Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why this specialist went to a direct patient care model

Joel Kahn, MD
Physician
November 26, 2015
Share
Tweet
Share

September first was a big day for me. After over 25 years of practicing invasive cardiology, I sent an affidavit to CMS to indicate for the next two years I was opting out of their insurance program. As of October first, I have begun accepting patients on a direct patient care (DPC) model that will not involve insurers, ICD-10, or billing fees. Why would a specialist consider this dramatic move?

Practice enjoyment and quality is the answer. I am known in my community as a hard-working and caring cardiologist. My peers knew that my hospital rounds began around 5:30 a.m. and that I was efficient at these, as well as cath lab procedures. My office days were generally booked with 30 to 35 patients, many of which were new.

What changed? Generally, I was seeing more complex cases of heart disease compounded by obesity, metabolic disorders, and poor lifestyle. Trying to manage or at least give advice to patients was getting more complex and time-consuming. In addition, the advent of advanced labs with inflammatory, oxidative, and genetic markers was taking more time to analyze and offer advice. Phone calls for preauthorization first for invasive procedures, then for nuclear procedures, and now for just echocardiograms waste more and more time during the day. They say that if you love what you do, you will never work a day in your life. I was finding that what I was doing was starting to feel suspiciously like work.

What were the options? Some days just to stay on time, I’d have to dart in and out of rooms in as little as four minutes. Though generally 10 to 12 minutes was more typical, I started referring to those moments as the “four-minute smile” sessions. Like a rat on a treadmill, the pace of practice was faster and faster as demands increased and reimbursement dropped.

I was not willing to just adapt to the game the way the book “Who Moved My Cheese?” describes. Rather, I wanted to look for ways out of the maze, to find that metaphorical cheese in a totally different manner. I was aware of very few specialists who had moved to DPC, but when I talked to those I knew, they seemed very happy. Their patient volume was down, their quality of care was up, and they felt more fulfilled by their interactions and results.

There is a lot of talk about medicine getting tougher to practice, about physician burnout. But every day, doctors are innovating and finding ways to change and improve the paradigm for themselves, for patients, and even for the hospitals in which many work. The problems are real, but so are the possibilities. And the solutions some physicians are creating are often nothing short of inspiring. Let’s take this time of change in our profession to be open-source with our struggles and solutions. Together, we can help the face of medicine evolve into something we and our patients can not only live with, but also thrive within.

Joel Kahn is a cardiologist and can be reached on Twitter @drjkahn. This article originally appeared on the Doctor Blog.

Image credit: Shutterstock.com

Prev

Broken by a thousand, tiny, thoughtless insults

November 26, 2015 Kevin 10
…
Next

Physicians looking for a new job should beware these 4 red flags

November 26, 2015 Kevin 21
…

Tagged as: Cardiology

Post navigation

< Previous Post
Broken by a thousand, tiny, thoughtless insults
Next Post >
Physicians looking for a new job should beware these 4 red flags

ADVERTISEMENT

More by Joel Kahn, MD

  • What we can learn from the tragic deaths of CEOs

    Joel Kahn, MD
  • Why millennials need some heart education

    Joel Kahn, MD

Related Posts

  • More physician responsibility for patient care

    Michael R. McGuire
  • The triad of health care: patient, nurse, physician

    Michele Luckenbaugh
  • The ultimate in patient empowerment: advance care planning

    Patricia McTiernan
  • Patient care is not a spectator sport

    Jim Sholler
  • Why health care fails to deliver better value in patient care

    Kristan Langdon, DNP and Timothy Lee, MPH
  • What Celine Dion can teach us about patient care

    Edward Leigh

More in Physician

  • Why more doctors are choosing direct care over traditional health care

    Grace Torres-Hodges, DPM, MBA
  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 9 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why this specialist went to a direct patient care model
9 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...