Letter To A Premedical Student.

Dear [Student],

It’s good to hear from you, and I am never to busy to promote the revolution and build the future of healthcare.

In the present medical education system, students and residents are unlikely to hear anything about direct primary care, or about the business of healthcare generally.  Forgive the analogy, but medical education approaches money the way most parents approach sex: if we don’t talk about, the young people won’t think about it, and their purity will be preserved.  The result, in both cases, is that ignorance leads to a lot of misguided behavior and unintended consequences.  Doctors owe it to themselves and especially to their patients to become knowledgeable about the economics of this industry, and  to experiment with payment schemes that improve the delivery of services.

Direct primary care is not for everyone, patients or doctors.  It would be great for the elderly, if they weren’t covered by Medicare.  They are the wealthiest part of the population, measured by net worth, and they would really benefit from having enhanced access to primary care to avoid having problems evolve into catastrophes.  It is possible to provide direct primary care to them, but Medicare makes it difficult.  Patients on Medicaid are usually incapable of paying anything for their health care, and they are well-served by Federally Qualified Health Centers and similar venues for primary care.  I have worked in FQHC’s for the past fifteen years, and they are organized specifically to meet the needs of this population.  There doesn’t have to be a single type of clinic to serve the primary health care needs of different populations, anymore than there has to be one kind of restaurant or clothing store in the world.

Young practitioners coming straight out of residency have opened direct primary care practices, for example, Dr. Josh Umbehr of Kansas.  It all depends on the market, and anyone who wants to open a practice will probably need a lot of savings or some moonlighting jobs as they get started.  I personally would recommend an FQHC for any young family doctor getting started as a place to get experience as well as getting loan forgiveness.

Find below an incomplete list of doctors I consider to be leaders in this field.  If you have a chance in your last semester, take a course on entrepreneurship, or at least read the books The Innovator’s Dilemma and Freakonomics.  Further, if there is a premedical society or some such that would be interested in hearing about direct primary care, I would love to speak to them.  Good luck, create the future.

Josh Umbehr, MD

Pamela Wible, MD

Brian Forrest, MD

Samir Qamar, MD

Zubin Dumania, MD (aka ZDogg).

Tim Ames, MD

blog at jtimothyames.com

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