When Experts Know Nothing

Here is a moronic opinion in a recent Annals of Internal Medicine. The article is called Did CMS Just Undercut Arguments for Direct Primary Care? and it is written by Brian Block, MD, a member of ACP’s Council of Resident Fellow Members. So….a resident. No experience in the real world.

Here is this blockhead’s pertinent points and my counterpoints:

  • By removing the insurance company and engaging in a patient-pays-clinician model, these practices become financially out of reach for many patients. (So $50 to $80 a month is out of reach for many patients? There is no data to support this other than the fact that 95% of direct primary care practices are successful. I guess he should be protesting cell phone plans too? Aren’t they out of reach for these same people too?)
  • For example, by reducing patient panels (to an average of 900 rather than 2300 patients) DPCPs can limit access to physicians.  (The same old argument. Since we have less patients in our practice therefore it is our problem to find care for the others. Why is it MORE morally ethical to rush through visits in seven minutes and see 30 patients a day than it is to see 10 patients a day 30-60 minutes for each visit? It isn’t. It’s just dogma.)
  • Disadvantaged communities and persons of color shoulder most of these losses. Indeed, a nationwide study found that DPCPs served fewer African American and Hispanic patients (this is a study from 2005 of high concierge practices. Talk about cherry picking! DPC wasn’t even around then. Welcome, you earned your very own FAKE NEWS card).
  • DPCPs interested in improving health care delivery and value should consider embracing these payment models and welcoming patients with Medicare and Medicaid into their practices. (I have Medicare and Medicaid patients in my practice. I just don’t bill Medicare and Medicaid. I do NOT want the government involved in paying me. That is why I left).

This dude knows nothing of what he talks about. He is a resident. He has never worked a day in the real world and isn’t even going into primary care. And he is ALL IN on the government fixing the model they destroyed. Well, Dr. Block, it is all yours for when you graduate. I am never going back.

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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] 

  11 comments for “When Experts Know Nothing

  1. Steve O'
    May 30, 2019 at 9:52 pm

    Awww, cut the little peckerwood some slack. He’s like a puppy chewing on shoes. Give him 10 years time, and he’ll be the one that passes the law mandating physicians to employ a Quality Survey Organization (mandatory, of course) to review the records, to keep the doctors from criminal defects in quality. Or one considered in my state – mandating all providers to see at least 15% Medicaid patients. Of course, at the University and the management levels, 15% of 0 is 0.
    They talk reason, but they are motivated by the hate for independence that comes from people too cowardly to try it.

    It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.

    They hate the woman or man who will venture into the arena. And more and more, the crowd is filled with the cold and timid.

  2. Thomas Winston, MD
    May 29, 2019 at 6:22 pm

    He was young and needed the publication, don’t judge 🙂

  3. jeremy m
    May 29, 2019 at 3:03 pm

    Are you allowed to bill medicaid patients with a private pay model? I thought this was illegal.

    • Douglas Farrago MD
      May 30, 2019 at 8:15 am

      I do not think so but I am not a lawyer

    • Michael Ciampi
      May 30, 2019 at 7:16 pm

      I believe it varies by state.

  4. jeremy m
    May 29, 2019 at 3:02 pm

    Are you allowed to bill medicaid patients with a private pay model? I thought this was illegal

  5. Pat
    May 29, 2019 at 2:52 pm

    Patients that can’t find $80 /month for health care have no trouble getting their smokes or their nails done. And yet doctors are held accountable for that prioritization.

  6. Dr Siobahn Hruby
    May 29, 2019 at 10:37 am

    Very disappointed in Dr Block, but also in ACP for allowing a resident to author something without him actually having experience or using real/current data. ACP you need to realize that DPC is not the singular solution to healthcare, is just one part of the solution and it works very well for many doctors and patients. You need to send your board to experience our clinics and our conferences.

  7. Randy
    May 29, 2019 at 10:22 am

    Dr. Block’s opinion is about what you’d expect from a resident not going into primary care, and without any real experience in managing an office or dealing with insurances. And he expects CMS to reduce administrative burden when historically all they have done is the opposite.

    There was a stretch in my residency when I thought I knew it all. I guess Dr Block has hit that stretch as well.

  8. May 29, 2019 at 8:14 am

    Most of the physicians who criticize DPC because it will worsen the physician shortage are academicians who have already left clinical practice and see NO patients. Hypocrisy at its finest.

  9. Rick Singel
    May 29, 2019 at 7:16 am

    The Dr. Blocks of the world are the reason the system is broken. Can he be this demented?

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