Break the rules
I am not someone who generally follows rules well... unless I think there is a good reason behind the rules. If someone tells me "that's just the way we do it," it makes me even more likely to want to break out of the status quo. I am constantly trying to do things better, or more quickly or more efficiently. When I see a system or process that is broken, I think of a million ways to make it better. Sometimes I say these things out loud, more often I just think them to myself. I come from a long line of innovators in my family from ship builders, doctors, investment advisors, to creative thinkers, dreamers and optimists. Before this year I would never have thought of myself as a "visionary," but now that I have been called it several times, I believe that the title is true. Visionaries have the ability to see the world as it SHOULD be, and can dream up a way to get there. I've been given a vision for the future of healthcare and I believe I have the ingenuity, stubbornness and optimism to get there.
From a very young age, I have wanted to help and heal. I distinctly remember one afternoon when I was about 5 or 6 I set up a "hospital" in my backyard. We had gotten a new refrigerator and my mother gave me the box to play with. I spent half an hour drawing a huge red cross on the side. My red Sharpie marker ran out of ink halfway through the shading! I set up my vet hospital with blankets and pillows and sat there in the shade of my box in the summer heat and I waited. I waited for the woodland creatures to come for their care. I remember as time went on getting sadder and sadder as the animals did not come. I imagined I would splint broken bird wings, and nurse little fawns back to health with milk in a bottle. I had little cups full of water and bowls for serving food. Eventually, after several hours of waiting, I gave up and dejectedly went inside. My heart wanted to HELP and even as a little girl, I remember being so sad when I was not able to deliver the care that I felt was so needed. My path never really wavered from the medical field. I stayed focused through high school, college and med school to pursue the vision of becoming a doctor.
I practiced medicine for 12 years after med school and had various positions. The most recent job was supposed to be my temporary job when I moved to Delaware but it ended up being a 5 year "temporary" position. Throughout my time at the occupational health clinic, I searched for a more permanent placement. I wanted to find a family practice that fit my personality, gifting and goals. I applied for several jobs and even got offers for many of them. However, I could never seem to find a job which allowed me the quality of life that I wanted for my own family balanced with that of my career. I have two young children and a husband and my family is very important to me. I believe that it is possible to have a balanced life even being a physician and I continued to search for it.
Meanwhile, in my occupational medicine job, our practice was taken over by a large insurer (that rhymes with 'banana'). After this, many things started to change. There was always a quota of patients that we were supposed to be seeing per day. When I was hired, the expectation was that I would see at least 20 patients a day. Within several months of the merger, this number was raised to 24 and within another year, I was expected to see at least 28 patients per day or I was not making my "quota." There was much talk about the budget and how we were not meeting our goals (though there was no mention of the fact that those said goals were just increased by 50%). Quality measures were always important but the ratings from patients became quintessentially important, hinging on them the bonus of the staff and the always out of reach "rewards" for success. The medical assistants and providers worked many hours a day, doing the very best they could but with one 3/10 from an impatient patient, the hopes of a Christmas bonus for the staff were squelched. The offered rewards for "hitting the numbers" never came. Morale was at an all time low.
Patients were also terribly frustrated by the system. The waiting room was always packed with barely a seat to spare. The front desk assistants were sullen, and the patients were worse. They would routinely spend 3 hours in the waiting room, 45-60 min in the exam room and by the time I got in to see them, they were hungry, tired, and they had missed their bus, or their break, or their dinner. Their kids had to be picked up by someone else, their freight load had to be taken tomorrow instead of today, or their work day was now over because they had spent so many hours in the clinic. Because I had 27 other patients to see, I was always rushed through their visit. I could perform a physical in 7 minutes, which was born out of necessity to see the required number of patients. But a 7 minute physical is nothing to be proud of. In fact, I am ashamed now that I did it for so many years.
Though my heart hurt, I pushed through patient's complaints, interrupting them and coercing them to focus only on the one reason they were there today. I cut them off as they told me stories because I simply did not have time to listen. On occasion I would sit and listen if I had the time but I was always aware of the pressure to see more, do more, and churn through the patients. This was abusive to patients. It was rude of me to put my agenda before theirs and I felt like I was now part of the problem. I saw the horrible state of healthcare, and I was part of delivering that hurried, brusque care. I had become that which I hated...
The more glaring faces I encountered and the more I would cry on my way home from work, I knew it was time to make a change. One of the medical assistants who had worked there for 2 years started having panic attacks routinely on the way to work in the morning. I knew there had to be a better way of caring for people and I had to get out before I, too, "burned out" like many other doctors before me. I had to get out before my heart hardened! I began to read about different models of healthcare delivery and ran across the term "Direct Primary Care." I researched the model for more than a year before I finally was able to take the leap of faith and start my own clinic.
Rekindling the art and the joy of the practice of medicine
Direct Primary Care is a new model of healthcare where the patients have a direct relationship with the doctor. Instead of relying on the broken insurance based system, it is an insurance free way for patients to pay directly for professional service. For a monthly fee, patients have 24/7 access to the physician via phone, email, text, video chat and in person visits. There are no co-pays or additional fees for procedures. Many in offices tests are included free with membership. Labs and radiology are offered at deep discounts, at up to 95% discount from insurance based prices. DPC takes out the middle man, cuts through the layers of complexity and provides good, old-fashioned customer service just like in the golden years of family medicine. I will unpack the model and the benefits in more detail in later blog posts.
So I took a flying leap out of the known into the world of the unknown. The world of the doctor turned solo entrepreneur. I have taken business classes, written a business plan, taken loans, gone to lectures and classes, constructed a comfortable space of my own, set up a clinic structure, created all new systems, developed EMR and software connections, furnished the clinic, hired staff, set up a lab, policies and procedures, networked, joined groups, lectured, had many meetings and prayed. And then prayed some more. Now I have created a solo family medicine clinic from scratch! I created this Direct Primary Care clinic because there is a desperate need for it. There is a need for authentic, relational care which completely bypasses all the "junk" that goes along with insurance based care.
I dove headfirst into Direct Primary Care. I came up out of the water refreshed, and exhilarated. Every day when I wake up I am excited to go into work and looking forward to the joy of interacting leisurely with patients again. I love being able to save patients money, and to care for them with technology visits that allow them to continue their lives uninterrupted by health concerns. I am now living that balanced life in which I am home every night for dinner, I am fully involved and engaged in the lives of my daughters and I am full of joy and hope for the future.
“Leap and the net will appear”
- John Burroughs
Stay tuned for the next blog post when I get into the details about Direct Primary Care and how it works.
Thanks for reading the very first blog post.