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1. What first appealed to you about the DPC model?
Practicing medicine again the way it is supposed to be. Most clinics are managed to focus on billing and volume. With the membership model, our first concerns are medical rather than financial. We are not collecting copays and structuring the medical appointment for billing purposes; since DPC is paid on membership, we can simply practice medicine. In a very important way, the DPC model takes money out of the exam room and no longer interferes with the patient-physician relationship. Practicing medicine in the DPC model is fun; I take care of my friends every day.
2. You were an Army doc for eight years. What's the biggest difference between practicing medicine in the military vs. as a civilian?
They are surprisingly similar, with some exceptions during military operations. Most medicine in the Army is like the VA or any other government-run medicine with many of the same bureaucratic problems other organizations create. Most patients are civilian retirees and dependents. There is a lot of pressure to see as many people as possible and driven by the same billing and coding problems as the private sector. Administrators are focused on making billing and the budget and judging medical care by arbitrary metrics, which is essentially a government form of corporate practice of medicine.
Although military medicine does not have surprise costs for drugs, imaging, copays, etc., there are instead access restrictions and rationing of available resources. For example, I always had to argue and do a lot of documentation to get a simple MRI.
Operational medicine is very different, focused on combat trauma. In sometimes chaotic and unstable conditions, we learn to use initiative and adaptability to support often fast-moving and changing operations. The skills needed for operational medicine translate to the business world of DPC, giving the confidence to face business challenges with innovation and willingness to accept risk. Not too much scares me.
3. What are the best and worst things about practicing DPC?
The best thing about DPC is practicing medicine based on medical needs and not billing needs of administrators – government or corporate.
Worst is managing expectations – not 24/7 – and maintaining the proper balance so as not to become so busy we lose our competitive advantage, then we are just like corporate or government medicine. Equally, I do a lot of my own business administration, and making sure that is not interfering with what I really like to do. So, not really that bad.
4. You have a PhD in European history and political philosophy - you are in that sense a double doctor. Do you use any of what you learned in your PhD program today?
Yes, quite a bit. There are 3 areas I use my past academic life.
First, I see a lot of the healthcare reform efforts in broader historical patterns, analyzing what has and has not worked, along with a healthy distrust of expanding bureaucracies.
Secondly, I have an ongoing interest in medical ethics in both day-to-day practice and also in controversies today from abortion to end-of-life decisions.
Third, I still keep my hand in academics and am planning on presenting a paper at a conference in Nov on the White Rose resistance against Nazism by German medical students in 1942-3. This small group showed courage and resisted the antisemitism of Nazi ideology, upholding the spiritual foundation of individual freedom and humanity, whereas many Nazi physicians actively supported the regime and the Holocaust.
Keeping active in my interests, I think makes me a better-rounded physician. My life story is leaving my studies under Socrates to go work for Hippocrates.
5. Who else in healthcare inspires you, and why?
I am inspired by several different people, and the common thread is honest pursuit of doing the right thing, whether in business or medicine. I have met several people in the insurance industry trying to do better, with Decent as my favorite innovator and partners, and other transparent benefit advisors (not a lot unfortunately).
In medicine, I have learned so much from the innovators of DPC like Drs Lee Gross, Doug Farrago, and Shane Purcell, as well as many others. Also, during COVID, public health and corporate medicine did not serve people well. Courageous physicians like Marty Makary, Vinay Prasad, Zubin Damania, and many others were willing to go against powerful forces and stay true to the Hippocratic Oath. Equally, there are many healthcare reformers, like my friend David Balat, working bipartisan to change laws and regulations to allow DPC, Decent, and other healthcare innovators that allow us to keep the healthcare revolution moving forward.
