Independence Day/Five Months In

Fireworks (from our wedding! 10/26/2013) courtesy of Scott Neisler. Photo credit: Torrence Photography

Last weekend I had the privilege of attending the annual Direct Primary Care Summit. Going to this same conference last year in Minneapolis pushed me to make the leap from insurance-based fee-for-service care to direct primary care. Going to this year’s conference in Dallas reminded me exactly why I made the switch - as an independent physician no longer constrained by insurance companies nor health system administrators, I am free to provide the level of care that my patients deserve.

Reimbursement from insurance companies for primary and preventive care services have not only lagged behind inflation over the past decade, those payments have repeatedly decreased over time. The only way to stay afloat and take insurance is to see more and more patients. Patients feel it - waiting 45 minutes in the waiting room and 15 minutes in the exam room to have only 7 minutes of the doctor’s time (you probably spend more time getting a haircut), rushed visits with the doctor’s head rarely appearing from behind the screen, booking the next appointment nine months out, never speaking with a real person when you call, waiting a week for a reply to a portal message, getting lab results two weeks after they’re drawn, etc, etc, etc.

We as physicians feel it and despise it too. I went into primary care because I love talking with people - getting to know my patients, their families, and their stories. Without that knowledge and that relationship, there is no way I can accurately diagnose what’s happening nor come up with a treatment plan that will work for that particular patient. As Sir William Osler said, “Listen to your patient; he is telling you the diagnosis.”

Sir William Osler Photo credit: American College of Physicians

But in the insurance-based fee-for-service model, I did not have time to listen. My days were a blur of seeing patients back-to-back who were frustrated by all of the above; returning phonecalls, portal messages, and emails; completing prior authorizations for the medications and imaging that I knew my patients needed; and trying to touch base with specialists. These tasks bled into the evenings, weekends, and vacations. I was never caught up and constantly worried that I’d missed something life-threatening among the thousands of results. This literally kept me awake at night. Not only had more than a decade in this broken model made me regret a career in primary care, it had taken a serious toll on my physical health, mental health, marriage, and my ability to be a good mother.

Now five months into opening my own practice and providing high quality, comprehensive, and convenient primary care for New Yorkers of all ages, I am starting to feel human again. My DPC colleagues tell me (and the moral injury literature backs this up) that it will be a couple more years before I feel totally like myself again. But the numbness that I was forced to develop in the old system is fading. I have time to get to know my patients, and I can care for  them because I have the bandwidth to care about  them. I get to see photos and hear stories of grandchildren, dogs, and vacations. I get to meet parents, spouses, and siblings.

I finally feel like I am doing what I was supposed to do, and I am so grateful - to my husband and son for going on this scary but wonderful adventure with me, to my parents and friends for encouraging me every step of the way, to the amazing physicians who started this movement to save their patients and primary care as a whole and continue to mentor us newcomers, and most especially to the patients who recognize the value of DPC and of our relationship and choose to grow this practice with me. I cannot wait to see what the rest of this first year has in store for Dr. Dilling Internal Medicine & Pediatrics.

If you value having a primary care doctor who knows you and knows the city, can care for your whole family, and is available when you need her, please contact me.

And Happy Fourth of July!!!

Grand Central Terminal Main Concourse