What DPC Gave Back to Me

When I asked Doug Farrago to beta-read my newest book—this one about opening and sustaining a direct care practice—he asked for a favor in return.

“Since you like writing, why not write a monthly column for DPC News?”

With the promise of exactly zero dollars in compensation—not far off from what I earn from the rest of my writing—how could I decline?

You see, writing has always been my passion. As far back as I can remember, I dreamed of becoming an author. I had an uncle who wrote a famous book on magic tricks and an aunt who published a series of cookbooks. As a child, I would page through their books in my grandmother’s library and imagine what it would feel like to see my own name on a cover. It seemed to me like the pinnacle of human achievement.

In high school, I chose journalism as the symbol on my class ring—even though my school was so small that we didn’t have a newspaper. I also won a few scholarships for my essays. One, sponsored by U.S. Sugar, asked whether sugar was “good” or “bad.” The correct answer, of course, was that sugar was wonderful—in moderation.

But when it came time to choose a career, my pragmatic side took over. Few authors make a living from writing, and journalism didn’t pay much. Medicine, on the other hand, paid better and would always be in demand. I pivoted to pre-med and strategically chose sociology as my major to balance out my B’s in the hard sciences.

Then I stopped writing.

Heck, I didn’t even read for pleasure for more than a decade. Looking back, I realize that nearly 20 years passed before I thought seriously about picking up a pen again. Those were years spent in school, medical training, and building a career—years in which I neglected one of my greatest passions because I was too busy, too distracted, and too focused on being a doctor.

Ironically, being a doctor was what finally got me writing again.

At my corporate practice, I was the top “producer,” and the C-suite regularly sent new hires to shadow me and learn my EHR shortcuts and workarounds. After explaining the same methods over and over, I began writing them down. What started as a handbook gradually became something more.

As I sat at the keyboard, the words poured out. Hours passed like minutes as I entered what psychologists call a flow state. Within a few months, I had written an entire book. A retired editor who was also my patient helped me self-publish it in 2015.

Finally, my name was on the cover of a book. I could die happy.

Even better, readers began telling me that something I had written had helped them. Not many readers, to be sure, but it only took one person saying, “This made a difference for me,” to remind me why writing mattered so much.

Then, shortly after the book was published, I was fired.

I know—me, a self-proclaimed “rock star doctor.”

Fortunately, I had already heard about direct primary care through SERMO, a physician social media site. For several years, I had dreamed about opening my own practice but had never found the courage to take the plunge. Losing my job supplied the necessary push.

DPC gave me the autonomy to practice medicine the way I believed it should be practiced. But it also gave me something I hadn’t anticipated: enough time and energy to rediscover who I was outside medicine.

My practice was busy, but it wasn’t working-in-the-system busy. Instead of spending evenings and weekends documenting, wrestling with insurance companies, and recovering from the workday, I had room in my life to write again.

During my decade as a DPC practice owner, I wrote three more books—one on physician wellness and two on scope of practice. I discovered other creative interests, including podcasting and editing my own episodes with the help of online tutorials. None of this happened because DPC is effortless. I had to design my practice intentionally, control my overhead, establish boundaries, and resist the temptation to recreate the same dysfunctional system I had left.

But DPC made that intentional design possible.

There are many reasons I am grateful for the direct care model: autonomy to practice medicine well, price transparency that helps patients afford their care, and financial sustainability that allows me to pay my bills, save for retirement, and enjoy a few well-earned splurges.

But perhaps its most meaningful gift has been the freedom to pursue the parts of myself that medicine once crowded out.

If you are considering DPC, what would you pursue if you finally had the time and energy? What long-lost hobby, interest, or talent have you neglected?

And if you are already practicing direct care, have you actually used your newfound autonomy to reclaim some joy outside medicine? Or have you simply built yourself another demanding job?

Thank you, Doug, for giving me this forum. I look forward to sharing my thoughts, occasional rants, and perhaps a few useful lessons gleaned from nearly 25 years in practice—and 10 years in DPC.

Most of all, I’m grateful for another reason to sit in front of my keyboard and live the dream I nearly forgot.