Letter To A Young Doctor Starting A DPC Practice

When a true genius appears, you can know him by this sign: that all the dunces are in a confederacy against him.

 Jonathan Swift
Direct Primary Care is a threat to any established healthcare organization, because it turns their assets into liabilities.
Their first asset is capital: they have a lot of money sunk into hospital buildings, MRI’s, billing software, and a whole bunch of other expensive things which cannot be used for another purpose.  Your purpose is to keep your patients from using these things, by providing high-touch, low-tech care that keeps them away from the hospitals and their specialists that subject patients to expensive healthcare of often questionable value.  It happens that a lot of these capital goods are paid for with borrowed money, and leverage turns a failing business model into a full-scale rout very quickly: see mortgage-backed securities circa 2008, or the earlier savings and loan collapse of the ’80’s that brought down a lot of the banking system of Texas.  When hospitals become a source of losses instead of profits, the capital markets are going to punish big healthcare organizations mercilessly.
Their second asset is management expertise: the skill set required to run a business with 3 employees is much different that that for a business of 300 employees or 30,000 employees.  The folks at (Big Healthcare Company) know how to run a big operation, and they are paid handsomely to do so.  But if you open a small self-supporting practice, they have nothing to offer you.  If many of us in primary care walk away from their jobs, the people paid to manage us will not have enough to do, and will lose their jobs in turn.  They would never think this with their conscious minds, but they can hear the low rumble of a threat in what you are doing.
Next quote:

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”― Upton Sinclair

And this:
Do you think that I have come to bring peace to the earth? No, I tell you, but division.  From now on there will be five in one family divided against each other, three against two and two against three. -Luke 12:51-52
I suppose what I am trying to do is to warn you that you are leaving the community of traditional healthcare providers, and you cannot expect their support.  But you are joining another community of providers who feel as you do, and want nothing but the best for their patients.

Tim

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