This topic of abandonment comes up regularly. There are tons of ways to respond to this. This is a section from my book:

I did a lecture at the University of Virginia on Direct Primary Care and was asked an interesting question.   The attendee, who was an older doc, tried to put me on the spot with this rant:

If all primary care doctors were to go into DPC, who would take care of the patients that couldn’t afford it?  Don’t you think you have a moral and ethical obligation to take care of all patients?

Ah, the old guilt trip.  The first thing I said is that if all family doctors went into DPC then maybe medical students would see the light and go that route as well.  Who wouldn’t want to make $240K plus a year and be the complete doctor they always wanted to be?  The way the system is set up now there are few medical students wanting to go into FP and there is a major shortage.  This is why the creation of physician extenders (NPs, PAs) occurred.  So, here is an idea.  Maybe as FPs start to move into DPC, and this would not be fast, then the desire to go into family medicine would increase?

Second, I give away 10% of care away for free.  It isn’t a major problem for me and I feel good about it.  It turns out that a lot of DPC docs I know do the same thing?  Why?  Because they are human.  If all DPC docs give 10% of care away, then we would make a big dent in the supposed lack of coverage of patients.

Third, affording a $75 month fee is different than choosing not to pay it.  There are plenty of patients that this doc is trying to speak for who just choose not to pay my fee.  That is fine and it is their choice but that is all it is, a choice.  They choose to get cable, high data smartphones, and on and on.  That isn’t a judgment.  That’s a fact.  For the ones who truly cannot afford that then we have other options.  There is the free care that I, and other, DPC docs give.  There are the federally qualified health centers.  Oh, and all those NPs and PAs, that the government is pushing to take over primary care can now have the non DPC patients.  That would work for me and the patients have full choice again.  They have a safety net of extenders or they can pay a monthly fee.  You get what you pay for.

Lastly, I want to reverse the question on this bitter doctor from the conference.  Is it moral and ethical for family doctors to be the pawns of hospital administrators?  To be paid the lowest on the doctor scale?  I can’t remember taking the vow of poverty when I graduated medical school.  Is it moral and ethical to see patients for seven minutes because the system as it is leaves you no choice?  I can make the case that is immoral and unethical!  Is it moral and ethical to give patients’ data away to insurers, the government and whomever else and not know where it is going?  I could go on and on. 

There you have it. I believe this debate just came up here as well. Once again, I defer to the image above.