Dr. Martin P. Solomon – Supreme Doucher of the Year

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Recently, a friend and fellow DPC doc was highlighted in a Boston Globe article.  It is great to see these guys get more attention and you can read the piece here. Dr. Jeffrey Gold “has stopped accepting health insurance. He charges a flat monthly fee for up to a dozen visits a year and is easily reached by e-mail and cellphone. He has far fewer patients now, but he can spend more time with each one.” I know, personally, that he truly is enjoying his job again.  It is really refreshing to see. Now to the good part.  Dr. Martin Solomon decided not to just leave a comment but to write an editorial entitled: ‘Personalized’ primary care is an egregious practice.  It is not long so here you can just read it below:

RE “BYPASS the insurance, these doctors say” (Page A1, April 20): The pursuit of an easy life with a higher income is a common American goal, but it should never be the rationale for the practice of primary care medicine.

Medical training is largely subsidized with federal taxpayer dollars, and I’m pretty sure I missed the course at Tufts Medical School, more than 40 years ago, that taught us how to take care of rich people. It is shameful that the Massachusetts Medical Society and the insurance commisioner allow the practice of shedding or denying care to patients who are not able to pay the extra fee for this so-called personalized care.

While doctors such as those mentioned in Priyanka Dayal McCluskey’s article cut their patient load to a paltry 600, the national and local shortage of primary care doctors and nurses continues to grow to an alarming degree, with an expectation that we will need more than 40,000 new primary care doctors and at least as many nurses within four years.

States that have allowed the practice of direct primary care to grow without control, such as Florida, New York, and California, have seen access to care suffer and the public deprived of decent primary care.

Rather than highlighting the joys of limited work and increased income, we should be demanding limitations to this egregious practice.

Dr. Martin P. Solomon

Brookline

The writer is medical director of Brigham and Women’s Primary Care of Brookline.

First, let me give you a little background of about Marty. He sold out his practice in 1998 to CareGroup, the corporation of six hospitals in Boston.  I wonder if he donated that money?

Here he is talking about the problems with managed care.  My best estimate of this article was around the year 2000. How did that work out for you, Marty? Is your “Pod 11” still successful? Yeah, didn’t thinks so.

Most importantly, though, Marty is also a doctor scorned. This was from an article in 2007:

Dr. Jeffrey Bass, 50, of Brigham and Women’s Hospital, and Dr. Ronald Katz, 51, of Beth Israel Deaconess Medical Center, are the latest physicians to give up large traditional medical practices, in which doctors see a patient every 15 to 30 minutes, in favor of a slower pace and potentially higher income.

A third highly sought-after doctor who practices with Bass, Dr. Martin Solomon, 58, has decided to stay with the Brigham but to scale back to a smaller practice. He recently mailed a letter to most of his 5,000 patients asking them to voluntarily switch to another doctor in the practice.

“Unfortunately, for many, many years I’ve had trouble saying no to new patients,” said Solomon, who added that the administrative burden in his practice has become overwhelming. “I just felt I couldn’t physically do it anymore.”

So, Marty is pissed that his partners left him. He is pissed that they make more money than him. He is pissed that they see less patients than him.  He is pissed because he is unhappy.  Sorry, Marty.

Before, I tear him a new one, let me explain why I need to be brutal. He uses terms “easy life” as if we doctors are lazy. He uses terms like subsidized as if doctors who now have hundreds of thousands in debt should still feel guilty.  Forget the fact that as residents they are paid pennies on the dollar to treat patients in the hospital for years.  Does that not count, Marty? He claims that some states have access issues and care suffers?  Was this due to DPC, Marty?  No, it wasn’t. He also uses the word egregious, which means outstandingly bad and shocking.  Okay, them’s fight’n words.

Marty, here is why you are a supreme doucher.  You were part of the generation of doctors that sold us out to Medicare, insurance companies and hospitals. You supported the AMA and AAFP and they failed you but you kept on doing the same thing until the whole system collapsed.  NO ONE wants to go into family medicine now because of doctors like you, Marty!  Let that sink in.  It is a dead specialty, given away to midlevels because the job sucks.  But here is the caveat.  It does not suck doing DPC.  It is fun again.  No more paperwork, coding, dealing with administrators, dealing with Medicare, dealing with insurers. Somehow, under your theory, I am obligated to do that?  Am I?  Is it morally more ethical to be a miserable doctor who sees patients for seven minutes a visit doing a crappy job? Only when I am doing that you will bless me?

And what about all those patients being discarded?  Well, look at the second piece I highlighted above.  Boy, it sure seems you were doing the discarding, Marty.  You were scaling back and asking patients to go somewhere else because “the administrative burden in his practice has become overwhelming”.  Pot meet kettle.

Now let’s look at DPC.  For $75 a month, which is what I charge, it is not budget breaking.  If you add in that there are no copays, no office visit fees, and labs are cheaper, then most people come out ahead.  I had a patient yesterday that had a physical, her ears cleaned, OMT on her back and I got her a medication that was $100 cheaper via a coupon.  Her labs will be more extensive but will cost 90% less. Oh, and I will put my 60 minutes against your 7 minutes any day of the week.   Is all this still egregious, Marty?

So, in conclusion, I define a supreme doucher as someone who not only DOES not know what he is talking about but also goes out of his way to write a letter to spread his ignorance.  A supreme doucher is bitter, jealous and angry but doesn’t even realize that he caused all this as noted above.  For all these reasons I have declared Marty Solomon MD a supreme doucher.  Congrats, Marty!

 

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] 

  31 comments for “Dr. Martin P. Solomon – Supreme Doucher of the Year

  1. 4th year med student
    May 6, 2016 at 2:44 am

    Love the smack down. Marty’s ego got the best of him–thanks for putting him in his place. I cannot stand the moral superiority that academic family medicine docs like him project.

    Re: Ellen. She owns a telemarketing company and wrote a book about her experiences as a patient in a Harvard teaching hospital. Ellen In Medicaland. 2/5 stars.
    http://www.tvyourhealthcare.org/Ellenk.htm

    • Pat
      May 6, 2016 at 9:17 am

      Thanks for sharing that info. So we’ve got a self-promoting, self-appointed do-gooder who has no knowledge about the actual state of health care or those who provide it. With her lack of insight and expertise, she would make an excellent CMS official, or congressman.

  2. Kevin Rahner
    May 5, 2016 at 1:05 pm

    I understand that DPC docs feel passionate about what they do, but it is his right to disagree w/ the DPC model. Don’t let it get under your skin. The way you responded makes you look petty and from what I know about you Doug you are above that. If you enjoy your current employment situation that is what matters, not the opinion of an “ivory tower” physician. I enjoy your newsletter and still miss the PJ.

    • Doug Farrago
      May 5, 2016 at 2:24 pm

      I am petty. That being said, this became personal not because he questioned it but he verbally destroyed us. I do appreciate the feedback, though.

    • Pat
      May 5, 2016 at 4:53 pm

      Kevin, I don’t think it petty to call out false piety and groundless moralizing. The attitudes and path Solomon made, he and his generation made for all of us, and they have been extremely harmful to patients and physicians alike. Making mistakes is one thing – clinging to them and insisting that others do likewise in the face of overwhelming contrary evidence is rotten.

  3. Craig
    May 4, 2016 at 7:02 pm

    Martin Solomon. Is his middle name Richard?
    No respect for the guy, who likely played golf and went on vacations with the drug reps back in the day then helped eliminate the practice once his arthritis kicked in.
    Good for you, Doug. Am double cert FP and IM and work hard in solo practice. I often hear myself singing silently in my head the Michael Jordan ditty, “If I could be like Doug! – wanna be, wanna be like Doug!”
    Gotta go. Thanks for the levity. Goning to go back to hurtling towards leaving the profession early.

    • Doug Farrago
      May 4, 2016 at 7:05 pm

      Thanks, my man!

  4. arf
    May 2, 2016 at 2:54 pm

    http://www.managedcaremag.com/news/study-rise-oncologists-working-hospitals-spurs-higher-chemo-costs

    I hope Doug doesn’t mind my banging on about “facility fees” brought up by another poster. Here’s why it should concern everyone.

    University of Chicago study – Outpatient chemotherapy treatment costs are higher if a patient’s oncologist works for a health care system than if the physician has his or her own practice.

    The researchers found significant consolidation between outpatient oncology practices and health care systems in the decade leading up to 2013, and linked that to a rise in spending on drug-based cancer care.

    Each 1% increase in the proportion of medical providers who were affiliated with a hospital or health system was associated with a 34% increase in the annual average spending per person on outpatient cancer drug treatments, the investigators reported. Part of the rise was fueled by the facility fees that hospitals and their outpatient clinics routinely tack onto bills, the researchers said.

    Read the above paragraph over and over, until it sinks in.

    This happens to have been an oncology study. I doubt it is any different when hospitals and health care systems take over primary care practices as well……like Dr. Solomon.

  5. AK.
    May 2, 2016 at 1:51 pm

    Marty made a mistake; were I Dr. Solomon, I would acknowledge my error and move on.

    • Doug Farrago
      May 2, 2016 at 1:54 pm

      Well, we are hoping he does this but that has not been the case. Overtures have been made to him and he has been just reinforced his position.

  6. Vance
    May 2, 2016 at 1:20 am

    You hit this one way out of the park Doug. The doucher has asserted that I’m in DPC for the money.

    Ok, doucher. Let’s do this.

    When I left government/managed care medicine for DPC, I took a greater than $200,000 pay cut, and sold 2/3 of my dream farm land (I sold 71 acres and a beautiful pond I had planned to sit at in retirement) to do it. Why? Because practicing non-rushed patient care giving people the same kind of attention I’d want my family to get was the right thing to do. I drive a 16 year old truck to work and I tithe 10% of every dollar I earn to my church, and give more to charity. My family of 4 lives in a 1,000 square foot home. I’d love to build them one where my kids wouldn’t have to share a room. I put all those dreams on hold so I could practice medicine correctly. Of course I hope I’m successful and can one day provide a place like this guy has for my family. And if I do, I HAVE EVERY RIGHT TO. BECAUSE…FREEDOM.

    This pious, no-talent-assclown lives in a mansion, drives a luxury car, and continues to suck the system dry practicing a style of medicine that would make his predecessors roll over in their freaking graves. And he says I’M IN IT FOR THE MONEY???!! Having just started my DPC clinic, it will be a year before I take home more than I pay my LPN nurse ($14/hr)! Gregarious??? Really????

    This dude’s verbal diarrhea: “States that have allowed the practice of direct primary care to grow without control” reeks of the worst kind of socialist freedom-killing humanity. I just want to throw up.

    Everyone: This self-righteous douchebag needs to come to the Midwest and get a taste of reality. He’s *absolutely* clueless.

    • Vance
      May 2, 2016 at 1:29 am

      You hit this one way out of the park Doug. The doucher has asserted that I’m in DPC for the money.

      Ok, doucher. Let’s do this.

      When I left government/managed care medicine for DPC, I took a greater than $200,000 pay cut, and sold 2/3 of my dream farm land (I sold 71 acres and a beautiful pond I had planned to sit at in retirement) to do it. Why? Because practicing non-rushed patient care giving people the same kind of attention I’d want my family to get was the right thing to do. I drive a 16 year old truck to work and I tithe 10% of every dollar I earn to my church, and give more to charity. My family of 4 lives in a 1,000 square foot home. I’d love to build them one where my kids wouldn’t have to share a room. I put all those dreams on hold so I could practice medicine correctly. Of course I hope I’m successful and can one day provide a place like this guy has for my family. And if I do, I HAVE EVERY RIGHT TO. BECAUSE…FREEDOM.

      This pious, no-talent-assclown lives in a mansion, drives a luxury car, and continues to suck the system dry practicing a style of medicine that would make his predecessors roll over in their freaking graves. And he says I’M IN IT FOR THE MONEY???!! Having just started my DPC clinic, it will be a year before I take home more than I pay my LPN nurse ($14/hr)! Egregious??? Really????

      This dude’s verbal diarrhea: “States that have allowed the practice of direct primary care to grow without control” reeks of the worst kind of socialist freedom-killing humanity. I just want to throw up.

      Everyone: This self-righteous douchebag needs to come to the Midwest and get a taste of reality. He’s *absolutely* clueless.

  7. Sir Hakum of Hugo
    May 1, 2016 at 11:33 pm

    Amen Brothers and Sisters.
    Medicine is not a suicide mission.

    Find a better practice style or niche and go for it.

    Whether you are in Brookline, Brooklyn, or Backwoods, Georgia….you still help they people you take care of. You make a difference in their lives.

    In fact, docs seeing fewer patients and taking more time will do a better job for their patients.

    I await the study from Dr. Bozo stating, “There is no clinical evidence that taking 30 minutes versus seven has beneficial outcomes,” or, “Those who do not take insurance or government program payments provide lesser quality care.”

    I fear that some next President may state, “Healthcare is a human right and any physician not taking Medicaid is a human rights abuser and subject to United Nations tribunals”.

  8. arf
    April 30, 2016 at 8:48 pm

    Thomas Guastavino

    Of course you know this, but maybe we still should spell it out anyway.

    EVERYBODY’S education was “subsidized with taxpayer dollars”.

    Why is it that people think they have a special claim on physicians?

  9. arf
    April 30, 2016 at 8:12 pm

    “…..You were part of the generation of doctors that sold us out to Medicare, insurance companies and hospitals. You supported the AMA and AAFP and they failed you but you kept on doing the same thing until the whole system collapsed. NO ONE wants to go into family medicine now because of doctors like you, Marty!…..”

    I am SO GLAD you said that Doug, because it is so true. Of course it’s not everyone in that generation, but enough of them, and especially academics and other medical “leaders” of that generation.

    This clown went into medicine when Medicare and Medicaid were throwing money at physicians. They grossly abused the system, which had to clamp down hard, and now the next generation of physicians is left to clean up the mess made by this generation of physicians.

  10. RSW
    April 30, 2016 at 5:44 pm

    “Primary Care of Brookline” – one of wealthiest zips in the entire country.

    10 to 1 his partners left because they couldn’t stand working with this bilge-spewing asshole.

    Would love to see an EOB for an office visit with Dr. Douche Bag – any guesses to what the facility fee he collects comes to?

  11. April 30, 2016 at 12:46 pm

    Right on, Dr. Solomon. Dr. Solomon was a guest on my public access tv series, Your Health Care:Choice or Chance? years ago. He talked about his new book and how hard it is to be a good primary care physician in today’s environment. And it certainly is. But the dedicated doctors, including the primaries, love what they do even if it is difficult. Unfortunately there are those just in it for the money . Why they did not go into business is beyond me.

    • Doug Farrago
      April 30, 2016 at 3:19 pm

      So, Ellen, are you on his side?

    • Doctorsh
      April 30, 2016 at 3:43 pm

      Ellen:

      What do you say to the many thousands of patients who value and prefer the care they get from their DPC doc?

    • Sir Lance-a-lot
      April 30, 2016 at 3:57 pm

      “… the dedicated doctors, including the primaries, love what they do even if it is difficult.”

      They do? Do you know any? Can you name them?

      I don’t know a single person doing “regular” primary care who’s happy.

    • Pat
      April 30, 2016 at 4:52 pm

      I hope Ms. Kagan will give us some specifics. What does “just in it for the money” mean? I don’t know any family doc, mainstream or DPC, who is rolling in the bucks. Some of them are comfortable, and increasingly more of them are barely staying afloat. Kagan may be interested to know that the ER company I work for employs a number of primary care docs who have to moonlight on the weekends just to pay their bills. I know, I used to be one. Does Kagan fault me for leaving a dead-end pursuit in order to financially survive, and live a happier life?

      What is her understanding of exactly what makes primary care so difficult? Clearly Dr. Solomon does not (or won’t ) grasp these impediments or their solutions. Does Kagan understand that going into medicine IS going “into business”, unless one works at an academic center or for the government?

    • arf
      April 30, 2016 at 9:05 pm

      @Ellen B. Kagan

      Silly me, I thought a medical practice was a business.

      Whether in USA, Canada, UK, Continental Europe. Unless the doctor is employed by some entity, the medical practice is a business that has to pay the bills before the doctor makes one cent.

      The only difference is whether that business cash flow comes from direct payment by patients, a private insurance company, or a government healthcare scheme.

    • Doug Farrago
      May 1, 2016 at 11:39 am

      So no answer? You truly amaze me, Ellen. You are an enigma wrapped in a riddle. You are someone who has this weird combination of ignorance for the facts as well as a sense of self importance who mixes that with a desire to giver her opinion without anyone really wanting it. This one, however, is too far as you support this lunatic and attack my profession as a DPC doc. Please, Ellen, do not keep emailing me your stupid newsletter about Bernie or whatever. OMG, I have spammed that a million times and it keeps coming back. Go away from this blog. I am saying this nicely. Ellen in Moronland, or whatever you call it, is your home. Leave me alone.

  12. Pat
    April 30, 2016 at 11:52 am

    What a sonofabitch.
    1. False morality – Marty might have missed the class on rich folks, but he caught all the classes on collectivism and class warfare. I guarantee he made an “A” on the final for the ethics class that taught doctors are commodities to be placed and traded at will by public officials and popular sentiment. While other family doc’s get extra certifications in geriatrics or sports medicine, Marty got his in false piety. He likely imagines (along with the general public, sadly) that he took some fictional oath requiring him to see all patients all the time, no matter what. The only possible conclusion from his philosophy of self-harm is that by becoming a physician one surrenders free will to those that claim to know better for patients, and opposing this immediately defines one as greedy and uncaring. His morality is the equivalent of a prisoner currying favor from the guards by informing on other prisoners.

    2. False economics – Yo Marty, what data can you show that DPC has reduced ANY access to anyone anywhere? You can’t, and you are a liar. The looming shortage of 40,000 PriCare docs is precisely your fault, as Doug spectacularly described. What about all the Merritt Hawkins, et al surveys over the past decade that are showing the majority of physicians in the 50-65 age range all working to limit their practices or quit entirely? Are they all “egregious” for saying to hell with it? What’s next, would you have the states force them back to work?

    3. Acute-on-chronic pitifulness – Marty is suffering, thinks the proper role of the family doc is to suffer, and demands we suffer along with him. Whether his anger is subconscious or deliberately hidden, he speaks in utter denial regarding his situation. He’s mad that partners left and mad that others want to, and madder still that physicians and patients enjoy a structure outside of his chained-down, sclerotic world view. Sneering at “the joys of limited work and increased income” is a dead giveaway. Marty knows very well that DPC docs are not making millions, but he implies that. His rhetoric drips with envy, and exposes him as yet another quasi-public official who believes the way to ease one’s own pain is to bully others. This is institutionalized Stockholm Syndrome.

    To steal a Tom Waits line, “Come down off the cross, we can use the wood.”

  13. DoctorSH
    April 30, 2016 at 11:38 am

    Nicely written.
    Should make “monthly doucher” a regular column.

  14. JT
    April 30, 2016 at 11:01 am

    Thanks for speaking truth to that douche canoe.

  15. Ben Van Raalte
    April 30, 2016 at 10:29 am

    Brigham no less.
    Their doctors make extra income doing Plaintiff work on a regular basis.
    He lives in Brookline, one of the most affluent and nicest areas in the world, and lectures the rest of us on humanity. I dont see him practicing in rural Mississippi. If he was I might listen to him. He lives in one of the nicest places to live in the United States.
    Furthermore, he is at an academic institution. Subsidy, subsidy, subsidy. The federal government has poured billions into Boston, (the rest of us paid for their big dig) and those dollars have made them rich. The institution receives higher payment for the same services ( I know Mayo gets 3 x the payment from Blue Cross than I do for the same service), DONATIONS paying for their glass palaces. Primary care and plastic surgery at the academic institutions make more than their private practice counterparts.
    He also already made his big bucks, his home in Brookline is probably 10 times what he paid for it, mine in Iowa 20% more over 20 years. His investments from selling his practice to them 20 years ago is also a significant piece of change, and he probably has enough money he is practicing because he has nothing else to do. Typical holier than thou. And who knows what the public/private pension system is at his institution, some of these are significant.
    But what do you expect from Boston liberals.

  16. J
    April 30, 2016 at 10:14 am

    One of the best smack-downs I’ve read in a long time. Thanks for having the courage to speak truth to that douche canoe.

  17. Perry
    April 30, 2016 at 9:11 am

    Funny, the docs doing DPC can actually go back to the way medicine is supposed to be practiced, rather than being a glorified “box checker”. Marty needs to do a little more soul-searching before he opens his mouth.

  18. Thomas Guastavino
    April 30, 2016 at 8:07 am

    The next time I here someone say that I am obligated to kill myself working because my education was “subsidized with taxpayer dollars” I am going to punch them in the face. The “government” got much more back when I spent five of my most productive years working 100 hr weeks in a city hospital for slave wages.

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