Idle Thoughts by David Rogers MD, MBA


I PAID TO ASK A QUESTION (at a Doc-in-the-box clinic).

How many ways is this screwed up?

Is it not possible to ask the same question by calling your doctor’s office (if you have one)? Does the doctor’s office simply say “come in”? Does the doctor’s office charge for the phone call? Maybe so, but I certainly never did that. We had protocols for the nurses to answer commonly asked questions and patients were only asked to come in if the answer wasn’t easy and obvious.

How is it that my well educated, intelligent, middle class daughter seems to relish her privilege to walk into a non-physician manned clinic and PAY to simply ask a question of an NP or PA, who doesn’t know and doesn’t examine her child? I didn’t ask, but I’d be willing to bet, that she would be upset if she called the doctor that actually knows her child, and was charged for asking the same question. I’m not suggesting the doctor charge for a simple phone call question, to the contrary. I am just flabbergasted that she doesn’t feel comfortable calling her doctor’s office but happy to pay to simply get advice from a health care provider with less training.

What does this all say about the state of our primary care physicians and their practices? How can we expect them to maintain high quality services when the playing field is tilted so heavily toward their non-physician competitors?

Screwed up all right.


How screwed up is this double standard?

How is it that a CVS or Walmart can have a medical clinic in their building, where they also sell drugs and medical supplies, and it not be considered a conflict of interest, when a physician can not own a portion of a hospital, surgery center, or imaging center because he or she has a financial interest in the facility?

This is truly a double standard and one that should face legal and legislative challenges, just as doctor ownership has in the past decade. I think that’s only fair.


Are people just stupid? How is it that seemingly well educated, intelligent persons think that insurance companies can be forced to sell high quality, broad coverage insurance policies to all persons, with no consideration of pre-existing illness and not expect premiums to rise significantly; AND if they are forced to do this and not allowed to raise premiums to cover their actuarial costs, why would it surprise us when they simply leave the market, leaving everyone with nothing but government sponsored healthcare, essentially Medicaid?

I am losing confidence in our (“We the people”) collective intelligence.. It seems to have taken a nose dive in the last few years.





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]

You may also like...

8 Responses

  1. Steven Gilles says:

    The Minute Clinic type clinics are an answer to a customer expectation (a strange expectation certainly). Unfortunate though it may be, they serve a certain percentage within the population who want to have service in that kind of environment, during odd hours, sometimes simply for an answer to a question that well trained triage nurse in a primary clinic could do for free over the phone.

    CVS and Minute Clinics/Target clinics are by their very nature creating a market and a demand where there might not have previously been one. In other words, because they exist, patients think they need the services and need it “right now”.

    We can put an “Express Care” type clinic in the parking lot in front of my clinic, but no one will use it. We have tried it. Patients either want their PCP and will wait an eternity to speak with them, or they don’t really care and will see anyone that can answer a question . .

    I don’t think Express Care type clinics are inherently bad, but they should be associated with a primary care clinic for proper follow up and referrals back to PCP. Target for example locally in Minnesota – the MD leadership/supervision is all primary care physicians from the local health care system, so any patient that isn’t fitting for the algorithm gets routed to the clinics and any questions the PA/NP has – the phone call is directly to the supervising MD at those clinics.

  2. David Rogers, MD says:

    Dr. D’Agostino: I was born, raised, educated, trained, lived and practiced medicine in Texas. I was fortunate enough to help build and launch a very successful doctor-owned hospital and it is a wonderful place. We take care of patients and families there as if they were our guests at home. Nurses, other staff and the entire administrative team work like a family, functional and all. Patients don’t want to be discharged when it’s time to go home. I guess that’s why I hate to see big government in collusion with other hospital groups for the purpose of disrupting the good things we are doing. Thanks for your comment. You are right about moving to Texas for those unfortunate enough to be somewhere else.

  3. Chris Rhody D.O. says:

    Bread AND Circuses. Better by marshmallows, it will all burn soon.

  4. Bob D'Agostino, MD says:

    I have often wondered why CVS can sell medications, give multiple vaccines, run clinics, and now provide primary care in our area, while doctors can’t provide prescriptions at reasonable margins. Restriction of trade? Unfair competition!

  5. Princess of Problem Patients says:

    Move to Texas. We have physician-owned hospitals here, and they’re actually expanding.

  6. Linda says:

    If Physician and Dental offices were open evenings and weekends, I wonder if patients would choose to go to their providers instead of the local CVS. It gets down to customer service, which is basically nonexistent in healthcare…

    • kurt says:

      We had evening hours and only got the public aiders. It allowed them to watch their soap operas during the day and put off going to the office till evening. That is no lie. Couldn’t afford to keep the clinic open with that kind of payment. I bet CVS and Wallmart take public aid? I bet not!

  7. Steve Roberts says:

    Re: Minute Clinic in CVS.
    I’ve wondered this myself for a year or so since they started doing this with flu shots and going forward from there. But be careful, some of our illustrious colleagues are selling all kinds of crap in their offices as well (but admittedly not drugs unless they want to get into trouble with the State Board of Medicine).

Get plugin