A profound lack of choice within Big Box Medical creates a matching problem that leads to dissatisfaction and disillusionment on both sides of the equation.
Patients typically don’t get much choice over what doctor they see, especially if they want to in their medical insurer’s “network” to make the service at least remotely affordable.
Doctors, similarly, don’t get much choice over what patients they see. Since doctors within these systems trade their autonomy for a consistently full schedule, they have no choice but to try to take care of patients with whom they don’t have a good rapport or who are borderline abusive towards them.
This mismatch creates an obvious problem with obvious consequences.
Small, independent, niche medical practices help solve this matching problem.
Consider the direct care model (no insurance, direct relationship between doctor and patient — the way it used to be).
In a direct care practice, when it’s not a good match, either party has the choice to move on from the relationship. This doesn’t mean free rein for discrimination. I’m happy to discuss that with anyone who may have concerns or questions about it.
However, when it’s a good match, patient and doctor get to enrich each other’s lives again and again for as long as they both agree that it makes sense and feels right.
If a patient doesn’t like the product they’re receiving, they can take their time and money elsewhere.
If a doctor/owner doesn’t like the way they’re being treated or feels they can’t adequately give the patient the results they’re seeking, they can focus their time, energy, and expertise on more ideal clients.
As a patient, you get to choose who you decide to trust and compensate.
As a doctor/owner, you get to attract the people you enjoy working with and have the skills and unique abilities to help. These people are excited and grateful to see (and pay) you, and you’re excited and grateful to give them everything you possibly can to guide them to the transformation they seek.
For example, if I want to help someone suffering from a complicated chronic disease like hidradenitis suppurativa or prurigo nodularis, I know from experience that having an hour to devote to the first visit is appropriate.
In a direct care model, I can arrange for that without sacrificing income or being late for the rest of my appointments that day, which is a huge stressor for insurance-dependent docs and their patients.
Practicing medicine in 2023 can be effective, fulfilling, sustainable, equitable, and profitable. Don’t let anyone tell you otherwise.
You just need to open your mind, find comfort and guidance in others who are doing something similar, and do the work.
