Cookie Doctor

I think I reached my pinnacle:  I got my face on a cookie!

This was part of the 10-year anniversary party we held with a few of my patients who have been with me the longest.  February 5, 2013 was the first day of my new, crazy, risky, selfish, brilliant practice.

One of the best decisions of my life.

The events that led up to the change were complicated, and at the time, not real clear to me.  Somehow things had gone downhill with my partners in the practice I had co-founded.  Financially, we were in good shape.  But there was poor leadership (I take blame for that), which caused there to be undercurrents, subterfuge, and a seemingly sudden decision that my presence would not be beneficial for the future direction of the practice.  I was shocked, and obviously upset.

But I am now incredibly grateful (and..yeah…perhaps a bit snooty towards my old practice). Their decision led to my decision, which led me to build something so much better, so much happier, and so much more in line with my values.  So I thank them.  And I feel sorry for them.

The life I lived before 2/5/13 was typical of a primary care doctor in fee-for-service medicine.  I had too many patients and too little time.  I was fighting to give good care while the system encouraged me to do the opposite.  I was increasingly convinced that I had to choose between good care and a good career in medicine.  As long as I worked in the US healthcare system, I could not do both.  I did everything I could to make that work, and became obsessed with making medical records so efficient that I had more time for actual care.  I was rewarded for this obsession when our practice won a national award for it.  

But the writing was on the wall, and thankfully my partners found cause for separation, and mercifully dismissed me from American medicine.  

They also let me pitch my new idea for healthcare to my patients, and nearly 200 followed me from the start.  I’ve added more of my old patients as the years past, and as the practice model not only proved viable, it proved preferable for both doctor and patient.  It didn’t hurt that fee-for-service primary care continued to alienate, frustrate, and harm.  

Many years ago, I came up with this true statement: People are not agitating for better healthcare because they don’t realize how bad their care is.  And the reason they don’t know how bad their care is, is because they don’t know how good it could be.  I wrote this down when I was still focused on improving quality of care through computerized records.  So I guess I never changed my vision, I just changed my means.  

While I went through the transition to direct primary care, I did something that would have repercussions that I didn’t anticipate: I wrote about my journey.  I blogged, and my posts were picked up by other websites (with much bigger viewership) and so my writing was read by many.  This had two big effects: opposition and influence.  The opposition came immediately, through comments on my articles.  These people felt that I was abandoning the system, and more egregiously abandoning my patients by bolting from the sinking ship of American healthcare.  I was told it was morally wrong, as it was giving decreased access to good care.  I was told that it wouldn’t work because I would cherry-pick patients and would abandon the elderly and poor.  I was told many things, some that had merit and some that were easily dismissed.  

But I knew I was right.  Once I had fully embraced the beauty of the simplicity of direct primary care, I was convinced that it was a revolutionary idea, one that could truly change things for the better.

The other big thing that happened as a result of my writing was slower in coming to my attention: I was influencing people.  While some took snipes at me, others understood the idea, and saw what I saw.  They saw the hopelessness of fee-for-service primary care. They understood that it was incompatible with good care.  And they realized what I realized: that a simple change to the payment system made things completely different.  It enabled good care where the old system prevented it. I’ve been thrilled to hear how sharing my journey though this helped others to decide to join me in this journey.

The proof to all of this has been my story of the past 10 years.  Not only has my practice succeeded, but the number of other doctors doing this model has exploded.  But the thing that matters the most to me is the personal impact of direct primary care.  My patients have gotten better care.  I have saved people money, have prevented them from being hospitalized, have prevented disease, and have saved lives because of the time I have with them.  I have cared for the elderly and poor in ways that were impossible in my old practice.   I see people walking out of my office with a sense of wonder, with gratitude to actually have my attention, my time.  

I have also seen the impact of this practice model on my colleagues.  Doctors who were ready to quit healthcare are able to practice it with quality they never dreamed possible.  Medical students who would’ve been repelled by the soul-crushing difficulty of primary care practice are choosing direct primary care.  I see happy doctors.  I see excitement about caring for their patients.  

Finally, I see the impact of this on my own life.  I still like being a doctor.  I still get a thrill out of making a difficult diagnosis.  I still have the honor of being there at the hardest moments in people’s lives, and the joy of being able to be a positive impact on many.  And as I do all of these things, I have a life!  I don’t go home late, I don’t usually have a full schedule.  It is still work, but it is satisfying work.

So now the focus goes toward the next 10 years.  I am 60, so my eyes inevitably move to the legacy I leave.  Yes, I want to create a successful, sustainable business that will support me in my old age.  Yes, I want to do things that will impact the lives of my patients.  But instead of being at the center of things, I want to be able to step off the stage and pass the baton to the next generation of doctors, nurses, and advanced care providers.  I believe we can build something more than just a niche in healthcare.  I believe we can do more than just help a few.  We can make a difference.

Trust me.  After all, I got my face on a cookie!