Doctors in the House

Patients over the years (and even still today) ask me why I don’t go into private practice.  They don’t understand that it is almost impossible to do it.   Other than concierge care, which is my dream, there are very few doctors who have been successful working with insurance companies.  How sad is that?  Even sadder is an article in the WSJ entitled Humana Brings Doctors In-House.

Humana is accelerating its move into directly providing health care, with new deals and planned investments that are expected to expand the number of physicians under its umbrella to more than 2,600. The insurer said Monday it is spending around $500 million in cash—or $850 million including debt—to acquire Metropolitan Health Networks, a Boca Raton, Fla., company that operates health-care-provider networks serving people on Medicare, Medicaid and other plans.

To summarize, we are turning into the Borg:

The Borg are a collection of alien species that have turned into cybernetic organisms functioning as drones of the collective or the hive. A pseudo-race, dwelling in the Star Trek universe, the Borg take other species by force into the collective and connect them to “the hive mind”; the act is called assimilation and entails violence, abductions, and injections of cybernetic implants. The Borg’s ultimate goal is “achieving perfection”.

I am asking that some reader out there comment by taking the Borg paragraph above and change it/tweak it by putting the word physician in there and make it reflect what is happening in healthcare.  Have fun!

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  12 comments for “Doctors in the House

  1. Sandy Brown
    November 14, 2012 at 10:19 am

    I guess I’m one of the few doctors who have been successful in working with insurance companies. It never seemed to be to be particularly difficult; I just learned how to use my office management software to bill them, then I taught my office manager how to do it so I could spend my time taking care of my patients. By in large, insurance companies pay me in a more timely fashion than some of my patients do. Taking the time to learn the nuts and bolts of running my business has allowed me to be in independent solo practice all these years without having to go to concierge care. Docs who don’t want to learn the business of medicine wind up working for someone else. If you’re unhappy being an employee, work for yourself they way we all used to. Trust me, it was much harder getting into medical school than it is to do this.

  2. November 14, 2012 at 8:41 am

    Insurance companies are a collection of brainwashed humans that have turned into sycophantic organisms functioning as drones of the Master organism. A pseudo-race, dwelling in our complex universe, the Insurance companies suck in other normal species by force into the collective and feed them the Kool-Aid daily; the act is called assimilation and entails cajoing, bribing, misdirection and an appeal to the “greater good”. The Insurance companies’s ultimate goal is “achieving financial perfection” for its CEO and shareholders at the cost of the huddled masses yearning just to be cared for properly.

  3. November 9, 2012 at 3:11 pm

    Then why work with insurance companies. There are many of us “out there”, more than you think that are fee for service. The list is growing as OBAMACARE takes hold. We refuse to deal with regulations. Unlike Star Trek or the Borg, I like to think of myself as a member of Rebellion (Star Wars). Our mission is to preserve the patient-physician relationship but also to promote patient responsibility.

    This is what US medicine is and always will be. It is is interesting to see the US moving towards the Borg like state but other countries now “rebelling”, like DATA in First Contact telling the Borg leader–
    “Resistance is futile” prior to destroying the collective.

    It can and will be done, it may take an effort but anything worthwhile does.

  4. Pat
    November 9, 2012 at 12:27 pm

    As the Borg queen said in “First Contact”, “Witness the end of your future!”

    As D Haugen demonstrates, anything other than an enthusiastic embrace of the collective results in personal attacks, fact distortion, and a relish of force, rhetorical or otherwise.

    Leaving private practice had more to do with huge overhead costs, and nothing to do with abandoning my self-Diefication… I did it for the cash and would not go back.

    “Anything else is peddling the practitioner’s birthright” … what a hoot.

    • November 9, 2012 at 3:48 pm

      Sorry if I missed the humor in the response.

      However, if I’ve done no more than given visitors here a good chuckle on this Friday afternoon, my response has resulted in some measure of hootable good.

      • Doug Farrago
        November 9, 2012 at 3:59 pm

        I don’t think anyone was critical of your response

  5. November 9, 2012 at 9:39 am

    If you truly care about the practice of medicine, you would not be so tunnel-visioned in your opinion that private practice physicians think they are God and make poor decisions as opposed to the corporate physician who makes only decisions the corporation allows.

    We should be looking at how to get back into the hands of physicians the ability to make medical decisions which are not controlled by insurance companies or the company that owns the physician. Anything else is peddling the practitioner’s birthright, no matter what term is used to justify the sellout.

    And last but not least, there should be room for many forms of medical practices, whether company-owned physicians, concierge practices, or independent practices. There are still those in medicine who think outside the box, although the media and the tunnel-visioned in medicine try very hard to claim independent thinking in medicine does not exist.

  6. November 9, 2012 at 8:21 am

    Wow, there’s a drone response already! “solo doctors have nobody but themselves to answer to… [so they make] lousy clinical decisions… and believe they’re God.” Yes, if you’re not connected to the hive you couldn’t possibly think for yourself or make intelligent decisions. Resistance is futile!

  7. November 9, 2012 at 8:15 am

    Hospitalists are a collection of primary care physicians that have turned into cybernetic organisms functioning as drones of the collective or hive. Hive collective administrators (HCAs), in association with partnered alien species drawn from the insurance industry and government, take other primary care physicians by economic force and connect them to “the hive mind”; the act is called assimilation and entails crippling reimbursement cuts, massive increases in documentation requirements, oppressive professional liability insurance rates, punitive bureaucratic legislation, and threat of imprisonment for failure to adhere to laws that HCA- partnered species interpret however they wish. The HCAs’ ultimate goal is “achieving perfect dependency” first for the drones, then for their patients, so that HCAs and their alien partners will become all powerful – dictating how neighboring species live, breathe, and conduct their affairs. Resistance is futile.

    • Doug Farrago
      November 9, 2012 at 10:26 am

      I love it!

  8. Stella Fitzgibbons MD
    November 9, 2012 at 8:08 am

    I never for one MINUTE considered private practice. My father was a small businessman and it was all too easy to picture myself spending time on accounts receivable, insurance contracts and equipment purchasing that I could be spending practicing medicine. Large group practices can afford to hire people who are better at all these than I am, and IMO that’s the way to go. Sure, there’ll be some oversight, but it’s no worse than the lousy clinical decisions I see made by solo doctors who have nobody but themselves to answer to and are surrounded not by colleagues but by employees whose livelihood depends on letting Doc believe he’s God.

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