More physicians are opting out of Medicare every day.  The burden of dealing with this bureaucracy, the risk (it is the only “insurance carrier” that has its own F-16’s and tanks), along with below market physician payment underlies this phenomenon.  Paradoxically, this will allow their Medicare patients to retain access to care, as the shortages resulting from the government’s price controls won’t materialize.  So much for health coverage equating with health care!

Physicians are not only walking away from government payments.  They are abandoning the private insurance “carriers,” as well, dealing directly with patients both medically and financially.  Sick of being bossed around by the apparatchiks of the insurance carriers, physicians and patients are taking back control of care delivery.  This has manifested as a surge in what has become known as DPC, or direct primary care.  This practice model has been for countless individuals their saving grace, as for less than a cell phone payment per month (much less), individuals and families have access to health care they would otherwise find unaffordable.

While what I have described above is healthy and exciting, there is another new “walk out” phenomenon about which I have been made aware, one which is equally disruptive.  Large numbers of primary care physicians are walking away from hospital employment.  Not just a few.  A large number.  Not the marginal types either, but those with the most gigantic practices, those that are the most “productive” for their hospital employers.  

Many of these individuals have honored me by contacting me to tell me of their plans, in some cases inspired by the fierce independence demonstrated by our practice here in Oklahoma City.  I must say there are not many things more exhilarating than talking with someone liberated, particularly when their freedom is the result of their simply walking away, not the result of having been released by a fist-like grip.  It takes guts to walk away, but judging by the conversations I have had recently, these are some of the happiest people I have ever spoken with.  

Here is my message to those who have or are imminently considering walking away from a hospital employer.  Do it.  The demand for your independent, non-hospital affiliated services is larger than you have any idea.  60% of all non-government medical bills are paid by companies on behalf of their employees directly out of operational revenue, these companies having seceded from the normal insurance game, having self-insured.  They are looking for you!!  At our recent Free Market Medical Association (FMMA) conference, employers and benefit advisors and administrators made important connections with DPC doctors in attendance, connections which have the potential to flood these practices with patients.  The self-funded crowd values the independent primary care doctors partly for their lack of incentives (or threats) to send referrals to the giant hospital mother ship, the generator of bills and charges which can bankrupt their self-funded health plans.

Without the primary care doctors on board, the giant hospital system’s model of guaranteed referrals falls apart.  These brave physicians, departing the hospital nest will many times embrace the DPC model, the logistics of which those who have done this are more than willing to share.  At the FMMA, we look forward to many of you joining, joining the growing group of smiling faces that so recently were willing to call it quits, but who now are as excited about their future and the future of the practice of medicine as we are here at the Surgery Center of Oklahoma.

G. Keith Smith, M.D.