Becoming a physician is hard work. No doubt about it.

Each phase felt like the steepest of learning curves.

Remember your MS-1 anatomy class? So many names and terms to memorize.

How about that first clinical rotation in your third year? It took me at least an hour to get a simple SOAP note written in a patient’s chart (yes, handwritten notes back in those days).

And then there was the dreaded internship year, PGY-1, that was riddled with problem lists, admission orders, and diagnostic codes.

Although those early years were tough and I learned a lot, it was my PGY-22 where the steepest learning curve seemed to catch me off guard. Yes, that’s right: in 2016, exactly 22 years after I received my medical degree, I learned more about medicine and health care than ever before. It just so happened that 2016 was also my first full year of direct primary care.

Coincidence? I don’t think so.

After practicing as a traditional network-employed physician for almost two decades, I made the leap to DPC. I never imagined that leap would allow me to learn more than when I was in training. Suddenly, the blinders of “this is how we do it” and “these are the guidelines” were off. I was able to think critically and question, “Why?” And wow!

Some of what I learned was eye-opening.

Here is a quick list:

• Not everyone has insurance. And those who don’t aren’t necessarily broke or ill-prepared for an emergency.
• Insurance, many times, is actually a barrier to good health care.
• Prices are falsely inflated all over health care: medicines, imaging, hospitals, labs—you name it. It’s overpriced, and patients get scammed.If a DPC doc can dispense a 30-day prescription of Lexapro for $2.10, why is CVS selling it for $18? Worse yet, why are some insurance plans selling it for $127?

  If a DPC doc can get a lipid panel done for $5, why on earth is BCBS charging their “covered lives” $65? RIP-OFF.

• Guidelines and cookbook medicine don’t work, especially if patients can’t tolerate or afford their medications—and many can’t.
• Creative clinical solutions don’t mean a physician is a quack or should not be a “preferred provider”; it means a doctor is a true patient advocate.
• EHRs are the worst thing that ever happened to the practice of medicine and communication between doctors.
• The best medical note is concise, accurate, and includes a clear assessment and plan. Sometimes, that only takes 2-3 sentences. There is no need to count VS, organ systems, or complex diagnoses.
• Don’t get me started about coding.
• Patients don’t get better care from fancy medical facilities or from doctors with world-renowned titles; they get the best medical care from a doctor who knows them.
• Patients want a doctor who has time to listen, can answer questions, and offer some insight. That is all.

My list could go on and on.

The most surprising fact I learned in my PGY-22 was that most doctors have no clue about these things. They are so busy on a day-to-day basis that they never get a chance to take off those blinders and question the very system that is burning them out. They can’t understand how health care can be cheaper as cash pay, how well medicine functions without insurance, how happy patients are when a doctor simply listens, and how rewarding medicine is when you get to take care of patients the right way.

It’s ironic, isn’t it? I learned more about medicine and health care when I left the system that was responsible for training me. I have said DPC was the best decision of my career. And why, you ask? Why was it the best decision?

It’s all because of that PGY-22 steep learning curve.

Amy Walsh is a family physician. This article originally appeared in DPC News.