I want to first list my biases before you read the rest. I am a direct primary care doctor. Second, I have written three books on the subject. Third, the article I refer to is about a great friend of mine, Julie Gunther, MD. You don’t mess with my peeps. In conclusion, I freely admit that this taints my opinion about this taint, Paul George, MD. So, let’s begin.
The article is called A Growing Number of Doctors Take Only Cash, Not Insurance and does a pretty good job discussing how DPC is a savior to both doctors and patients. It talks about how it allows Dr. Gunther to continue doing the job she trained for. It talks about the savings and great care patients get. Then they talk to our friend Paul.
One of George’s chief complaints is that DPC supporters make claims about the supremacy of their cash-only model — it lowers overall health care costs, it results in less hospital visits, patients are more satisfied — without providing any data or funding any peer-reviewed studies comparing DPC and non-DPC patient outcomes.
“There’s no data whatsoever,” says George. “You can’t really tout something as the next great, big thing without showing us the evidence that it really is the next great, big thing.”
Pauly just doesn’t want to look at the studies. You can find them here but there is the Qliance study and on and on. The funny thing is that we are all independent and small, so it is impossible to really do a large scale study. Who is going to pay for it? But some have been done and more are coming. I still think that the best indicator is that patients pay monthly out of pocket for this care. If patients were not satisfied then why would they stay?
“They’re saying, ‘If you can afford our fees, you can join us in our DPC practice. If you can’t, you have to look for a new primary care doctor,'” says George. “That feels inequitable, even a little amoral. As physicians, we take the Hippocratic oath and say we’re going to take care of people regardless of race, nationality, socioeconomic status, etc. I think the DPC model in some ways stands in opposition to the Hippocratic oath that we’ve all taken.”
I went over this in my book but let’s do it again. Our fees are affordable. People are paying triple that for cable bills, cell phone bills, and other subscriptions. It turns out that if you don’t pay these companies then, yes, you won’t get service. We, and they, are a business. That being said, I and many other DPC docs give about 10% of our care away for free.
I am amazed, though, that this doucher throws the Hippocratic oath in our face. Are you kidding me. We are amoral? What an asshole. Is it more moral to see 30 patients a day and do a terrible job with them because you are rushed and have to do metrics? Is it more moral to get burned out and quit? Is it more moral to train as a family doctor and never practice? Here is the funny part. Paul George, MD, as far as I can tell, never went into practice himself. Looks like he went into academia right out of residency. I just love when these ivory tower jerks, the same ones who defend the metrics and quality crap they came up with, try to tell us in the trenches how to do our job. If he practiced what he preached then he would have been seeing 5000 patients a year since he graduated or about 50,000 patient visits. Isn’t it amoral that he abandoned those patients?
Honestly, all this guy does is try to pad his resume. How about seeing patients, dude? And no, five patients in a residency clinic once every two weeks doesn’t count.
Lastly, he says this:
“I’ll eat my words,” says George. “If your model is showing that it’s beneficial to physicians, beneficial to patients, that you’re reducing health care costs, and that there’s no social inequity, then I’ll eat my words. But prove it!”
Oh, it has to do all that, huh? Does any model do that now? No. But I think DPC is the closest. And “eat my words”? It takes every ounce of me to not respond to that by saying, “Dude, you can eat my _____!”. But I am too classy. (I thought it, though).
Direct Primary Care is the last hope for primary care. Dr. George and his model is dead. No one likes it. Doctors are burning out. Patients are unhappy. But Pauly and his cohorts continue to teach their “new” models, which are the same as the old model, because it keeps them in a career and keeps them getting awards.
Well, Dr. Paul George, here is another award you are nominated for and you will probably win. The Authentic Medicine’s Supreme Doucher of the Year Award is very prestigious and you may join the likes of Martin Solomon, MD. So good luck to you.