it is what he pays me for. He left with a look of appreciation we doctors seldom see.  It is incredibly freeing to not have to apologize for doing the right thing.

But I don\’t want to brag.  I\’m no saint, and the system I\’ve built to this point is far from perfect.  I\’ve still not taken a paycheck, and that can\’t go on too much longer.  Things could still go wrong.  But my decision to no longer try to live in my dysfunctional and destructive relationship has been worth the pain and uncertainty.  I miss the patients I had to leave behind, and I am sad to hear about the care they are getting.  I hope I can build something good enough that lets me offer to them what my new patients have, something I\’d given up on: hope for the future of health care.

That\’s all I\’ve got for now.  Thanks for listening.  One day at a time.

Live and let live.

5 thoughts on “Recovery”

  1. It’s inspiring to think that maybe medicine of the future returns to building relationships with people.

  2. Service Delivery ModelThe basic problem is that you have the customer (patient) -> middle man/distributor (insurance company) -> manufacturer (doctor). Obama care forces everyone to use a middle man. How can that be less expensive for everyone? What if we end up having to use 2 or 3 middle men? Distributors can be great when products are manufactured in large volumes when the customer only needs a small volume. But this is not the way healthcare works, is it?
    Problem of Pricing
    If you go for an MRI today it is currently difficult for someone to quote you a price for the procedure ahead of time. Do you need contrast or not? Two different prices. Then different facilities will charge different rates for the machine time, staff, overhead… They say it is impossible to provide meaningful pricing information.
    Yet if you go to an auto mechanic they will quote you a price. Prices will vary from one mechanic to another. I may have a trusted mechanic that I use who I know charges me more than some other options but I know overall this mechanic is a better deal. I don’t need to have a middle man (insurance company) tell me which mechanic to use or what service will be paid for on my car.
    A interesting model, similar to what Rob is doing, is in buying a new BMW where all maintenance is included for 4 years in the original purchase price. No hassle for the customers. Only one place do you need to bring the car. No fear of being cheated on service upsells (unnecessary medical procedures). The dealership is motivated to fix the car right the first time.
    Rob you are on the right track – eliminated the unnecessary middle man. People will adopt your model for 4 states of health (healthy, acute, chronic, trauma) the fear comes from massive traumas where a long hospital care is needed. The fear is how will the customer (patient) pay for those expensive (sometimes unaffordable) services if needed. If you share these risk across your patient pool then you are providing insurance. Once you go back to having some patients bare more of the risk than others then you are back close to what we have today. If you can solve this expensive healthcare event for the patient, then you will have more customers than you can service.

  3. Gurneet Kohli

    The problem with us doctors is that we have always done what is told and keep getting pushed (probably a remnant of our residency days…”this is how it is done, we have to do it, and what choice do we have?”). And, this is true with doctors in all countries. I finished my internal medicine residency 2years ago in NYC… and was the only one in my batch and 2batches up(total of 75) to go into primary care. My colleagues would rather become hospitalists (working odd shifts and no freedom at all) than go into primary care because they dread it. What you are doing is inspiring, and it will work because that is what patients want (basic economics). Bravo!

  4. This breaks my heart a little… maybe a lot. Not because I don’t understand. Not because I’d want to force you to remain in the system. Because of the loss to Medicaid and Medicare patients. We who can’t escape them are receiving worse and worse care as the good doctors break out of the system. I am right now faced with wanting to get back to one of the very best doctors I’ve seen (I have RSD/CRPS,) but wondering if it will be possible, because they don’t want back in that system. I don’t blame them! I Really don’t! I just don’t know how I’ll be able to work out how to regain this doctor’s care when my only means of paying has been through Medicaid. It’s a rotten system!

  5. We see this happening more and more. I think patients if they are paying themselves for something they take owner ship of that, and in this case their health. I also think, and could you comment on this further, it strengthens the doctor/patient bond. From other docs that practice like this family members pay for their parents especially if they live out of town. It gives good piece of mind. This type of practice isn’t for everyone either but works great for those who choose. Best of luck!
    My medical Satire site: -enjoy

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