How to be an Authentic Doctor #27: Own Your Own Practice


Well, I took the plunge.  Today is October 13th, 2014.  I graduated medical school in 1994.  It took me 20 years to be the doctor I always wanted to be.  On this day I opened Forest Direct Primary Care.  I can’t even explain the feeling.  My only boss is the patient.  How weird is that?  No more administrators telling me about quality metrics, benchmarks, devaluing me, scolding me, judging me and treating me as a piece of meat.

Honestly, I never thought I was would be employed.  This concept of direct primary care is a movement and nothing is proprietary about it. It is a concept and not  franchise and I love that about it.  Funny thing, I had the idea while in residency.  I told my peers that why don’t we just be our own mini-HMO for the patients?  They thought I was nuts.  I would write up business plans, collect ideas on “self-pay” models, and visualize my future and I was happy….but somehow along the way I got lost.  I had two kids already, owed school loans and was lured in by the succubus (hospital employment).  I NEVER enjoyed it. Sure, I liked my medical partners and patients.  I enjoyed being a doctor, finally, after years of training.  Soon, however, the games started. Total RVUs were being massaged by the administration and our pay was cut.  These soon became work RVUs and we were cut again.  Our staff was rotating in and out like a carousel. Our building was old and we were promised a new one, even to the point of grand architectural plans being drawn up. It took a year to get it right only to have it squashed because a new cath lab was needed to be build (it closed a year later).

I almost jumped about ten years in as the games continued but got sucked in again by another hospital who promised to treat us like gold.  They did…for six months.  Then the administrators needed to prove their worth and started to kill us with a thousand cuts. I left Maine and came to Virginia.  I had to work for an urgent care for a year and it almost killed me but I still had my dream.  The problem was that I was still chicken.  I created my own locum company to rent myself out to a local and large family practice organization.  They treated me well but I knew joining them would put me back into the world of industrialized medicine.  I yearned for something else.  I yearned for authentic medicine and my clinic of dreams. I have built it.  Now the patients just have to come.  Please say a prayer for me.  🙂

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]

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17 Responses

  1. Andrea says:

    I have been in private practice, the VA, and academics (I even made full professor), but I have returned to private practice recently, and I have never been happier. Always, the patients have come. Congratulations!

  2. Suzanne cachat MD says:

    Awesome awesome awesome! Best of luck !!

  3. Bridget Reidy MD says:

    That’s great Doug! You’ll do fine. And it doesn’t matter what size your retirement savings is, (mine’s negative). All that really matters is that you love your work, cause no matter what, that’s what you do most the time.

  4. Lisa says:

    Congratulations! So happy for you. Sending prayers.

  5. Melinda says:

    Congratulations, Doug! I DO believe in the power of prayer and just said a prayer for you. May you always remember, if and when things get tough, to give it to God so that He can intervene in your free will and help you and in any weakness have His strength. You are a good man and a good doctor doing good things and I believe you’ll be very successful and much happier!

  6. Kurt says:

    Best of luck. From the information you’ve shared, looks like you were very careful with your research and picked the right environment to get established. Too bad it won’t work in a rural environment with a high concentration of “gimme this, gimme that” public aid.
    Perhaps you’ll have better luck with compliance with your patients. I still have to remind
    diabetics until I’m blue in the face to bring in a sugar diary. Even if they’ve seen me for years. Kurt

  7. Mamadoc says:

    Congratulations! You’re going to do fine!

  8. Lady Di says:

    Good for you and God speed!! The patients will come and finally you can a physician practicing medicine without the crap weasels stabbing you in the back!

  9. Dennis says:

    congrats on the new practice… I have been on my own since 2002…. I still work for “the man” part-time because I haven’t dumped insurance yet… I keep threatening…. it is inevitable but I feel bad for the patients I will lose (when I should spend more time worrying about how I am going broke fighting the good fight)…anyway it is the best way to go.. good luck…maybe I will stop by to see you one day!!!

  10. Sharon says:

    You’ve come a long way, Doug. Set your sight on success and keep doing what you really love. Medicine can grind you up and spit you out or polish you so you can see what you really want to do with all that knowledge and experience. I will say a prayer for you and light a candle. Blessings!

  11. politovski says:

    Our prayers are with you. I worked for someone else, briefly, and will never do so again. I was working so much that my daughter got stranger anxiety when I came home and held her. Working for yourself is definitely the way to go, perhaps with a small group of like minded individuals, as I am. Ultimately, we are accountable to our patients, which is as it should be.

  12. Pat says:

    Congratulations and respect old friend. Amongst us all, you will be one of the few who can legitimately claim to be practicing honest medicine.

  13. Russell Brunet, DO says:

    Way to go Doug!!!

  14. Scott says:

    As an atheist, I feel prayers are useless, however we all are hoping for your success, for our sakes as well as yours. I suspect you’ll have some lean weeks but word of mouth spreads fast with this kind of thing.

  15. Sir Lance-a-Lot says:

    Yup, the same reasons I got into medicine, and the same thoughts I had in residency, and I’m stuck with the same crap, most recently with the Vice President calling me “disruptive,” which means I’m on my way out.

    I’m glad you were able to do it, and am trying to figure out how, with big loans and no credit, I could do the same.

    Good luck!!

  16. Dave Mittman, PA, DFAAPA says:

    All the best of luck. It’s a huge leap but you needed to do it.

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