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”

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