September first was a big day for me. After over 25 years of practicing invasive cardiology, I sent an affidavit to CMS to indicate for the next two years I was opting out of their insurance program. As of October first, I have begun accepting patients on a direct patient care (DPC) model that will not involve insurers, ICD-10, or billing fees. Why would a specialist consider this dramatic move?
Practice enjoyment and quality is the answer. I am known in my community as a hard-working and caring cardiologist. My peers knew that my hospital rounds began around 5:30 a.m. and that I was efficient at these, as well as cath lab procedures. My office days were generally booked with 30 to 35 patients, many of which were new.
What changed? Generally, I was seeing more complex cases of heart disease compounded by obesity, metabolic disorders, and poor lifestyle. Trying to manage or at least give advice to patients was getting more complex and time-consuming. In addition, the advent of advanced labs with inflammatory, oxidative, and genetic markers was taking more time to analyze and offer advice. Phone calls for preauthorization first for invasive procedures, then for nuclear procedures, and now for just echocardiograms waste more and more time during the day. They say that if you love what you do, you will never work a day in your life. I was finding that what I was doing was starting to feel suspiciously like work.
What were the options? Some days just to stay on time, I’d have to dart in and out of rooms in as little as four minutes. Though generally 10 to 12 minutes was more typical, I started referring to those moments as the “four-minute smile” sessions. Like a rat on a treadmill, the pace of practice was faster and faster as demands increased and reimbursement dropped.
I was not willing to just adapt to the game the way the book “Who Moved My Cheese?” describes. Rather, I wanted to look for ways out of the maze, to find that metaphorical cheese in a totally different manner. I was aware of very few specialists who had moved to DPC, but when I talked to those I knew, they seemed very happy. Their patient volume was down, their quality of care was up, and they felt more fulfilled by their interactions and results.
There is a lot of talk about medicine getting tougher to practice, about physician burnout. But every day, doctors are innovating and finding ways to change and improve the paradigm for themselves, for patients, and even for the hospitals in which many work. The problems are real, but so are the possibilities. And the solutions some physicians are creating are often nothing short of inspiring. Let’s take this time of change in our profession to be open-source with our struggles and solutions. Together, we can help the face of medicine evolve into something we and our patients can not only live with, but also thrive within.
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