Nothing pays like (physician) autonomy!

October 30, 2017 by Sameer Lakha
Physician autonomy, Kavalek, M..
Matthew Kavalek, MS3

“Nothing pays like autonomy.”

Dr. Julie Gunther (SparkMD) gave one of the most inspiring quotes I heard at the Direct Primary Care (DPC) conference in Orlando (co-sponsored by Docs 4 Patient Care Foundation and the Florida Medical Association): “Nothing pays like autonomy.”

This is a very powerful idea. Medical school places a very large debt burden on its graduates. Whether students care to admit it or not, this debt load is a highly influential factor in one’s decision regarding a medical specialty. It’s been amusing to observe students’ attitudes as we progress through medical school together. As first year students, many claimed, “It’s not about the money.” As Step 1 approached at the end of second year, I heard students remarking, “I need to do well on this exam to get into a competitive specialty that pays well to pay off these loans.” As third year continues, I hear more students remarking on which specialties pay the highest salaries. This would be more amusing to me if it were not so sad.

Julie Gunther, MD

Making a decision as critical as a future career choice based merely on the current medical model, with no understanding of the history of medical practice models nor how Medicare/Medicaid influence payment structures, is destined to lead to disappointment, frustration, and burn out. I firmly believe this is a major factor in the high physician “burn out” rate currently facing the medical profession.

Under the current medical model, primary care is not well compensated and not well respected. Rumors abound of primary care physicians practicing “treadmill medicine” and fighting with insurance companies on a daily basis for reimbursement. Who wants to deal with that? It’s quite rational to literally run away from such a specialty.

But this situation reverses in the DPC model. Not only is DPC pure in the sense of no third parties and no red tape, it also gives back physicians the power to control their own destinies. We are no longer at the mercy of some bureaucrat or insurance company. We determine how much we work, how we work, and with whom we work.

As a direct primary care physician, you can see as few or as many patients as you like. You negotiate your reimbursements with individuals before they ever become your patients. You determine how you practice and the kind of lifestyle you choose to lead. These are all your decisions. You are fully autonomous, you are captain of your own ship. This in turn leads to dramatically improved career satisfaction.

It was inspiring to see physicians at the conference who grasped this concept and ran with it. They realized the power of DPC, and they couldn’t hold back their renewed energy.

“Nothing pays like autonomy.”


[Ed. note: Matthew Kavalek is a third year medical student at New York Medical College.]

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