I Don’t Get It


I loved the movie Big with Tom Hanks.   There was this one scene (above) that hits home for me now.  After doing Direct Primary Care for the past year I am feeling like Josh Baskin listening to some idiot administrator rattle off his stats and me asking him questions like:

  1. “I don’t get it.  Why do you need to see patients every seven minutes?”
  2. “What’s fun about an EMR?”
  3. “There’s a million codes in the ICD-10.  Why do we need that?”
  4. “Can’t we have a system where the insurance companies don’t make the decisions and it is just the doctor and the patient?”

You can say that I am dreaming but I didn’t need Zoltar, the fortune teller machine, to help me out.  It just took gumption, grit and determination.  But now I am Josh Baskin, a big kid.  Medicine is fun again.  Won’t you join 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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5 Responses

  1. politovski says:

    congratulations on your first year of dpc. unfortunately, from what I have seen from my patients, this is not really a viable option for those of us in rural areas, or in poor areas. perhaps in larger, more affluent areas, but certainly not where we practice. i love the concept, and i think that this model, or perhaps just going all cash (and charge at straight $200/hr for services like lawyers do) would be the “SOLUTION”, but with the older medicare crowd (who is the majority of my patient panel), these are truely a hardship. good luck on year #2.

    • Doug Farrago says:

      Perception is the issue. At $75 a month, people pay more for their kid’s music/dance lesson, martial arts membership, cable, cell phone and on and on. They can use their HSA so it is tax deductible and everyone is going on a high deductible plan now. No copays, no office visit fees and 80-90% cheaper on labs. It actually becomes a value play BUT with much better care. And all you need is 600 pts.

      • politovski says:

        Oh, a colleague of mine locally, who enrolled himself in an MBA program locally to learn how to set these up, showed us the economics of this. I realize that 600-1000 patients will fuel a practice rather nicely, and with ultra low overhead (potentially) and unlimited services to any patient who may need them. i personally would love the time to sit down with a newly diagnosed diabetic or with someone who is depressed and do some real one on one counseling for an hour. but, the truth is that some folks do not have the money and others will not choose to spend their money as such.

  2. Bill Ameen MD says:

    Dr. Doug, congrats on getting through your first year! But what about CLIA and OSHA and HIPAA? Every office has to deal with those issues (unless of course you send all lab out). Wouldn’t you have to have ICD-10 to send your patients to specialists or to the hospital with a coded diagnosis? Just curious…after all, I AM retired, permanently (for now…).

    • Doug Farrago says:

      Yes, that is true. On a few labs with patients that use insurance or Medicare, I have to use the codes. But it is rare. I opted out of Medicare so no HIPAA. Labs are drawn in my office but taken by LabCorp so no CLIA. We follow OSHA which isn’t hard.

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