I was recently sent this Sacramento Bee article by a loyal reader of AM. It talks about being an upstream doctor and I will let you read about it to understand what that means. There is some purity to the concept and it makes me nostalgic to a time when I wanted to become a doctor. The physician highlighted in the piece actually switched from surgery to primary care and claims it’s a great time for others to go in to the field. Listen, I love when anyone talks like this because being an “upstream doctor” is really what authentic medicine is all about. That being said, the article misses so much. In today’s insurance environment with behemoth EMRs that make you work for it instead of the other way around, this is no time to go upstream. Instead, you drown along side the patient. The only way to accomplish the goal that this doctor talks about is to work within the insurance model and go broke or go into Direct Primary Care.