Direct primary care physicians are trying to rescue other doctors

In a recent interview, Dr. Farzad Mostashari (former national coordinator for health IT and current CEO, Aledade ACO) gave some advice to physicians on how to avoid burnout and “restore their role as caregivers”:

The key is two things. One, if you’re in a kayak in the rapids, you have to lean in and dig your paddle in and push ahead. If you lean back, you’re done. You’re going to flip over. So be more active. Don’t be passive. Take control. Step two is join together with others to increase your power, increase your control, increase your ability to have someone else help you deal with that crap, deal with the quality reporting, deal with the EHR optimization, deal with the ACO regulations.

So I think that’s the solution — not to retreat into some direct primary care model. That, to me, is not a solution for all of our docs to say, “I’m not going to take insurance.“ That’s not the solution. We have to find ways of coping with the change and feeling more in control.

I am a family physician who has operated a direct primary care practice (DPC) for nearly five years. In that time, I have met hundreds of physicians planning or operating DPC practices; many of whom I now consider good friends. While they each have a unique story and perspective, your comments are not remotely reflective of the mindset of doctors opting for DPC. I honestly wonder whether you have ever talked to a single one of them.

These DPC physicians are among the most courageous, creative and determined men and women I know; the exact opposite of what you describe. They have each taken huge risks — professionally, personally and financially — in an attempt to “take control” as you suggest. Most have sacrificed hundreds-of-thousands of dollars in pursuit of becoming the caregivers they envisioned while in medical school.

Out of necessity, they are educating their communities on the importance of quality primary care. They hold town halls and talk to the media. They network heavily with technology and medical vendors. They engage employers and policy makers. They write blogs and vigorously in online discussion groups. They are the epitome of entrepreneurship and activism.

The DPC physicians I’ve met nearly always possess a passion that has sadly been beaten out of most of my physician colleagues. Despite giant obstacles and an uncertain future, DPC physicians forge ahead. Our vision for the future of primary care may be naive to you Dr. Mostashari, but to claim we are passive or “retreating” is flatly absurd.

I do agree that a major driving factor behind the DPC movement is physicians feeling powerless to deal with an ever-growing pile of “crap.” Can you blame them? Older physicians have lived through many decades of initiatives purporting to improve the practice of primary care — only to realize the newest barrage of alphabet soup was keeping them even more distracted from patient care. Is it possible to outsource some of that administrative burden? Sure, but physicians are rightfully skeptical about why the “crap” exists in the first place.

Being born and raised in Kansas, I admittedly don’t know much about kayaking. However, I would suggest that the rapids have already tipped over many of our boats. Direct primary care physicians have bravely climbed back in their vessels and are now trying to rescue others; hopefully, before we all go over the waterfall.

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