A Doctor Leaving Solo Rural Practice by Marsha McKay DO


I am one of the docs who decided that medicine is not fun anymore, and more importantly is no longer tolerable with all the documentation, coding, referrals, prior authorizations, begging insurance companies to “let me” prescribe necessary medications and so forth. I can’t practice medicine anymore as an Authentic Doctor so I closed my private solo rural practice five days ago and will now just work 8 hours a week in small county jails. I am tired of spending my days clicking templates on an EMR so that if I get audited I don’t have to go bankrupt paying back Medicare or being accused of fraud when I just forgot to document that someone has a gun in their house or doesn’t wear their seatbelt. I did the EMR incentive program for a year, got my $14,000 and then realized it was a loser financially and time wise and added nothing to good patient care. Ditched the program the next year. Then it was time to cope with ICD 10, ACO’s, patient centered medical home, an electronic health record at the local hospital which is completely unusable and adds hours to hospital work. I really loved my patients, my little office and wonderful staff but I am completely exhausted and done with the struggle of trying to be a good doctor when the forces out there seem to be determined to wear me down. So now about 1500 people have to find a new doctor and I will retire from active family practice at the age of 59. Pretty stupid waste of my training and compassion to be done so early. I am also tired of being perceived as the rich greedy doctor who only wants to make money and is the source of all the health care problems in this country. I am anything but that. Life is too short to work so hard, sacrifice being with family and friends and spend all my time servicing the insurance industry. I’m not tired of being a physician, I’m just done with all the unnecessary garbage that comes along with it. I agree that doctors are wimps and in our defense, we are just too busy most of the time to get organized and do something about this mess. Most of us are just trying to do some good in a complicated world. Now I’m going to take care of myself, my family and have a real life. Yahoo!

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] 

  15 comments for “A Doctor Leaving Solo Rural Practice by Marsha McKay DO

  1. Gaspasser
    May 22, 2014 at 3:40 pm

    Best of luck. I jumped off the hamster wheel last year at the same age, and haven’t looked back. The system will collapse under it’s own weight when enough physicians say “NO”! Until that happens, my advice to my colleagues that have a choice is to go completely concierge. Lose your addiction to the biggest and the best. I’m living on a fraction of what I used to spend, and have never been happier.

  2. Dr. Saul
    May 21, 2014 at 1:25 pm

    Well, Marsha, it was the “greedy docs”, the “greedy pharmas”, and the “greedy hospital/instutions” that got us into this fix and it ain’t over yet. The “push back” from the govt agencies, insurance companies, and your very patients has just begun, and rightly so.

    • Pat
      May 21, 2014 at 5:28 pm

      Dr Saul, not sure I followed your answer, particularly “very patients…rightly so.” I’m probably being to literal, but would you please elaborate?

      • Kurt
        May 21, 2014 at 8:16 pm

        I think Dr. S. was being facetiously jocular.

        • Pat
          May 22, 2014 at 8:21 am

          I hoped… 🙂

  3. Kurt
    May 21, 2014 at 12:34 pm

    Another nail in the coffin of physician mediated primary care. I wonder what BS they
    are mixing in with the pablum they are feeding the med students concerning FP.
    When they find out a lot of patients ignore their advice and that they, the physician, are going to be held responsible for their crummy outcomes, they will avoid the specialty in
    droves. It will go to the NP’s like mentioned above and then they will vacate it too when they realize what we already know. Kurt

  4. May 21, 2014 at 11:36 am

    Dr. McKay, Good luck to you. If it helps a tiny bit, we patients really do understand your position and wish you the best. Be happy!

  5. Rural Ob_Gyn
    May 21, 2014 at 10:14 am

    I could have written this as almost every item is true for me too in my rural solo obgyn practice. As we say to our veterans, “Thank you for your service, Dr. McKay.” Very sad for your patients.

  6. May 20, 2014 at 11:17 am

    We must realize now, of course, that whoever pursues this course that is destroying physicians, is doing it with full premeditation. We should stop warning each other that they must stop this error – they don’t see it as an error at all! No leader invades a country by accident.

    • Fred LaVenuta
      May 21, 2014 at 12:38 pm

      Doctors are expensive and I’m sure the federal regulators would like to replace most MDs with “midlevel” providers as they are easier to control, dispute less and are paid less.

  7. Helen
    May 19, 2014 at 1:51 pm

    My doctor of nearly 20 years also left his practice within a group that was bought out by the hospital. He checked into working outside of the U.S. but returned months later as a concierge doctor. He still has his hospital privileges and even tho hospital had doctors for patients there..still took care of his own patients then. He has saved both my husband and myself from what could have been fatal misdiagnosis. Will hang with him. Perhaps some who are leaving in frustration should look into this concierge practice.

  8. Frank J. Rubino MD
    May 18, 2014 at 3:45 pm

    Sad But True. We will be replaced by Temporary Nurse Practitioners and Physician Assistants who will start out in Primary Care and move on to a specialty office that pays more. They will practice for a few years and move on to another part of the state or country where the hours are better etc. With their master’s degree they can teach at nursing or PA schools and not have to deal with as much paper work. They won’t have to deal with the human condition over a lifetime in one town or one area . I have been at it more than 36 years. Thanks for your comments.

  9. Charles Davis
    May 18, 2014 at 1:47 pm

    SO TRUE…&…SO SO SAD! Doug, predictions are coming true!

  10. Pat
    May 18, 2014 at 11:16 am

    Dr. McKay, you are taking the step that many of us are too frightened, constrained, lazy, comfortable, cynical, or apathetic to pursue. Yours is the only completely honest choice, and I sincerely admire you for it.

    • May 22, 2014 at 10:34 am

      God bless you, and never look back. Pam Wible MD has written about some of our colleagues who have stopped a bullet in the head, or overdosed, or jumped off of things. The life you save may be your own.

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