MAKING DEALS WITH THE DEVIL. BASEBALL. PHYSICIANS. AND DPC. 

The following is a post by Thomas White, MD

You do not need to be an avid baseball fan to know that the New York Yankees have long dominated Major League Baseball. The Yankees have many devout fans, but perhaps even more detractors, even haters. No time in baseball history was perhaps more illustrative of the Yankees’ success than the early 1950’s. The Yankees seemed to have all the best players, and they typically won year after year. This theme was captured in the 1954 novel by Douglass Wallop, The Year the Yankees Lost the Pennant, which was then adapted to the Broadway musical “Damn Yankees” in 1955, and later released in film in 1958, starring Tab Hunter. 

The storyline went like this. Joe Boyd is a middle-aged fan of the beleaguered Washington Senators, perennial losers to the Yankees.  Boyd despises the Yankees and their winning ways. One day, in a moment of extreme anger after watching the Yankees win yet again, Boyd declares out loud that he would sell his soul to the Devil in exchange for his team to have a long ball hitter who might help them beat the Yankees, and lead them to the American League Pennant. 

Sure enough, the Devil does show up, in the guise of a conman named Applegate, who offers Boyd a proposal, a classic Faustian deal. In exchange for his soul, Boyd would be given youth, handsome looks, and the athletic ability to lead the Senators to a pennant title. 

There is much more to the story, and the ending, and I would not dare spoil it for you. But basically, Boyd gets what he asks for, but not without regrets. 

Make a deal with the Devil? There is usually a price to pay. 

Sound familiar? 

Bright, well-intentioned student chooses a career in Medicine. Wants to be a Physician. Finishes school and training. Gets a job offer, which seems too good to be true. Takes the traditional, insurance-based, volume-driven job. Finds out it was indeed too good to be true. Realizes that the benefits were largely at the expense of the values which once led the now burned-out Physician to Medicine to begin with. 

As they say, seen that movie before? Not only have I seen it, but I have had both starring and supporting roles in my career.

I share this story not to suggest that deals with the Devil are unavoidable and all bad. We sometimes feel compelled to do what we do for a purpose or goal, which, at the time, seems justifiable. Pay off debt. Get that new house. Take care of family. Take nice vacations. Have “benefits.” Reduce call. Be more secure. 

Come on, the Devil says. You deserve better. Come work for me. I will make your life simpler, and better. 

I understand. Been there, done that.  

Even in my current DPC world, the Devil shows up occasionally. Without an appointment, of course. Think Big System, now interested in this “thing” called DPC. Think Big Employer, wanting to save money on primary care. Think Big Network, anxious to broaden its footprint. Think Greedy Middle Conman, dangling all sorts of bells and whistles. Think DINO, able to appear in a vast wardrobe of deceit. Again, they say, we will make your life better. 

Yet, I confess. Hardly a week goes by that my staff and I do not scream out loud that we would do most anything to be freed of the “Prior Authorization Curse.” We continue to dutifully complete those ridiculous prior auths because we fear that patients would ultimately suffer if we did not. But, I admit, I may be open to a brief Zoom call with the Devil to discuss. To simply review my options, of course. What could it hurt? 

The point, I suppose, is to recognize the Devil when he appears. To think twice (maybe three times) about our choices and for whom we will toil, to whom we will answer, and from whom we might benefit. To try, if we can, to be true to our patients and ourselves. To remember our values and why we chose Medicine in the first place. 

I still believe DPC comes closest to why I wanted to be a Physician.

As less than perfect as DPC is, as tempting as greener pastures may look, there are priceless advantages to DPC, such as professional independence, unfettered loyalty to the patient, and the personal pride that comes with owning your own business, to name just a few. All of these, of course, are difficult to measure. They tend to get omitted in the Devil’s boilerplate contracts.

As unhappy as Joe Boyd thought he was, Joe Hardy became even more miserable. Yes, you need to watch the movie. 

Beware the Devil and his temptations. It’s difficult to say no. Those pastures look very green. Damn those Yankees, Joe Boyd declared. Damn, those green-looking pastures. 

As sung in the movie, “Lola gets what Lola wants.” Usually. But not always. 

If you are considering DPC, trust and follow your heart. If you are already a DPC Physician, count your blessings. 

Again, watch the movie. 

Be Well, Devil. Be Well.