The 1960s were a tumultuous, boundary-pushing, authority-defying, history-changing decade in American history. The Cold War. Vietnam. Anti-war Protests. Hippies. Counterculture. The Beatles. Sex. Drugs. Robots. The Civil Rights Act. MLK. The Great Society. Feminism. Medicare. Medicaid. Assassinations. More protests. Black Power. The Moon Landing. Earth Day. Woodstock. And yes, Astroturf. 

One of the brilliant minds from that era was Stewart Brand. An activist, writer, photographer, concert organizer, and futurist, Brand founded The Whole Earth Catalog in 1968 and served as Editor. This iconic publication was indeed unique, providing reviews and guidance on a variety of products and do-it-yourself projects, mainly targeted at those who wished to lead the communal life and spurn tradition. It also published the first photo of the Earth taken from space, an image Brand envisioned changing how we thought about our planet and environmentalism. 

In 1971 Brand made the decision to terminate the publication of The Whole Earth Catalog.  The last edition was met with much sadness and regret. Thousands of subscribers felt that they had lost a friend, an important part of their lives. The last page of that final edition was poignant, to say the least. It depicted a winding country road, with the words “Stay Hungry, Stay Foolish” written above. Years later another rebel and admirer of Brand, Steve Jobs, took those words and used them to promote and grow a company also rooted in effecting change and going against the norm. 

The connections between DPC and the Sixties are many. We do represent a counterculture.  We protest what health care has become, and what physicians have become. We have our own communal gatherings. We have our own books and social media presence. We tend to be hungry, in multiple ways, and we are often considered foolish. 

Which leads me to the purpose of this little history lesson. 

Just as the Sixties ended, and society moved on to new trends and events, and just as The Great Earth Catalog published its last official copy, how will YOU end your time in DPC? 

As I near 70, I contemplate this. Ten years ago when I set out on my DPC journey, I spent the majority of my time and energy focusing on such things as fees, EHRs, staffing, hours, opting out, and growth. I knew one day it would all end, somehow, but looking back, my planning for my eventual exit was rather superficial, and as it turned out, miscalculated. I actually thought I had a strategy, but alas, it was not meant to be. I had to pivot. 

So I now contemplate my options. Do I simply end it, like the catalog, or is there a better path? 

There are few role models for this, to my knowledge. Dr. Doug Farrago has shared publicly how he sold his practice and “retired.” Dr. Jenna Silakoski shared with Dr. Maryal Concepcion on The DPC Story Podcast how she acquired her practice from Dr. Richard Samuels, enabling his retirement. I strongly believe these issues of transition and retirement need more exploration and discussion, hopefully at future DPC meetings.

Our lives, including our professional ones, will no doubt take unexpected twists and turns. But one thing is inevitable: one day we will all see our last patient. Either by choice, a tap on the shoulder, or our last breath, it will happen. 

Now that you are bursting with optimism and joy, here are the options I see: 

1. Keep working as you are now, until you no longer can, and then your survivors can close shop. At that point, your remaining patients will need to find a new home. 
2. Reduce your patient panel, by natural attrition, raising fees, and/or overt selection, as well as your staff, enabling you to work longer until your departure becomes clearer, or simply happens. Maybe hire some part time help. Maybe a locum. 
3. Announce your retirement date, and assist your patients and staff to a soft landing elsewhere as you work toward that date. 
4. Add a partner, or more, and eventually sell (or “give” via sweat equity), the practice to them (provided they actually desire ownership). 
5. Sell your practice outright to another physician, a nearby DPC practice, a larger DPC network, private equity, or (gasp) a hospital system desiring a bigger footprint, then step away. 

Each of our situations is different, and I am not presuming any particular path is better than the others. Each has obvious pros and cons. Each has its own possible permutations. And there are always uncertainties. You may be surprised what your practice is or is not worth to someone else. Another physician may or may not want to assume care of your patients with whom you have built trusting relationships over the years. They may want their “own” patients. And whatever you think today may well change twenty years down the road. 

Of course, inaction is always an option, which makes the first choice above more likely by default. And if you are thirty-something, there may be no way, or reason, to spend much time on this. But as DPC ages, this will for sure become a more common consideration. 

What I am encouraging is that all DPC physicians give this some thought, as I am now. 

And I would like to hear those ideas. Maybe you know another DPC physician who has exited and can share their name and their story. Maybe you have a plan, at least a tentative one. Or maybe you simply have other reactions to the topic. Send whatever to [email protected]. I will summarize what you share, anonymously unless you say otherwise, in a future article. If nothing else, you will be helping this old goat as he ponders his future. 

Meanwhile … Stay Hungry. Stay Foolish. Stay Defiant. 

Love and Peace to all.