Why Independent Practice?

This is it! Recover Together CT goes live on January 2, 2025 and the scheduling page is open. Starting a private practice has been a dream of mine for many years. It may seem strange to be bucking the trend of physician employment, so I thought I’d use my first blog post to just explain why independent practice is so important. In the future, I hope to use this space to discuss new therapeutics and other developments in the field.

Our medical system is sick. It reflects in our poor outcomes, our crazy bills, our “there’s-a-pill-for-everything” management style, and our burnt out staff. When you call a doctor’s office, can you even figure out how to talk to a human being, let alone your doctor? Most of the time you have to navigate through phone tree after phone tree, and you may not know the staff on the other end. If you are trying to get registered as a new patient, good luck! You can look forward to forms, referral requirements, red tape, insurance glitches, and long wait times. In many cases, when at last you get to know a doctor for a while, they depart for greener pastures. In many big healthcare systems, doctors are treated as a commodity. These days, doctors have been given the generic term “provider”, reflecting this commodification and interchangeability.

It doesn’t have to be this way, but very few doctors have any sense of what independent practice is even like. Most go straight from med school into residency, then in their final year of residency they sign a contract with a big employer and that’s it. I had a similar path at first, but a few years into my career I had the opportunity to work for a small private hospitalist practice, which contracted with private primary care practices.

That was an eye-opening experience. I was one of the inpatient doctors, and I had the cell phone numbers of all the outpatient doctors. Not only did I personally send them detailed REAL notes (not piles of computer auto-generated garbage), but often I would pick up the phone and talk to them to coordinate care. And there wasn’t a game of phone tag. They would see that I was calling and simply pick up the phone. The nurses and scheduling staff often knew patients by name.

What I found is that in private practice, the doctors and patients have a partnership that is very difficult to build within big hospital systems. And if the doctor needs to go above and beyond for the patient in some way, he or she can do it with minimal red tape. This was a huge issue during the pandemic when the healthcare system was incredibly strained. Independent doctors could make the right things happen quickly, in a way that big systems simply couldn’t.

I’ve experienced this dynamic as a patient as well. A few years ago, when I developed a significant health issue, I went to at least 5 big healthcare system practices without obtaining an accurate diagnosis or appropriate care. Each time I tried to get enrolled as patient, I encountered delays and bureaucratic hassles. When I finally saw the “provider”, I felt like I barely had a chance to explain my symptoms and was treated like just a number. Finally I found a private practice that got me in immediately. I was diagnosed correctly on the first visit and received effective treatment right away. It was a life-changing experience.

There’s a place for big complex healthcare systems. They have a huge breadth and depth of services that private practices struggle to match. They can make big investments that small practices cannot afford. And the best systems are truly mission-driven to improve the health of their community, and not just their bottom line.

But for many less resource-intensive medical needs, independent practice has many advantages for both patients and doctors. There is no middleman. There is little to no overhead. There aren’t MBAs monitoring every metric to achieve maximum productivity for minimum “utilization”. There’s just you and your physician, working together. We need to go back to that old fashioned doctor-patient commitment.

In a practical sense, what does this mean for you if you decide to be a patient with me? It means you have my full undivided attention. There’s no one looking over our shoulders. When you call, you get me - not a phone tree. It also means you may be able to access therapeutics that are hard to access within a big system. Addiction medicine is an incredibly fast-moving field with new groundbreaking studies coming out every month. Just within the past year we are seeing really important studies on psychedelics (including ketamine) and GLP-1s (i.e. Ozempic and others). There’s a massive literature coming out on methadone as well, though current regulations prevent methadone from being used effectively in private practice. In a small private practice, we can have the flexibility to carefully evaluate the pros and cons of new treatments and then do it with far less administrative red tape.

There’s the final question of cost. There’s a myth that independent practices are “concierge” care or are somehow exclusively for rich people. But it’s only in recent decades that our healthcare system has become so unbelievably bloated and expensive. In reality, the vast majority of the the cost and complexity in healthcare goes to overhead, not to direct care. For example, you could easily pay $200 for 15 minutes of a physician’s time, but that doctor only sees maybe $35 of that, and the staff is getting even less. The rest is going to overhead. When you walk into a big, beautiful hospital, that lovely facility is overhead cost to the actual healthcare you are receiving. Recently there’s been news of hospital systems spending tens of millions of dollars or even one hundred million dollars on parking garages. Some hospital systems have spent a billion dollars on their electric medical record system alone!! Our minds have trouble contemplating these numbers, but those are your dollars that are not going towards directly taking care of your health, yet were incorporated into your healthcare bill.

Again, there is a role for big health systems that can make big investments and impact a big population. But I think we’ve gone too far in that direction. We need to go back to small medical practices, with highly trained physicians who know you and your family. That’s why I’ve started this practice, and I truly hope it will serve a need in our community.

Jason