Below is an essay written by Dr. Julie Gunther, a family physician in Boise, Idaho. It appears in the Kevin MD Blog. In 2014, she opened Spark MD, using the same Direct Primary Care model that we have at Ciampi Family Practice. While I have not yet met her personally, we have corresponded on social media along with a group of other primary care physicians at different stages of a similar journey.
Michael A. Ciampi, M.D.
How I became the doctor I always wanted to be
I could wallpaper a rather large wall with my diplomas, certificates, awards, and licenses. Each gilded slip of paper demarcates a moment in the last 20 years when I finished, graduated, certified or did any one of many steps required to become a board certified physician. Yet, after all of the sleepless nights, deferred self-care and catastrophic debt — after all this — 3 years ago I sat at my desk in between patient visits and cried.
I cried. And I kind of felt like I was going to vomit. The job I had was completely, infuriatingly, unsustainable.
Don’t get me wrong, I love the work of being a physician. I love patient care. But the job was intolerable. I was tired of saying I’m sorry. I was tired of having no control over my day. I was tired of the revolving door of clinic administrators and front office staff. I was tired of not having the resources I needed. I was tired of my services bankrupting my patients. It was a perpetual battle to build and maintain trust when I couldn’t control the most essential aspects of my relationships with people.
I read somewhere that primary care physicians are the only PhD-level educated “CEOs” accountable to 3 to 10 million dollars of annual revenue that type their own documents and rely on the help of a high school graduate. This is not meant to demean support staff but to illustrate: No other business model takes its most highly educated resource (the person who’s name is on the door) and marginalizes them to a data entry clerk. Why? Because it makes no sense. Primary care has become marginalized. We are seen as widget counters, gatekeepers and data entry clerks. This is unsustainably problematic.
National data shows that 33 percent of mid-career primary care physicians plan on leaving medicine in the next 3 to 5 years. There are innumerable reasons why, but the widget processing concept is a motivator in physician dissatisfaction. As I charted, coded, hunted down supplies, turned on lights, dug for pens, sat through one more EMR update, I realized my patients needed a doctor. They needed someone who had the time, energy and know-how to make clinical decisions. And it was clear to me that was not what I was going to do so long as I had this job. One-by-one, all of my outstanding physician mentors had left clinical practice. I needed to find another way.
In late 2013, while at the AAFP Scientific Assembly, I lucked into a talk with Dr. Josh and Dr. Doug from AtlasMD. They introduced me to direct primary care. Direct primary care is one facet of private medicine where physicians are engaging directly with their patients. For a low monthly fee, patients have access to their physician via phone, text or email, same day and next day visits, urgent care after-hours visits and, at times, home visits. Patient panels of 600 to 1200 allow for more personalized care. Monthly rates range from $40 to $100 per month, often without any further charge or visit fee. Many clinics dispense medications directly, at cost, with up to 80 percent savings. Direct primary care is a business model for anyone who believes that for $2 to $4 per day there is value in having a direct, transparent relationship with their physician. This is feasible because direct primary care clinics do not bill insurance.
My name is now on the door of my own clinic. I put paper in the printer and answer the phone. But I don’t count widgets. I don’t go to meetings about coding or EMR updates. I don’t share lunches with administrators who talk to me about caring for the patient. My CME time is spent learning how to efficiently run a business, finding affordable labs and refreshing my clinical decision making. I spend 60 to 90 minutes with my patients. I offer same and next day visits. Patients can call, text or email. It is so much simpler and so much more enjoyable.
Direct primary care is restoring the integrity of the physician-patient relationship. It’s not widget counting. It’s relationship building. In short order, quitting my job has allowed me, at last, to do my work. I am happy I became a physician. It is a joy and a privilege. I now don’t look at my glided certificates as symbols of the time sacrificed in becoming something exhausting, compromised and unsustainable. All of these paper milestones are small reminders of the earned privilege of being a physician. They remind me that it is our job to carry this profession, delicately, on high shoulders. For the first time, ever, I’ve even put a few of those certificates on display. But that’s mostly because my patients, of all walks of life, asked me to.
Julie K. Gunther is a family physician.