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June 02, 2009


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Sofia Fernandez, MD


You have hit the nial on the head. I too am struggling with my own finances, my ethical dillemmas and my concern over the future. We cannot depend on the goverment to solve this mess. We need to create the change. We need to educate our patients. We cannot sit idly by any longer.

I propose we start creating a blogging network. I propose that anyone who has any connections in the media-USE THEM!
I propose that we create the organisation that is necessary to put a face on this problem.
The patient/doctor relationship comes first, not the government or the insurance company!

It must start now.

Sofia Fernandez, MD

Rocky Balboa, Jr., MD

You are so right. Most primary care docs, in my opinion, are paralyzed by fear and passive to disruptive innovation.

Great quote in Inc.magazine by Nolan Bushnell, founder of Atari:

On Layoffs: "I have come to believe that job security is one of the worst hings that a person can have, especially early in their career. Getting fired gives you a chance to reinvent yourself. All of a sudden you have the whole world in front of you and you can now leap to a career that you may love more."

Primary care needs to reinvent itself. The answer is the low overhead IMP without accepting insurance. No brainer. How do we convince patients to pay cash? That is the tough part. I think stick to the basics of primary care: offer 1. access 2. broad array of services 3. care coordination 4. longitudinal relationship.

Asking for cash for these services is the right thing to do at this point in time. If we continue to feel guilty, primary care will soon be dead. The folks at HelloHealth have an incredible electronic interface to make this happen. It is cheap and affordable for most everyone. We have to start small scale, reach critical mass, and then have negotiating power with bigger entities.

Atul Gawande's recent article in New Yorker makes the entrepreneurial doctor look ugly... because they are. Entrepreneurial primary care docs are a different category because we are trying to reinvent the patient-doctor relationship and practice medicine as an art. Not suck the system financially dry.

Come join in on the dialogue at ourhellohealth. There is hope.

Rocky Balboa Jr

Steven Horvitz, D.O.

I couldn't agree with you more!!!

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