The Need For Concierge Medicine

Concierge Medicine & The Lion King: “Simba, it is time…”

It is indeed a dark time in medicine. Nature is out of balance. The wrong species are in charge. The pride lands – once ruled by medical giants – are now barren. Internists are now nonexistent in the hospitals, a place where they once roamed free. Similarly, the strong and proud general surgeons are all but extinct. In their place is a group of complacent, demoralized, cubs – the emasculated sons of warriors - who willingly accept the rule of the hyenas. 

I was a pioneer in the concierge medicine movement. I opened one of the first concierge medicine practices 10 years ago. I could not accept the mandates of the bureaucrats of Medicare, the pack predators of the HMOs or the crony-capitalism of big insurance and big government. I opted out. 

The weak and politically correct lions in my medical community were initially very critical of my independence and autonomy. I was publicly scolded for “pandering to the rich”, as they participated with unethical third-party payers to ration care for their patients, lining the pockets of the HMOs…all to protect a guaranteed income stream. I was described as mercenary and selfish for contracting directly with my patients, as if this were somehow violating the ethical gold standard set by United Healthcare, Humana or Senator Pete Stark. I was assailed by one academic physician on the front page of the Arizona Daily Star stating that what I was doing was, “boutique medicine at its mercenary worst.” 

In my opinion, much of the destruction of medicine has been due to an epidemic of acquired hypogonadism among doctors. Perhaps more accurately, it has been a peculiarly, voluntary castration. The present distortion in the medical food chain is due, in large part, to the complacency of doctors.

Many physicians share the same pitiful attitude of Simba in Disney’s The Lion King. Just listen to the whining that goes on in every doctor’s lounge across the country. Instead of taking their rightful place as medical leaders in the circle of life, they have indulged in self-pity, viewed themselves as victims, and hidden behind a false pretense of “humanitarianism” – as if it is somehow humanitarian to cede control of their profession to others. Somehow, it is “caring” to accept the absurdities of ObamaCare, work for Medicare or Medicaid or have a clerk at an HMO tell you that the MRI of the brain that you ordered for your patient is unnecessary.   

The future of the pride lands is now at stake. Clearly, ObamaCare will not save medicine; it will only hasten its demise. However, ObamaCare may have the unintended consequence of causing physicians to wake up. In this current landscape, dominated by medical hyenas, I would argue that Mr. Obama is very much the “Scar” figure. He is an agitator and a manipulator, who has overpromised to his opportunistic pack. He has no skill set upon which to turn his words into reality. He has promised all the hyenas – the trial lawyers, the insurance companies, the big unions – that he will create great prosperity for them all. And yet his most transparent act of “audacity” has been to pretend that you can “reform” healthcare, without even considering tort reform. Obamacare will ultimately fail, but it will cause much suffering until it is repealed. 

To the disenfranchised, Obama has demonized those of us who have given countless hours of free medical care to the poor during our careers. He has said that he will wrestle power from the greedy doctors…you know…those surgeons who would rather “amputate a leg for $50,000 than prevent the diabetic foot ulcer from occurring in the first place.” (Remember that gem?) 

As medical care and resources become rationed and scarce, all of the hyenas –even those who put Mr. Obama in power - will become disenchanted. Obama will ultimately share the fate of Scar.  He will be eaten by his own…the pack-predator brethren who put him in power. This is the nature of the rise and fall of the Scars of this world. It is all a part of the circle of life. It is a simple enough concept for Disney to explain to small children. 

When that day of reckoning comes, and the medical pride lands have been completely scorched, it will be time to rebuild. It will be then that doctors should heed the words of the wise Rafiki: “Simba, it is time.”   The only people who will have the expertise to rebuild medicine will be the doctors. Time will tell if they will be up to the task. To do so, they will need to find the strength to be leaders, and if necessary, they will need to find the strength to become warriors. 

The best method to restore the doctor-patient relationship and physician autonomy will be a movement toward private practice. Medicare and Medicaid will ultimately perish. In truth, they are already dead.  There is no Medicare trust fund. All of the money that was supposed to be put into the fund has been spent. Medicare is now just part of the mounting national deficit. 

The hyenas of the HMOs and insurance giants must get a clear and consistent message from physicians.  This message should be contained within a single, powerful word: “NO!”  No, you will not dictate the nature of my practice. No, you will not be the unwelcome middleman any longer. No, you will not tell me what tests to order, how to practice medicine or how much I will be paid for my services. Go back to your pack or be killed. Tell the other hyenas that your reign of terror is over. You may sell insurance plans to patients if they desire to purchase them in a free market, but that will be a relationship between you and the consumer. It will not involve us. If you choose to challenge us for control of medicine again, there will be no negotiations. The lions have returned to their rightful place in medicine. And we will do whatever is necessary to protect ourselves, our patients and our freedom. 

There is no contradiction in a healer being a warrior. Many famous physicians throughout the ages have also been martial artists. There are times where war – be it literal war or political warfare – is the only solution. Leadership, by its very nature, sometimes involves going to war. Leadership, by its nature, cannot be founded on pacifism.

A MD As A Financial Planner?

Is your financial planner a physician? I didn't think so.

After finishing medical school and residency, I was suddenly making a lot more money but I had no clue what I was doing with my finances. I didn't know about retirement plans or where to invest my money. I didn't even know what an estate is.

So I did 2 things: I hired a financial advisor at Smith Barney and I started picking stocks on my own...after all if I graduated from Johns Hopkins medical school, one of the top med schools in the world, picking the winning stocks was easy, right?

Well a few years went by and then my wife got out of her residency training (she's a Hopkins med school grad also and West Pointer) and then we had kids, and all of a sudden I started looking more closely at my finances and realized a few things:

1. My financial advisor was NOT acting in my best interest. All he was doing was selling me products to get a commission. It's like me choosing a drug for a patient just so I get paid more instead of simply being paid a fee directly.
2. My financial advisor wasn't providing any advice.  I needed to know whether I have enough insurance, whether I'm saving enough, what to do about my kids' college funding and so on.
3. An insurance guy sold me insurance products I didn't need and he appeared to suffer from point #2 also.
4. My financial life was becoming more complicated and I needed to organize it, simplify it, and enhance it.
5. I didn't have the knowledge and training to manage my finances. There wasn't even a single hour in med school or residency devoted to financial planning.

And that's when my passion for financial planning and investment management was born. As my situation became more complex, I started reading voraciously about the academic studies on investing and numerous other aspects of financial planning.

BUT SOMETHING ELSE FUELED MY PASSION EVEN MORE.

I noticed that lots....and I mean LOTS....of doctors didn't know how to manage their finances either.  And to make it worse, the physicians who hired financial advisors were being ripped off.  We were being taken advantage of by financial advisors that have no intention of acting in our best interest.

That made me really mad.

After working so hard and sacrificing so much in our lives, doctors deserved better from their advisors. And we needed someone who can truly relate to us, understand our situation, and actually act in our best interests just like we act in the best interests of our patients.

So I decided to become a financial planner for doctors.

Medical Tourism Is Changing

Medical tourism used to be tiny and only for the wealthy. Now it's 'Medical Travel' and it's growing, fast.

Leaving home for care is nothing new. People have been traveling around the world for treatment since the beginning of time. Now we call it medical tourism, and it is growing quickly.

Patients seek care away from home because it is cheaper, unavailable in their home location, can be accessed without waiting for a long time, can be combined with a travel experience and can be kept secret. Despite the talk of healthcare reform, patients and employers are paying more for care with no forseeable decreases and they are looking for safe, affordable alternatives to care in the US.

There are several serious barriers to adoption and penetration of the notion of leaving home for care. In fact, we're not even sure what to call it these days. "Medical tourism" has morphed into global healthcare referral or medical travel, underlying the fact that we are talking about healthcare in a different place, not sipping Margueritas by the pool. The growth of the industry is being fueled by mostly medical outsiders who see the commercial potential of opportunities that have resulted from medical cost inflation, globalization and cheap information and communications technologies.

There are lots of opportunties for physicians in the medical travel industry. Substantial challenges to the traditional notions of face-to-face care, continuity of care, itinerant surgery and global healthcare information exchange are but a few of the issues that the medical provider establishment will have to confront as medical travel continues to grow around the world.

Medical Fusion Conference

The Medical Fusion Conference was held this last weekend in Las Vegas.

A number of the physicians that I've interviewed on the Medical Spa MD Podcast were there as speakers, and a number of physicians that I met at the conference are going to be on the podast.

The Medical Fusion Conference is still relatively small. I think there were less than 100 physicians attending.

(There were a few Medical Spa MD Members that I got to say hello to which was very nice. I didn't come close to going bankrupt with my offer to pay for a month of Frontdesk SEO oursource marketing services which I think of with somewhat mixed blessings.)

I'd attended the conference for a number of reasons; Medical Fusion is a Select Partner for both Freelance MD and Medical Spa MD, I wanted to find out what value the conference held for physicians, and I wanted to guage the reaction of the physicians who attended.

Across the board it was all positive. Every physician I spoke to gave the conference two thumbs up and described it as an excellent overview of potential options in non-clinical medicine that had the wheels spinning.

One of the take-aways was that every physician is looking for what the military world calls 'actionable intelligence', ways to put these strategies and information into action. The result? Freelance MD.

From Doctor to Blogger?

Physician's who are choosing non-clinical careers are becoming increasingly common.

In doing background research for our Medical Fusion conference, I began looking around for examples of physicians who have branched out into other areas. Had I done my search even a few years ago, the examples would have been few and far between. In the not-so-distant past, it was very unusual-- almost unheard of-- for a competent physician to leave medicine. The training was too long, and the prestige factor was just too high. Doctors didn't leave medicine unless they were incompetent, corrupt, or very, very unique.

Now the examples are more plentiful, although it still is unusual for a physician to completely leave medicine behind.

All this brings me to the very interesting story of Dr. Arnold Kim. Dr. Kim might be the story of our times-- a Nephrologist from Virginia who gave up medicine to become...a blogger?

Dr. Kim runs a blog called Mac Rumors that he began in 2000. As the site grew, Dr. Kim saw an opportunity to focus on something that he was truly passionate about and that gave him more time to spend with his young daughter. He made the decision and has not looked back.

What makes Dr. Kim's story so interesting is not just that he left medicine, but that he left medicine for a "career" that was not even a possibility until recent years.  Of course, with the rise of the internet, technology has changed how people view work and opened the door to a variety of interesting opportunities.  In upcoming posts I'm hoping to review some of my favorite books on the subject including Free Agent Nation by Daniel Pink and The World is Flat by Thomas Friedman.

The point of all this is not that the typical physician-- or anyone else for that matter-- should begin looking into a career in the blogosphere.  The point is that interesting niches are available for those motivated individuals who are willing to take a little risk and step out of their comfort zones.  

Doctor Discontent

Here's an older but good article in the New England Journal of Medicine entitled Doctor Discontent.

Interestingly, the article was published in 1998, a full ten years prior to where we are now.  I would argue that everything the author says in this article is not only accurate and applicable to today's environment, but today's environment exceeds his even most dire estimations.

At the end of this article, the author discusses the theory that the young physicians coming into the current medical culture would not be as affected by the perceived negatives as their older counterparts. My perception is that this has not been the case.  If anything, the younger generation of physicians is even more prone to leave than the older.  For the older generation, the stigma of leaving medicine is still very strong and they often have no exit strategy.  For the physicians who are just graduating from medical programs, there is little stigma to leaving and the opportunities for them outside of medicine are great.

Unfortunately, the author's call to take doctor discontent seriously apparently fell on deaf ears.  Physicians who voiced concerns were dismissed and even today, much of the health policy change is being driven by those who are overtly antagonistic to physicians and physician concerns.  It is a sad day.

My prediction is that health policy "experts" will win their battle to impose their will on physicians, then look around with wonder when their policies fall flat because there are no clinical physicians around to implement them.

The Physician's Guide to Investing

I wanted to recommend a book that I have been reading entitled The Physician's Guide to Investing by Dr. Robert M. Doroghazi.

The first edition was published a few years ago and received rave reviews from numerous people and institutions including renowned investor Warren Buffett and the American Journal of Cardiology.  A more recent edition will be published in paperback next month. You can read an excellent review of the book here .

The book is a fantastic read and offers much excellent advice about debt, saving, budgeting, insurance, and investments. While you might not agree with everything the author says, his writing style is easy to read and his financial perspective seems timely considering the economic conditions we find our country in these days.  

Pick up a copy of the book next month or visit Dr. Doroghazi's website here. Also, the majority of the book can be read on Google books.

Thanks to Dr. Doroghazi for this excellent contribution to medical education.