“MEN WANTED FOR HAZARDOUS JOURNEY. SMALL WAGES,
BITTER COLD, LONG MONTHS OF COMPLETE DARKNESS,
CONSTANT DANGER, SAFE RETURN DOUBTFUL. HONOR AND
RECOGNITION IN CASE OF SUCCESS.”
With this want ad, circa 1914, Sir Ernest Shackleton recruited 28 souls with an unimaginable challenge: To cross the unexplored Antarctica on dogsled. The polar explorer knew exactly what human characteristics he needed to pull off such a feat and understood that straight talk would resonate with a few select men.
Shakleton and his crew boarded their ship, the “Endurance,” and sailed the world’s most dangerous oceans straight into harms way — still considered one of the world’s greatest survival stories. Amazingly, all men survived against unimaginable odds. Their story reminds us that we all stand on the waves and wakes of dreamers, doers, slaves, and fools, all who say, “We did it, took our chances, immigrated to the U.S., headed West, built a new business, risked it all.”
And, if you listen closely, you will hear their stories as an invitation that has been repeated throughout history: “What will you do? Whether your turn or your calling, what will you do?”
Today, I’m posting a similar want ad to medical colleagues. The journey may be far less physically dangerous, but considering prevailing attitudes, perhaps it’s as daring in imagination.
The mission? To walk away from the security of contracts with health insurance companies and Medicare and join us on a mission to contract your medical expertise directly to all Americans for a reasonable time-based fee.
It is to deliver a much better service for at least 40 percent less money than the real cost of the current model, and restore the integrity, vibrancy, affordability and viability of primary health care. Doctors will control their work and focus wholly on their patient. Patients will take control of their day-to-day healthcare decisions. It means the patient, not insurance or Medicare, will become a doctor’s boss. Like in other parts of our lives, it means using insurance for big ticket items and fighting to get the rest of the insurance money back for our own daily health care.
Similar to Shackleton, I appeal to primary care physicians who are ready to dream an idea. These physicians:
• Are 100 percent committed to the primary care mission.
• Look out for what is best for their patients, providing trust and continuity of care.
• Follow evidence-based decisions or what works best for the patient, not insurance codes and malpractice fears.
• Recognize the humanity of our work and the importance of patients being in control of the time it takes to explain and explore their healthcare decision.
• Appreciate the money, but isn’t working for the money.
• Think primary care doctors should play a leading role in reshaping day-to-day healthcare but not led or controlled by policymakers or administrators.
There are many such practitioners out there. Many of you feel trapped by the current insurance-based system, and are seeking an alternative: Wwitching to a concierge practice (which disproportionately benefits the doctor, not the patient), turning to urgent care or other specialties, cutting back your hours, or retiring early. You have thought how good it would be to reoganize your practice to get back to the original values of family medicine, or perhaps to put one of your partners on an alternative business pathway to restore patients’ trust and escape the nickel-and-dime antics of insurance systems. But you can’t afford the time to do the needed research and experimentation, or absorb the transitional income loss, and you feel isolated stepping out on your own.
There is an option: DocTalker Family Medicine, which, for over the past eight years, has experimented and developed a robust and practice-tested operational model for primary care. It’s so affordable that patients can pay out of pocket, and save their insurance for emergencies and specialty care. The practice is supported by customized electronic medical records, communications systems, branding, marketing, web presence, and contracts directly with patients and employers. We use cutting edge communications and software applications to provide care to patients through not only the physician’s office, but also the phone, videoconferencing, and house calls. Our practice has a significantly reduced office overhead and support staff. Two physicians with 1,500 active patients per provider can make a reasonable income.
Since these support systems are already in place, you could switch to a DocTalker-type practice in just a few weeks. Your only risk is not knowing how many of your patients will follow you immediately, even when you explain that 75 percent of people can get a concierge-quality service for about $300 per year and that insurance (depending on their plan) still covers everything else.
But, by increasing our numbers, we can mobilize press attention, strengthen our voice in healthcare debates, provide economies of scale, pool resources for outreach and marketing to employers and patients, enhance the legitimacy to the public, provide solidarity and mutual support among doctors, and develop a learning network to continuously improve the system.
Invest in your future and the future of primary care. Here is my “want ad” — not as daunting as Shackleton’s, but not for the faint of heart, either:
PIONEERING AND PATIENT-CENTERED PHYSICIANS AND PRACTITIONERS
TO LEAD A SEA-CHANGE IN PRIMARY HEALTHCARE DELIVERY COUNTRYWIDE
BY ESTABLISHING VIBRANT, INDEPENDENT, BUT INTER-CONNECTED PRACTICES, THAT RESTORE INTEGRITY AND TRUST, AND ENHANCE COST EFFICIENCY AND QUALITY OF DAY-TO-DAY HEALTH CARE. HAPPY, HEALTHIER PATIENTS AND A FOOTNOTE OF RECOGNITION IN THE HISTORY BOOKS IN CASE OF SUCCESS.
Until next week, I remain yours in primary care,
Alan Dappen, M.D.