The Cowboy Docs


Harvard Magazine had this to say about who is driving up U.S. healthcare costs?

A recent study by Harvard professors and colleagues revealed that the culprits may be “cowboy doctors”—physicians who provide intensive, unnecessary, and often ineffective patient care, resulting in wasteful spending costing as much as 2 percent of the nation’s Gross Domestic Product—hundreds of billions of dollars annually. The authors, including Eckstein professor of applied economics David Cutler and assistant professor of business administration Ariel D. Stern, found that physicians’ beliefs in clinically unsupported treatment procedures can explain as much as 35 percent of end-of-life Medicare expenditures, and 12 percent of Medicare expenditures overall.

First of all, two percent is just that, two percent. This compares to administrative costs, which accounts for 25 percent of hospital spending in the United States.  Second of all, and I am being devil’s advocate because I know there are some lowlife doctors out there, unnecessary treatment is in the eye of the beholder.  Sure there are some rare greedy and unethical doctors who exploit patients’ illnesses but most of the time the doc isn’t making the money on the extra treatment.  Also, it takes two to tango. Many patients are looking for anything they can find at the end of their lives.  No one is complaining about Jimmy Carter getting radiation at age 90 for mets to his brain. Yeah, that’s happening.  Are you kidding me?

This is another hack job trying to blame doctors for the rising healthcare costs. Sorry, I’m not buying it.

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] 

  10 comments for “The Cowboy Docs

  1. August 26, 2015 at 3:26 pm

    Who is Making Cost Of Care So High? Not the Docs/PTs -Medicine’s Top Winners Are…

    Big Medicine is the problem, not “Cowboy Docs”. Cowboy docs are nothing more than doctors trying to do what they became a doctor in the first place… help their patients in need and recover if possible. Hospital execs now own doctors, medical staff, patients and the medicine that will and will not be provided in THEIR hospitals. The hospitals that have or are buying up all the independents. They are also well on their way to owning the medical schools and having the blessings/backing of the government to do so. Until then, they will use self written EBPs to get all doctors to comply, so as to maximize stakeholders’ profits on hospital patient flow protocols. Welcome to “Toyota Assembly Line Medicine” in America (aka: 2nd curve). Doctors are now a line cost item in a money manufacturing plant.

  2. Melinda
    August 24, 2015 at 10:50 pm

    I know a doctor like that–he convinces patients that they need IV infusions of vitamins and that he has to add cochicine and steroids to get it covered by insurance, but that’s OK because colchicine is just an anti-inflammatory like Motrin, according to him. He gives a lot of these “Myers Cocktails” plus colchicine and steroids if the insurance doesn’t cover them without the real drugs.

    I have a friend who nearly died of colchicine poisoning and now has mitochondrial disease, diagnosed at Cleveland Clinic. Complaint against the doctor was made to the licensing board but the doctor’s lawyer made a deal in which the complaint was grouped with 7 other complaints against the same doctor, and he would plead “no contest” to SOME of the points on one complaint and not have to answer to any of the other complaints including my friend’s, whose had several points on which the licensing board did feel he was guilty. He had limits on his narcotics prescriptions and supervised practice for 4 years and then was done. My friend’s malpractice lawsuit now cannot bring up her board complaint because he was not found guilty since he didn’t have to answer to hers.

    How can a licensing board find 8 complaints against the same doctor valid for multiple points of each and yet let him off with minimal punishment? This is one of the doctors referred to here, and getting him out of practice would certainly cut out a lot of waste!

  3. Pat
    August 24, 2015 at 3:15 pm

    Or like the idiot mother last night who insisted her son with a mild concussion and completely negative work up be transferred to a larger hospital because…well, just because. I hope they jam the unnecessary ambulance ride bill somewhere painful, and break it off.

    Lawyers, remember the $(;&@%# lawyers.

  4. Randy
    August 24, 2015 at 3:10 pm

    I have to say this is a fairly big problem in my town. One of the good things about being solo is being able to try and steer patients away from physicians that clearly rip people off.

  5. Van Raalte
    August 24, 2015 at 2:36 pm

    2% of GDP, not 2% of health care spending.

    That is a lot since health care in the US is about 18% of GDP (compared to countries with less lawyers, administrators, patient expectations, advertising, and government regulations of 10% of GDP)

    So 2% of 18% is roughly 10% of health care costs. I think he is underestimating. Add in the aggressive cardiologists that put in 6 stents in 10 patients a day, the orthopod doing 10 knee replacements, the surgeon who owns his own ASC and bills out of network facility charges of $30,000 and others , I think we are talking double if not triple that, or 20-30% of health care costs.

    • Doug Farrago
      August 24, 2015 at 7:55 pm

      I stand corrected. Good points.

  6. Perry
    August 24, 2015 at 9:22 am

    What we really need are cowboy docs to ride into town, guns blazing, horses snorting and blast out the slimy two-timing ornery sidewinder varmints who stole medicine from the doctors and are making a sham of it.
    Where are Clint and John Wayne when you need them?

  7. Steve O'
    August 24, 2015 at 8:13 am

    It’s the stab-in-the-back myth. Germany flat-out lost World War One, and they couldn’t handle it. They had to come up with an unreal excuse, so they blamed a fictitious enemy at home for sabotage. You remember how that went. There must be an excuse for disintegration, so blame the Jews doctors!
    It’s about equally senseless. Notice it’s not the regular doctors, it’s the unregulated “cowboy doctors”—physicians who provide intensive, unnecessary, and often ineffective patient care, resulting in wasteful spending .
    found that physicians’ beliefs in clinically unsupported treatment procedures can explain as much as 35 percent of end-of-life Medicare expenditures…
    If all medical practice is simply following some app, iEndOfLife or something, then the rules will be enforced equally, and expenses can be held down. “Let nature take its course.” It worked for most of the existence of Homo sapiens. Perhaps with global warming, we will run out of ice floes to put the elderly on, to cast them out to sea.
    If they took all the doctors, and gave us a US Mail bag full of $100 bills, and asked us all to frolic around and cast fistfuls in the air – we couldn’t MANAGE to get rid of that kind of lucre. This is big-money spending. Every criminal government looks for someone to loot – the Soviet Union looked for the swinish Capitalists, the Nazi’s for the greedy Jews. Great idea, but when you get down to it, there’s no gold at the end of the rainbow.

  8. fred powell
    August 24, 2015 at 7:46 am

    Amen. I’ve been practicing for 15 years now. I dont make more than I did then, but I do work more. They’ll need to look elsewhere for where the money is going.

    • Joe
      August 26, 2015 at 1:32 pm

      Have to agree with most of these comments. I am in my 25th year of family medicine and am on pace to make the least this year that I have in probably 18 years or so. Somehow, the administrators keep multiplying ( and increasing their salaries, bonuses,etc.), in the health systems, insurers and the government, with all heaping on EHR, “meaningful use”, etc. requirements that increase costs incredibly (with effort on my part, but not theirs), yet the docs , somehow, are considered to be the problem?!

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