Remember when you were younger and the times you were asked –
“What do you want to become when you grow up?”
The choices seemed endless back then.
If you are reading this, you probably chose to be a physician and are studying to be one. Maybe you are still exploring what your dream career could be.
I will tell you a story about my journey as a primary care physician – with plenty of ups and downs, difficult choices and decisions, new friends and mentors leading to an exciting dream career.
The year 2020 was my first year as a primary care physician fresh out of residency.
I wanted to live in beautiful San Diego and found an exciting job opportunity in the outskirts of the city.
The beach was a 20 minute drive, work was a 30 minute drive and everything seemed perfect in my life.
My first job was important to me. I was finally not a trainee anymore. I was Board Certified in Internal Medicine and the possibilities were endless. During residency training, I completed a fellowship in Primary Care Psychiatry to equip myself with skills to treat mental health illnesses. I was prepared to step out into the primary care universe.
My first couple of months went well in the insurance-based world.
Then gradually things took a turn for the worse.
It all began when I started seeing twenty patients a day.
My patients could only communicate with me directly if I called them after-hours and then only if they were lucky enough to hear the phone ring. They had to leave me messages if they missed my call. Thus began the phone-tag diaries.
Insurance denied simple medications like metformin and my patients’ health worsened until they were able to see me and tell me about the denial two months later.
Insurance denied life saving CT scans that could diagnose cancer.
Meaningless and redundant paperwork piled up and handling the influx of phone tags regarding important health matters was getting harder and harder everyday.
I would come back home emotionally and mentally drained and wake up each morning dreading the prescription requests for opioids and benzodiazepines.
Meanwhile, my employer wanted me to see more patients in a day to meet the goal RVU (a number that decides how much money I bring in as profits to my employer).
Emails from billers and coders flooded my inbox to make sure my coding ensured good reimbursement from insurance companies.
I was caught in a whirlwind of insurance paperwork, biller and coder emails, tips on how to practice medicine the way insurance companies want us to, patients telling me the dose of percocet that works best for them, patients threatening to harm me while I tried to frantically look for ways to fix this broken system so that I could practice humane medicine.
Patients were doing their best to engage with me to solve their health issues.
I was doing my best to make time for all my patients’ needs.
Insurance companies’ mysterious paperwork and denials along with my employers focus on billing-coding-RVU made it impossible to fix this broken system.
One evening in the month of March 2020, when a patient bullied me repeatedly for being a female physician, I quit my job. This event may seem benign in the big scheme of things. To give some perspective, I had already received enough disrespect from the system on a daily basis in various forms of shaming including insurance companies doubting my assessment, medical assistants doubting my skills since I was obviously new to the common insurance denials, an office manager keeping score of the number of patients I am able to see in a day and more…
Profits at the expense of poor quality of care to patients,
at the expense of danger to a physician’s life,
at the expense of patient deaths from missed diagnoses, and
at the expense of broken doctor-patient relationships seemed unconscionable…
yet somehow the other physicians in the clinic had accepted their fate in corporate medicine.
I had not seen this coming.
By now I was dreading the health outcomes of my patients who had received such poor care during my first six months due to the systemic problems.
Within six months of my first job, it felt like I had failed terribly. I had failed to survive corporate medicine. Was it my time-management skills, was it my interpersonal communication skills? It seemed like the system was happy to give me extra coaching on billing and coding but did not care to share the discharge policy when I wanted to discharge an abusive patient.
Even though it felt disheartening to quit my job, it was the only practical option to keep my sanity.
After quitting, it took me a month to realize that I was not a failure and the healthcare system had failed me.
I was a cog in the system. I was a tool in the toolbox. I was a means to profit in the business of medicine.
I looked everywhere for support. My family stood by me. I heard about Direct Primary Care (DPC) for the first time through physician friends on social media.
I watched Ted talks by DPC physicians and then I did not look back.
Prioritizing the quality of medical care I provide over the profits I make – was an easy choice for me. Choosing DPC was a no-brainer because the starting costs are low.
July 2020 I launched myhappydoctor – a direct primary care practice in San Diego, California.
No one said practicing medicine is easy. I wasn’t looking for something easy. I was looking for an honest doctor-patient relationship.
Now I can look my patients in the eye and say that I will do my best for them.
Dr.Deepti Mundkur is an Internal Medicine graduate from the University of California San Francisco School of Medicine Fresno Medical Education Program. She hails from a small coastal town in India. Her medical schooling was at Manipal University in India. In the second year of her residency, she found that primary care was her passion. Psychiatric conditions being a very common comorbidity encountered in primary care, she pursued a fellowship in Primary care Psychiatry from the University of California Irvine School of Medicine to provide comprehensive care for her patients. She has a Masters in Clinical Research from the University of California San Diego and has won accolades for various Quality Improvement Projects. She worked at a big box clinic in San Diego right out of residency and soon realized the many hurdles to provide primary care in the insurance-based healthcare system in the United States. To meet her personal and professional goals in the chosen career path of Primary Care, she has now begun her journey in Direct Primary Care.