The Only Choice? by Pat Conrad MD

With one exception, medicine has largely become the picture above. The name of the game is Direct Primary Care. It is the only sane and healthy way to deliver primary care, and it is the only truly honest venue left to physicians. The attacks against it will intensify as DPC becomes more prevalent. There are limp-wristed, cowardly doctors trapped in their own sarcophagi of misery that want to be buried with company. 2016 “Supreme Doucher” winner Marty Solomon is one such, calling DPC and “egregious practice”, hiding behind sad class warfare by trying to tie it to “rich people.” There are utterly corrupt crony corporate commissars like Farzad Mostashari who feign sympathy for the docs they have oppressed. After taking the lead in implementing rules that have caused major economic harm to tens of thousands of physicians, Mostashari is now the CEO for a company helping doctors to join ACO’s – another form of selling “protection.”

So Marty is the stupid one taking his punishment, and Mosty is the slick one, meting it out for fat bucks. Sadly these two represent the masochist-sadist relationship that has largely strangled any sense of fun or accomplishment out of medicine, and they both see DPC as a threat to their sick love.

Please read this letter in the latest issue of Medical Economics. Its author nails it, and properly defends DPC:

“In one of your articles, Dr. Farzad Mostashari (“Mostashari’s biggest Meaningful Use regret and health IT’s future,” August 25, 2016) gave some advice to physicians on how to avoid burnout:

“The key is two things. One, if you’re in a kayak in the rapids, you have to lean in and dig your paddle in and push ahead. If you lean back, you’re done. You’re going to flip over. So be more active. Don’t be passive. Take control. Step two is join together with others to increase your power, increase your control, increase your ability to have someone else help you deal with that crap, deal with the quality reporting, deal with the EHR optimization, deal with the ACO regulations.

So I think that’s the solution—not to retreat into some direct primary care model.”

I am a family physician who has operated a direct primary care (DPC) practice for nearly five years. In that time, I have met hundreds of physicians planning or operating DPC practices, many of whom I now consider good friends. While they each have a unique story and perspective, your comments are not remotely reflective of the mindset of doctors opting for DPC. I honestly wonder whether you have ever talked to a single one of them.

These DPC physicians are among the most courageous, creative and determined men and women I know; the exact opposite of what you describe. They have each taken huge risks—professionally, personally and financially—in an attempt to “take control” as you suggest. Most have sacrificed hundreds of thousands of dollars in pursuit of becoming the caregivers they envisioned while in medical school.

Despite giant obstacles and an uncertain future, DPC physicians forge ahead. Our vision for the future of primary care may be naive to you Dr. Mostashari, but to claim we are passive or “retreating” is flatly absurd. I do agree that a major driving factor behind the DPC movement is physicians feeling powerless to deal with an ever growing pile of “crap.” Can you blame them? Older physicians have lived through many decades of initiatives purporting to improve the practice of primary care—only to realize the newest barrage of alphabet soup was keeping them even more distracted from patient care.

DPC physicians have bravely climbed back in their vessels and are now trying to rescue others, hopefully before we all go over the waterfall.

W. Ryan Neuhofel, DO, MPH

Lawrence, Kansas”

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] 

  4 comments for “The Only Choice? by Pat Conrad MD

  1. Bill Ameen MD
    December 31, 2016 at 10:04 am

    Always fun and illuminating to read your blogs, Dr. Doug. Being retired, I’m an “innocent” bystander but I like to comment since I practiced since the late 1970s. It seems that DPC is like reinventing the wheel, in a way. In my first practice we were cash only except for the small number of Medicare patients…$5 a visit (we raised our prices to $7 in November 1977!). The downslide of office practice began when insurance started paying for office visits, as I recall, about that time, and the various insurance companies started following Medicare’s “U-C-R” ritual, meaning that over time you couldn’t get reimbursed for all your expenses. Hence the DPC solution…draft the patient’s bank account or credit card to help your office expenses (which are lower anyway because you don’t have a crew filing insurance forms) and the trade-off for the patient is ready access to your skills. I think I have that right, right? However, one thing I’ve discovered in retirement is that it’s not a bad thing to download all of your previous patients’ woes from your gray matter. I just hate that I can’t write my own statin or my wife’s asthma medicines any more!

  2. December 31, 2016 at 8:56 am

    you had me at hello

  3. Steve O'
    December 31, 2016 at 8:56 am

    “If you want to survive…”

    Yes, Farzad, that is exactly how to survive in the labor camps! “… if you’re in a kayak in the rapids, you have to lean in and dig your paddle in and push ahead. If you lean back, you’re done. You’re going to flip over. So be more active. Don’t be passive.”
    Yes, you are quoting the spirit of Ivan Shukov, the protagonist in Solzhenitzyn’s novel about survival in the Gulag. Don’t let the harsh Siberian winters crush you! You can’t overthrow the guards, you can’t escape, there’s no place to go…but don’t let that daunt you! Keep trying, double your effort!

    …join together with others to increase your power, increase your control, increase your ability… Precisely! Don’t go it alone, join spirit with your fellow prisoners to stay alive! You can do it!

    The zeks under Stalin understood, at least a little, what they were doing in the icy hell of Siberia. But aren’t doctors in America confused, Farzad? What the hell did we do wrong to wind up here?

    ( http://i.gr-assets.com/images/S/compressed.photo.goodreads.com/hostedimages/1462146287i/18958891._SX540_.jpg )
    ( http://c8.alamy.com/comp/A14P9H/one-day-in-the-life-of-ivan-denisovich-year-1970-director-caspar-wrede-A14P9H.jpg )

  4. Kimberly Legg Corba, D.O.
    December 31, 2016 at 7:37 am

    Once again, Dr. Farrago, an excellent blog.

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