11 Comments

Unfortunately, I think most practicing physicians do not think about the big national healthcare picture since they are too bogged down in cramming too many patients into their schedule, answering a huge volume of patient questions, documenting the minutiae in their EMRs to get maximum payment (ie physician employers checking their work so the healthcare system gets maximum payment), and filling out prior authorizations. I lived this life for 11 years after FM residency employed in a big health system until I couldn't take it anymore. I got out and started my own Direct Primary Care clinic. DPC is not going to solve our nation's healthcare problems (at least not right away), but there is a groundswell of primary care physicians out there that want to change the system from the ground up (but are afraid of leaving the relative comfort of being employed). DPC in its infancy stage right now cannot compete with the healthcare industrial complex, but in order to eat an elephant, you have to start with one bite at a time.

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Unfortunately most doctors are now employed by the very hospital or insurance “ systems” you describe. The younger ones know no other way. The middle group will lose their jobs if they dare to try to revolt against the healthcare industrial complex. The older group are already out like you and me.

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Ken,

I'm the McGarrah who was at AFSCME and I'm now doing pro bono at Maryland Legal Aid --health care debt and battling UnitedHealthcare's Medicare Advantage that was suddenly forced on all AFL-CIO retirees as of January 1, 2023!

I don't know the McGarrah at Duke, but my son, Patrick, is now an oncologist at Mayo Clinic.

I hope all's well with you and your family!

Rob

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Excellent piece, with one suggestion. There were two partners in the tango - funding sources and care providers.

All along the care continuum the move to a profit (or margin for non-profits) motive, including the commercialization of clinical breakthroughs using predominantly government sponsored research (see pharma, device, etc.) has led us to this unsustainable situation. Advocacy efforts for change from all sectors of the medical industrial complex are needed.

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Great piece/excellent points. I worked for the pharma industry for 37 yrs in R&D, and was somewhat insulated from the commercial part of the company until my last 10 yrs - at that point, I started to see the ugly. Having just retired but still a few years from Medicare, I am reading more and more about our healthcare system and am extremely concerned as to where its is headed. However, in my work travels over the years, I have talked to colleagues about their healthcare in CA and the UK, and although my 'n' is small, I have not heard much that would make me believe a nationalized health plan is the way to go (as an aside, anyone in CA or the UK who has an employer, they essentially get extra care because they have the gov't plan, plus the employer's plan....but are still dealing with their broken system: https://www.wsj.com/articles/nhs-uk-national-health-service-strike-costs-11675693883

Not entirely sure what the answer is but in this vast country, there has to be folks like you who can put their heads together to ensure we have affordable, good quality care (I'd put good quality as the first priority)! Thank you for your writing.

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I am very concerned that by saddling medical students with huge debt, they will, upon graduation, be forced to abandon their values to repay their loans. What an insidious system.

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What do you think about Medicare Advantage plans?

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Great piece, Ken—-keep up the good work!

Rob

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