Say no to bureaucrats and yes to direct care

Yes, it really is time to revoke the health care mandates issued by bureaucrats who are not in the profession of actual healing.

Daniel F. Craviotto Jr. writes in the Wall Street Journal, “In my 23 years as a practicing physician, I’ve learned that the only thing that matters is the doctor-patient relationship.”

Craviotto, Jr. is a doctor who embodies the fight of direct care. How we interact and treat our patients truly is the practice of medicine. There’s a problem with the rising cost of health care. (For starters, Oregon spent over $1,000 per subscriber on just a website to sign up for coverage that might not even provide a doctor.)

And there’s a larger problem when the individual physician in the trenches doesn’t have a voice in the debate. Bureaucrats are telling doctors what they can and can’t do.

And that needs to stop.

As a group, the nearly 880,000 licensed physicians in the U.S. are, for the most part, well-intentioned. Does anyone endure the gauntlet that is a residency program — 10+ years of training — to do anything except their best work?

Yes, the demands on physicians are great, and many of our families pay a huge price for our unwavering commitment. But shouldn’t our nation take great shame in knowing fee-for-service docs tack on 2+ hours of transcription every working day just to get paid, maybe, for the work they’ve already done?

How can bureaucracy, split between so many non-practitioners, own up to the cleavage of time that it brings upon the very people working to keep our nation healthy?

When do we say damn the mandates and requirements from bureaucrats who are not in the healing profession?

How do we stand up and say we aren’t going to take it any more?

For starters, we say yes to direct care.

We say, stop, every time a doctor joins the movement, every time a doctor pledges to make that transition (and makes a plan to help their patients through it).

We say it every time a patient says, “Give me affordable primary care.”

We say, stop, when we cut the red tape: Offer affordable services for cash, make insurance something that’s only used in real emergencies, and render EMR regulation and meaningful use incentives null and void.

The Centers for Medicare & Medicaid Services do say that fee-for-service docs have to use an EMR or they’ll be penalized with lower reimbursements in the future. Some meaningful use criteria from Medicare tell physicians what they need to include in the electronic health record or they won’t be subsidized the cost of converting to the electronic system and we will be penalized with lower reimbursements.

Meanwhile, keep in mind: EMR vendors are raking in the dough and saving us nothing.

Meanwhile, across the country, fee-for-service doctors waste precious time filling in unnecessary electronic record fields just to satisfy a regulatory measure.

Is that the best use of time for a highly-trained individual?

Physicians are tired — tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way they practice medicine.

And as we know, physicians top the list of professions with the highest suicide rates.

Yes, we’re irrational humans. But we’re doctors, too. So let’s be scientific — saying that EMR machines are literally making doctors kill themselves is a stretch. But, if we have the data that says, “We work in a profession where suicide is common, and we promulgate activities that are totally meaningless, i.e. hours of transcription that could be spent with loved ones,” how is this ethical?

No other profession would put up with this kind of scrutiny and coercion from outside forces.

The legal profession wouldn’t.

Labor unions wouldn’t.

So why should we?

Josh Umbehr is founder,

Before starting your own practice, do these 3 things first

If you’re a young doctor reading this, chances are you are employed by someone else. Your paycheck may come from a hospital system or a group of other doctors, but you’re not your own boss. This may be working out just fine for you: I hope you are happy and have a well-balanced work and personal life, and are getting a fair paycheck. I hope you have a sense of professional and personal satisfaction, and can see yourself working for the same organization for the rest of your days with a smile on your face each day! If this describes you, you can probably stop reading now because you have found a unicorn job! Keep it!

However, if you’re like the majority of doctors I know, there may be something that you feel is lacking in your life. Maybe you feel overworked with no time left for yourself or your family. Maybe you feel under-appreciated, under-valued, and think you have more to offer your patients but can’t make it work in your current job situation. Perhaps there is pressure on you from above to see more patients per hour than you think is reasonable, and you are being forced to rush your patients in and out without giving them the time they deserve. Maybe your senior partners aren’t using you to the best of your abilities, and see you as cheap labor to feed their endless desire for more of everything … more money, more patients, a bigger practice, fancier cars, more expensive toys, whatever.

Does any of this sound familiar? When the honeymoon period is over and you realize you’re running uphill everyday chasing promises that are actually lies, trading your hard work and sacrificing more of the prime years of your life to make more money to stuff into someone else’s already fat bank account, what are you going to do about it? Have you thought about where this path will lead you in ten years? You’re not going anywhere good; I can tell you that with certainty!

If you’re employed by a hospital or private group and have thought about leaving them behind and going solo or finding another employer, this article is for you! Even if the thought of opening up your own medical practice seems completely overwhelming right now, keep reading. A few years from now the idea of going out on your own will seem less scary. If you ever actually make the move, you will be happy you did the following three things NOW. Think of yourself as planting trees that will take many years to grow — you can’t wait until you’re sweating in the sun and desperately looking for shade to plant the seeds!

1. You need to build an internet presence centered around you. Doctors need a digital footprint on the internet. This should be built around you personally, as your employer may change in the future, but you are a constant. Patients increasingly use Google to find their doctors and read up on all kinds of health-related topics. If you are relying on your current practice’s website as your internet presence, as soon as you leave that practice *poof!* you’re gone from the internet too! How will patients find you? Will your patient’s even look for you? Do they remember your name? Are you engaging your patients in some meaningful way or are you just another doctor following an algorithm that any other “health care provider” can do?

How do you build an internet presence? Start by signing up for social media accounts as your professional self. Use your title in the profile name and use a professional headshot as the profile picture. Try to post regularly and let patients know where to find you. This is super-easy and you can literally do this right now. (Make sure to adhere to professional guidelines about social media usage for professionals. Don’t even think of sharing inappropriate content or making comments online that you wouldn’t share with an actual real patient in a medical setting. HIPAA still applies online too. This should go without saying.)

If you want to take things to the next level (and you should), start your own website, blog, or whatever you want to call it. Think of a name for the site (you can just use your name for now, for example, buy the URL for $10 on, and put up something basic on there. You can learn how to do this by searching Google, but you can also just pay someone to set up a website for you. Either way, there are many ways patients can engage with you on your own site, and a few years from now when you make the move your patients should have no problem remembering your name and finding you on Google. (I should mention that you actually need to like writing, otherwise having a blog will almost surely fail after a few months.)

Just to illustrate how long it takes to generate some real traffic on your blog, here is a snapshot from Google Analytics for Retroflexions (this site). As you can see, it takes time to get the traffic going, and it’s not a linear growth, it’s more like a punctuated equilibrium. This is why it’s important to start your site now, not a month before you are starting your new position.
If you don’t want to commit to having your own blog-type site, you can also write some high-quality articles and shop them out to other blogs, news sources, websites, etc. Many places are happy to publish your stuff for free as long as it’s well-written and pertinent. Make sure you can put links back to your own website (which can simply be a static page with your picture, credentials, contact information, and social media links) in the biography and these articles will continue to serve you for years to come.

2. Evaluate your financial situation now, save money, avoid lifestyle inflation. This can’t be stressed enough. Don’t paint yourself into a corner where you are forced to stay in a job that is crushing your soul because you desperately need the money to pay for things that you have no business owning anyway. Do you really need a $90,000 luxury car? Do you truly get enough enjoyment out of it to justify the cost? Are you running yourself ragged, putting your own health and your family’s well-being at risk, just to afford all this bullshit that you don’t need? Be honest with yourself!

What if you drove a nice $30,000 car instead, and instead of working all of those extra hours, you put that time into some productive activity, like taking care of your body or your mind? Would your family be happier if you were home a little earlier each night to spend time with them but didn’t drive a 362-hp Mercedes S 450? I think you already know the answer to that question!

It will take a bunch of your own money to make a career change, especially if you choose to go solo and start your own practice like I did. You will basically need to live on savings for a while since even if you start out busy it will take months or longer for your accounts receivable to ramp up to the point where you can take home a reasonable paycheck. Sure, you can amass more debt and take out big loans to pay yourself from, but why? Make things easier on your future self by cutting the fat out of your spending today, and save the money you’re making now to help with your escape later!

3. Keep kicking ass every day! Continue to work hard for your patients and build a good reputation among your colleagues. If you are a rockstar physician, your patients will find you and follow you no matter where you go or who you work for in the future. Your reputation with your colleagues and co-workers (other doctors, nurses, office and hospital staff) will follow you wherever you go. You are not defined by your employer, you are a professional and it’s your name on that medical license…not your bosses name. Don’t forget that!

Truth be told, it’s easy and somewhat natural to become bitter and feel burned out when you’re not happy with your job. These feelings can quickly turn into apathy and other counterproductive behaviors, which can be self-sabatoging in the long run. Don’t let your circumstances define you. Focus the energy from these negative emotions and use it to start a fire in your heart that burns for a brighter future. You are moving on to bigger and better things, so act accordingly!

Two years from now when you finally pull the trigger on your new life, your future-self will be happy you did these three things today.

Frederick Gandolfo is a gastroenterologist and founder, Precision Digestive Care. He blogs at Retroflexions.