DPC Myth #8: When a doctor leaves the system and starts (or joins) a DPC practice, their former employers will be supportive.

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Stories abound of colleagues making horrible remarks as someone departs. One story that I will never forget is Dr. Jennifer Harader’s.  She left the system in 2015 and co-founded Oasis Family Medicine in Topeka, KS— a pioneer, and someone I consider a hero and mentor. When she announced her departure to partners in a large hospital-owned family medicine group and described DPC, a particularly loathsome physician asked: “What are you going to do when this fails?”  Not “Goodbye, you’ll be missed.”  Not “Best of luck, I know you’ve got a bright future ahead”. Not “Wow that sounds phenomenal but also terrifying and risky: good luck!”  Just “What are you going to do when this fails?” How demonstrative of the condition of the soul of the person who uttered those abhorrent words!

Doug Farrago has aptly described this phenomenon as Death Row Syndrome.—the concept that those shackled together (by employment, in this case) foster a brotherhood, but when one escapes (such as when a death row inmate is pardoned), envy and resentment emerge.

Dr. Harader’s “admirer” illustrates this perfectly. DPC docs enjoy their practices far more than their system-employed counterparts. We’ve blogged about the difference in Net Promoter Scores between DPC and system docs — no surprises there. One might ask:”If it’s so much better out here, why do so many stay on the inside?”   The main reasons: money—the golden handcuffs of the system, the fear of change, aversion to risk, and laziness. Leaving a lucrative career for DPC brings great risk and sacrifice, especially early on, and success only follows hard work. Many people (not just doctors) avoid risk and sacrifice—and that’s a poor combination for starting any business! So, naturally, envy arises in the barnyard among those unwilling to do what the Little Red Hen did to earn her bread.

To be fair, this is NOT a universal truth.  I myself have past colleagues who are very kind to me and supportive of my decision.  They may say “That’s not for me” (referencing a smaller paycheck, 24/7 patient duty, or running a business), but they don’t begrudge my decision, efforts, or success. They’re good people.

In fact, this image, which was at the top of my last blog, dates back 14 years, from when I worked at the hospital. Doug and I wrote a parody ad for Placebo Journal called “Medical Mythbusters.” Dr. Clint Colberg (one of my colleagues at the hospital) and I dressed up as Jamie Hyneman and Adam Savage from the real show for our parody. Clint still works at the hospital and remains one of my closest friends—he’s very supportive of my DPC mission.

Regarding the system groups themselves and Death Row Syndrome: some hospitals or systems do hassle the departing DPC doc to some expected degree (enforcing non-competes, making departure difficult, hamstringing your efforts to start solo.)  Our hospital sent the obligatory letter (“Sorry your doctor no longer works here, we have other great folks to care for you.”) to my 2,000+ patients, but said nothing about my opening a clinic literally right next door to the hospital. The letter was carefully worded to imply that I was leaving town completely—without actually saying it. Such behavior is expected from “the cartel.” They rarely embrace DPC. Knowing this I prevented much of the hemorrhaging by preparing my website and FAQ page in advance, sharing it with anyone I could. I still get widespread support in the community from nurses and docs who work at the hospital. Occasionally, the hospital expresses interest in offering affordable services to my patients, although this remains a slow, decade-long process—most of our best cash prices come from other hospitals in the region with more free-market-minded leadership.

This DPC Mythbuster Series aims to debunk the most common fears, misconceptions, and half-truths that deter doctors from embracing Direct Primary Care. These opinions are from each individual blogger. You may or may not agree with them, but either way, leave a comment with your thoughts. 

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About Vance Lassey, MD

Dr. Lassey earned his medical degree from the University of Kansas School of Medicine and completed his residency at the Smoky Hill Family Medicine Program, where he served as the chief resident. He went on to practice rural inpatient, outpatient, emergency room, and obstetric care, in Holton, Kansas. He found the calling he loved to have been hijacked by middlemen. Stuck in a broken system, mired in bureaucracy, clicking boxes, coding, not seeing his family, and hearing patients complain bitterly about medical costs he had no ability to control, Direct Primary Care (DPC) became the solution for him, his family, and his patients. He is passionate about restoring the physician-patient relationship, bringing transparency and sanity to medical costs, and advises physicians around the country on how to get out of the FFS system. He serves as an Assistant Clinical Professor at the University of Kansas School of Medicine, is the recipient of numerous clinical and teaching awards, and is a founding member and the past President of the Direct Primary Care Alliance.