We Have Our 2019 Supreme Doucher of the Year Nominee: Paul George, MD

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.

Idiot.

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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] 

  21 comments for “We Have Our 2019 Supreme Doucher of the Year Nominee: Paul George, MD

  1. James
    August 31, 2019 at 10:31 pm

    Whenever I hear someone say DPC is for the wealthy, or cherry picks patients, I think about all the patients I have that can’t afford insurance and had NO access to medical care before they found me. That group isn’t even on the radar for these critics. They act like everyone has health insurance and easy access to a physician that takes it. Where I live there is a huge Medicaid gap, many self employed people can’t afford insurance, and many offices don’t take Medicaid or Medicare. So what does a PCMH/CCM “gold standard clinic” according to CMS clinic do for them? Charge them about $200 for an 8 minute visit where they order labs that will cost them another several hundred and if they do something simple like an I&D or freeze a wart they charge hundreds more. That’s equitable?
    Ignoring everyone that is uninsured, underinsured, or can’t utilize there insurance In their area?
    He’s got my vote

  2. willett
    August 31, 2019 at 4:19 pm

    I’m weary of ‘assholes’ used as a term of attack, especially by articulate writers, especially physicians. Who should know better? When it’s functioning right, an anus is a terrific body-part in a number of ways. Call creeps ‘stools’, ‘fæces’, ‘excrement’, ‘piles of shit’, ‘dung’, or ‘doo-doo’, but let’s quit with the banal-anal.
    Like these columns, thanks.

  3. Joe Smegma, DO
    August 29, 2019 at 10:44 pm

    Dr George you ignorant Sl#t. Try spending a few decades caring for the underserved in a FQHC clinic. Try getting meds for uncompliant diabetics who care less about their meds than a cigarette or an Italian hoagie. My patient “ Lou” ate 2 large Italian hoagies prior to his diabetic visit. He had a laugh. I was horrified. A1C not within limits. I was penalized by metrics. Transition from the old paper chart, rounding daily on patients, nursing home, on call, ER coverage and daily grind of family medicine. Fucking hell! Now ask me if DPC is a better way to practice medicine? Are you fucking kidding me? All of my peers have either quit medicine, went to work as a hospitalist, ER Doctor, functional medicine, or killed themselves, literally. Primary care medicine is a wasteland of zombies. There are a few physicians left, but they are already dead. DPC is a movement that is trying to resuscitate this dead profession we’ll call primary care or family medicine. This DPC model is our only hope. My community in Maine has no DPC docs. All the primary care docs have left, retired, or died. My piers are gone. Med students don’t come calling anymore. Get the picture. Get out of the Ivory tower and into the trenches with the grunts. It sucks to be a family doctor. It also sucks for patients, and their care has suffered. No study needs to prove that reality.

  4. Kurt
    August 29, 2019 at 10:47 am

    Stick to your guns Doug. You’re right. I too hate ivory tower bastids with a vengeance. Hate Obama for mandating EHR. You mandate something when nobody wants to do it. As far as DPC goes, as long as one is in a geographic area that supports the payer mix then go for it. Setup in the wrong area where patients are too used to sucking off the government teat and aren’t likely going to keep up paying a monthly fee, I can see a DPC practice failing.
    Otherwise, go for it. I’m still stuck in the outdated practice model of office, hospital practice and taking call and am underpaid for what I do, due to the uncompensateable paperwork we never had before. Fortunately, I’m retiring in exactly 24 months as that’s when I hit Medicare age. I need that because in 12/2016 I had a robotic prostatectomy for Ca and the little basturd was right at the capsule and a tiny bit leaked out into the adjacent bed. Choline PET scan showed that was the only spot so 45 Rad treatments with boosting to that little s#it along with 4 six month duration Lupron shots (by criteria) and hopefully I’ll be a success on the salvage arm. PSA is staying way down but this October’s test will be pivotal.

    • Joe Smegma, DO
      August 30, 2019 at 7:30 pm

      Good Luck Kurt. You are a trooper to continue your work in that scenario. The stressors we face are substantial outside of personal issues.

  5. Craig Netzer
    August 28, 2019 at 11:42 pm

    This guy is an institutional meow. So many choice words. But he just makes me more jaded and depressed as a board certified internist and board certified family practice doc in rural America on an island. My MOC burden is huge! Just for the air travel to reach the test site. Need to go before I ponder a b*tch slap to paully.

    • Kurt
      August 30, 2019 at 7:26 am

      Hmmmm, Am in a rural area too but at least we have a Walmart. K-mart went out of business years ago. My spouse used to call it an island too! Must be a commonality there. 😉

  6. Brian
    August 28, 2019 at 9:31 pm

    If you link to his bio on Brown website, he does have a 25 page resume…. in lieu of seeing patients, he writes scholarly articles, gives interviews and teaches the next generation (of academics). I would love to see one of these ivory tower doctors spend some time actually caring for patients.

  7. Celia Entwistle
    August 28, 2019 at 4:57 pm

    He has my vote, I can’t stand all the ivory tower folks that blab blab and get a guaranteed salary. have done that in my life in the military and for the feds and in a large group–saying it is bad–just he is so sanctimonious–and wrong

  8. Former Primary Care Doc
    August 22, 2019 at 4:35 pm

    Great article!

    I suppose Dr. Douche would prefer all primary care doctors to be like me…so burnt out after only 15 years of practice that I quit clinical medicine completely. I’ll never go back. Never.

  9. Vijay R. Singh, MD
    August 22, 2019 at 3:42 pm

    Hey, ask the doucher whether doctors did or did not take fee for service they provided from the time period between Hippocrates penning The Oath and first ever health insurance plan was signed by first ever insured patient.

  10. Brian
    August 22, 2019 at 12:58 pm

    Did a Harvard physician like Gawande really need to try to search outside of his own office for outrageous billing? He couldn’t look to his own institution? He couldn’t look at the administrative costs being passed on to the patient? Does he even calculate the overhead of his own practice and institution? Do he calculate the anti-competitive practices of Partners in Health? Does he calculate the costs of the insurance industry overhead?

    What’s amazing about DPC is that it allows the free market to actually work. Do you want longer appointments? Pay for one. Want to not participate in MACRA which is amazingly costly and time consuming, but has provided no discernible benefits to a patient? Don’t. This is probably the most appropriate model for a responsible consumer.

    Thanks for taking a stand Doug. Really. Someone has to break the PC culture of medicine and start calling a spade a spade. This clown criticizing DPC probably has never owned a business in his life.

    • R Stuart
      August 22, 2019 at 1:57 pm

      I would hazard that Gawande hasn’t looked at an EOB for a long, long time – if ever.

  11. August 22, 2019 at 10:20 am

    Doesn’t anybody ever read the Oath of Hippocrates? It says nothing about treating all comers whether or not they pay. It does say not to harm anybody that you undertake to treat, and also not to kill patients. I suggest that churning patients on the managed-care treadmill is harmful.

  12. August 22, 2019 at 10:15 am

    TAINT.

    Any hypocrital ivory tower jerkoff in clinic a half day per week telling the rest of us how to do our job…is a taint.

    In Direct Primary Care I can take care of patients SO much better than I could in rushed 8 minute visits forced upon me by the broken and corrupt system. My patients are saving money, they have access to care, and they’re more satisfied with their care. And if they really can’t afford my $40/month average (hint…few people can’t afford that- it’s way less than the poorest around spend on a phone or cable bill), then I’ll hook them up for free. If I’d have stayed in the system I’d have quit. Which is better, taking excellent care of 600 patients, taking horrible care of 2,500 patients, or taking care of zero patients after burning out and quitting? The answer is obvious.

    I will NEVER go back. This guy is an elitist douchebag, and he will NEVER eat his words, because he’s a coward. He’s run away from numerous offers to debate DPC vs whatever it is he thinks is better.

    Doug, strong work as usual my friend.

  13. Pat
    August 22, 2019 at 9:48 am

    I will continue to scream this peeve of mine, that dishonest, self-interested scum like Paul George deliberately misuse, and thereby pervert the Hippocratic Oath to push their own agendas. The Classical oath (and as far as I’ve read, the silly modern adaptations) say NOTHING about obligations to take -third-party insurance, or treat the whole world based on quality metrics and cultural competency.

    I damn sure never took any such oath, nor would I. For its anachronistic mentions of stone, abortifacients, and slaves, beware anyone who runs at you waving the Hippocratic Oath. They probably didn’t take it themselves, and in any case, they are merely trying to tell you what to do.

    A self-promoting, putrid academician damning DPC out of ignorance, fear, or envy, deserves every insult we here can hurl. His title may be “doctor,” but he is no physician.

    • Bill Ameen, MD
      August 22, 2019 at 10:00 am

      When we “took” the Oath almost 50 years ago, mentally I called it “the Hypocritic Oath”…something we did by rote, like the Pledge of Allegiance. Certainly it’s specious to say that being a DPC doctor “violates” the Oath, which my guess is that a lot of medical schools have abandoned.

  14. Bill Ameen, MD
    August 22, 2019 at 9:04 am

    Totally agree, Dr. Doug. Social inequity?? Kudos to doctors who act like real business people and control their practices and income without depending on corrupt and malignant insurance companies. It always seems to be the Ivory Tower guys who are clueless about guys in the trenches. I was sorely disappointed to hear the “esteemed” Atul Gawande, MD, in a speech here and afterwards he answered attendees’ anonymous questions submitted on index cards. In response to one female physician facing loss of income and burnout, he basically answered “Grow a pair.” Clueless.

    • R Stuart
      August 22, 2019 at 9:56 am

      Gawande is a pompous, self-righteous idiot. He goes off to McAllen, Texas to search for excessive charges while his own institution, Brigham, is taking patients and insurers to the cleaners every minute with some of the highest charges and facility fees in the country.

  15. Dennis VanCamp
    August 22, 2019 at 8:38 am

    Go get ’em, Doug!

    • arthur gindin MD
      August 22, 2019 at 11:06 am

      All you’re asking is that the DR demonstrate which method is better. This is done by setting up different types of clinics and measuring certain variables. Isn’t that what academicians are supposed to do?

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