Direct Pay Doctors: Davids of the David-Goliath Health Care World

My sling is the sling is the sling of David.

Jose Marti (1835-1885), Cuban National Hero

With the help of David Racer, of DGR Publications in St.Paul, Minnesota, I have just produced an E-book Direct Pay Independent Practice : Medicine and Surgery, which will soon be available on Amazon, Nook, and other E-book outlets.

The book’s thesis is that the time has come for focused health factories rather than comprehensive health facilities , for customer care rather than system care, for single-tasking rather than multi-tasking, for single-doctoring rather than multiple doctoring, for the medical industrial simplex rather than the medical industrial complex, for the Davids rather than Goliaths of the health care world.

These ideas go against the grain of traditional thinking , indeed against ObamaCare itself, for they may eliminate or minimize powerful middle interests – hospitals, health plans, and government. The positives are reduced overhead, lower predictable costs, transparency in pricing, and more direct relationships between payers and physicians and consumers and physicians.

The ideas are not as far-fetched, simplistic, and naïve as they might first appear. Malcolm Gladwell (born 1963) has popularized them and shown their practicality in a series of five best-selling books: The Tipping Point: How Little Things Can Make a Big Difference (2000), Blink: The Power of Thinking Without Thinking (2005), Outliers: The Story of Success (2008), What the Dog Saw: And Other Adventures (2009), a collection of his journalism, and David and Goliath: Underdogs, Misfits, and the Art of Battling Giants (2013).

In a a March 13, 2014 Forbes interview with Robert Pearl, M.D., “Tell People What It’s Really Like to b Doctor, “Gladwell spoke about a doctor’s office he’d recently visited. He described interacting with four support staff: three doing paperwork and only one assisting the physician with medical care.

“That’s insane,” he said. “The only other industry in America that has a higher ratio of back-office to front-office is financial services, which also is a massively crazy business. It’s just wrong. It’s a misuse of resources.”

In my book, I show these ideas have power and promise in the case of direct pay health care, as practiced by concierge medicine practitioners and ambulatory surgery centers. In most cases, direct pay care lowers overhead, sometimes dramatically lowers overall costs by a factor of two or three, effectively eliminates time-consuming and annoying bureaucratic obstacles, is more consumer-friendly and personal, and satisfies the mutual interests of consumers and physicians alike.

These ideas, however, threaten existing special interests of hospitals, health plans, and government and generate controversies as to whose interests are being served and whether quality is being maintained.