"Hi, I'm Rob, and I'm a Recovering Doctor." | Rob Lamberts | TEDxAugusta

[Music] hi I'm Rob and I'm a recovering doctor no no no no that wasn't very good let's try it again hi I'm Rob and I'm a recovering doctor much better on September 28 2012 after 18 years in a private primary care practice I walked out of the door into the to a new life I stopped being paid by insurance companies that was five years four months and six days ago not that I'm counting it was not easy to leave we doctors had developed quite a dependency on insurance money and as is often the case in dysfunctional relationships familiar suffering is often a lot less scary than change even if that changes for the better but I was ready to burnout I was unhappy I was depressed I loved being a doctor and I feel like I'm gifted at it but I was ready to quit and unfortunately I am not alone doctors are reporting burnout and leaving medicine at increasing and alarming rates a 2014 study found that one in four doctors planned on leaving their practice in the next two years and just last year 51 percent of physicians surveyed said that they were feeling burned out now why is this why would a doctor who loved medicine and loved his patients be ready to quit well it's not taking care of patients that's the problem it's the system that makes doctors want to leave it does so in two ways first it floods us with busy work taking our eyes off of our patients for doctors and normal practices much of the time is spent following insurance company rules dealing with unruly computerized medical kurz and submitting data to the government and to insurance companies less than half of the time the doctor spends is spent with patients and that is simply not enough before I left I was going home each day feeling depressed like I was not able to give good care to any of my patients but the bigger reason for doctor's dissatisfaction and burnout is the system itself which has perverse financial incentives now if you're a patient in a normal practice your doctor is financially rewarded to do the following to force you to come in for all care no matter how little the problem for you to be as sick as possible because the sicker you are the more insurance pays to do as many procedures on you as possible such as injections or lab tests and finally to spend as little time with you as possible nobody wants this it's terrible for patients but it's also terrible for doctors I was forced to choose do I do what's good for my business or do I do what's best for my patients do I sacrifice money for my children's college fund or do a sacrifice time with the depressed patient or the diabetic it's a lousy choice and it's a choice that I had to make all day every day so on September 28th 2012 my sobriety date I left I looked at a number of options but my best choice was a practice model called direct primary care this model has two central differences first is that doctors are paid directly by the patient's not by insurance companies and the second is that instead of paying for office visits the patient pays a monthly fee generally less than $100 my patients paid between 35 and 65 dollars depending on their age I believe that these two changes and how the doctor is paid are the key to giving better care cutting cost and radically improving the experience for both doctors and patients having patients pay the doctor directly increases the value of the care the patient gets the idea of value is something that's foreign to most of the health care system it's not normal for somebody to shop around for the best deals on doctors or lab tests or colonoscopies but doctors paid by patient but doctors paid by patients are motivated to keep things as inexpensive as possible because people who save money are more likely to stay the practice grows if it's willing to go the extra mile to save the patient's money this isn't done out of generosity or self-sacrifice it's simply good business and there are lots of ways to save money such as finding the lowest cost on medications whether by searching for the best pharmacy price or as we do by selling drugs directly out of our practice at wholesale prices lab costs can be cut by 80% or more simply by negotiating prices with the lab companies and finally there are significantly less expensive places to get x-rays MRI scans colonoscopies and other procedures you just need to know where to look patients pain also improves the customer service now health care is notoriously bad at customer service but doctors who are paid by patients are motivated to give the best experience possible again because those patients are more likely to stay directly primary care practices can improve the patient experience in many ways like using communication tools like secure text messaging or video chat to improve access from outside the office using online tools to track blood pressure diabetes and other chronic problems on a daily basis and by bringing care to the patient directly by doing house calls and these this is me with my very first two patients on the first day of my practice in their home now this probably sounds wonderful to the patients out there which is everybody but the doctors are probably getting a little nervous I mean how can this be done in a way that is still profitable that's where the monthly payment comes in when a doctor is paid by the month they're no longer rewarded for having a full office this means that doctors don't need you to be sick all the time and they don't have to bring you in for every little problem normal doctors lose revenue when they give care by the phone or via text message but the monthly fee makes it so care can be given in whatever way is convenient since the doctors paid the same regardless of how the care is given office visits are fine but I've found that less than a quarter of the patients coming into my old practice actually need in an office visit for that care so indirect primary care if you have a rash you can just take a picture of it send it via text message to your doctor and get it taken care of that way or let's say you're vomiting and have a fever clearly a virus you're just staying home from work but your worker requires a work excuse well you can send a text message or call your doctor's office and as long as it's reasonable they can just give you your work excuse nobody benefits from pointless office visits and because most of the care is done via phone or text message the office schedule is rarely full I saw only 15 patients on the busiest day over the past five years and my normal days are between eight and ten patients which is about a third of the volume in my old practice when doctors first adopt direct primary care and I did too you have to resist the urge to freak out when the office is empty because in truth I'm paid just as much when the office is empty as when it's full the stress level is so much less and an empty office benefits the patients as well because people almost never have to wait to be seen in the office a two o'clock appointment can be seen it get this two o'clock patients can almost always get same-day appointments to no more waiting two days or two weeks or two months to be seen and finally the doctor can spend much more time with each patient I give new patients between 30 and 60 minutes of face-to-face time with me and my routine visits are generally scheduled for 30 minutes so you see how the system is better it just makes sense it's better for patients but it's also much better for the doctors well here are some real-life examples Joe is a 52 year old who has been my patient for many years he was at home and he noticed a lump in his neck and he was worried about it so he sent me a message I messaged him back and said come on in when I examined him I too was worried about this lump in his neck so I sent him to a specialist who unfortunately diagnosed Joe with cancer but we had caught it early now after he was treated and in remission he told me that he would never have come in so soon in my old office there was way too much hassle so he would have waited maybe too long to be seen Susan is a 48 year old who messaged me on the weekend saying that she had been out running and she stepped in a ditch and hurt her foot she was worried that it might be broken and wondered if she needed to go to the emergency room I said I told her not to bother that she could just come in on Monday and I'd check her we ordered an x-ray which only cost $40 by the way and and it was in fact fractured but the fracture was in a place that the orthopedic surgeon would have just put a boot on it for six weeks and let it heal so that's what we did without the orthopedist sorry orthopedist now after everything was said and done I thought about the fact that she had fractured her foot with fairly minor trauma especially for a 48 year old who was athletic so I ordered a bone density test which showed that she had osteoporosis thinning bones which we've been treating ever since - changes to central changes in how doctors get paid and the cost can go down the quality can go up and the overall care can be the overall experience can be much better doctors and patients can be partners not adversaries and it has worked I've been open for five years I have over 700 patients I have a small office staff so my overhead is kept low I've never been happier my nurses have never been happier and my patients are delighted with the care that they get from us and and I feel like I've never given better quality health care to my patients plus my income is approaching that which when I left my old practice and direct primary care is growing when I started five years ago there are about a hundred or so practices in the United States now there's nearly a thousand doctors who make this change are often criticized for being selfish for doctoring for wealthy people and that this approach will be the downfall of American medicine well obviously I disagree most of our patients are working-class many don't have insurance and a significant percentage of them are elderly as to the downfall of American medicine how is giving better and more cost-effective care a bad thing the real question is why don't more doctors do this and how can we figure out a way to make this generalize to the whole system to all primary care doctors imagine how much money how much hassle and how many lives that could save so with all the depressing news about our system be encouraged there are new ideas out there there are ways that we can radically change our system for the better and those changes don't have to come from politicians or bureaucrats the best changes come from the people who those changes affect the most I believe that people don't agitate for better health care because they don't realize that the quality of care they're getting isn't all that good and the reason they don't realize the quality of their care isn't good is because they don't realize how good it could be though to the doctors and medical students out there I say there is hope you can love medicine again you can partner with your patients and you can enjoy them as people if I did it you can do it and to the rest of you I ask you to do one thing expect or from your doctor thank you [Applause]

Channel: TEDx Talks

Views: 18,975

Rating: 4.8400002 out of 5

Keywords: TEDxTalks, English, Health, Economics, Entrepreneurship, Impact, Medicine, Reform

Id: eJYJPWpAX-Y

Length: 16min 11sec (971 seconds)

Published: Tue May 29 2018