Direct Care & Doctor Shortages Are Related, But Not How You’d Think

David Bornstein recently reported on doctor burnout, something we’ve been following over the last few years. This concern isn’t falling on deaf ears, instead half of the nation’s medical schools are reacting, by including a course called The Healer’s Art (this course was created by physician Rachel Naomi Remen, and according to Bornstein, helps “doctors and students discover and reconnect to the deep meaning of their work and maintain their commitment for it.”) His article caused a commotion on the Web, with hundreds of readers — patients, medical students, doctors and spouses and children of doctors among them — expressing their personal experiences. After we reviewed a host of comments, we noticed something missing in the conversation: direct care…

We’re all running out of time
One reader from New York writes, “I am a primary care doctor who started idealistic, and am disillusioned and dejected. By far, the biggest barrier to being a compassionate healer in our current working environment is time. We simply don’t have the time we need to do our jobs well. And we all lose.”

This is true, and we believe the direct result of bureaucratic constraints. As more and more doctors bark up the insurance tree, it’s no surprise that some tire of the additional energy required just to stay in business, which compromises the quality of care, and diminishes the satisfaction of doing a good job. Direct care, while requiring discipline and entrepreneurialism, enables docs to pay the bills by seeing patients.

Direct care does not contribute to the doctor shortage
“I retired early from medicine, was glad to get out, and don’t regret fleeing a broken system,” wrote J. Skinner from the Midwest.

“#Directcare doesn’t make doc shortages: Doctors quitting makes doc shortages; Students changing majors makes doc shortages.” – @AtlasMD (CLICK TO TWEET)

Unfortuantely, direct care isn’t on everyone’s radar
Bornstein’s readers were not rosy-eyed about medicine reform. Those who saw potential for change placed the main responsibility with us doctors. “A lovely and touching article,” wrote Steven Frucht from New York City. “Unfortunately it won’t change anything in the real world. Why? Because physicians do not control the way medicine is practiced.” Then he added: “Physicians must stand up, specialty by specialty, and refuse to accept this ridiculous system that rewards electronic care, rather than patient care.”

Mr. Frucht, we hope you come across our work here at Atlas MD. We refuse to accept this ridiculous system. We do not believe that electronics should matter more than patients. We don’t believe that federal kickbacks rewarding crummy EMRs will improve the quality of care. We believe time and energy, allocated in a wiser fashion will improve healthcare. We believe doctors serving their patients, and going home with a sense of purpose and satisfaction, will improve our system today, and tomorrow, because if students see happy docs, who are actually paid, they will put energy into becoming happy doctors who are actually paid. This is called a positive feedback loop. This is why we are so adamant about the success of our model.


When Bornstein asks, “Could physicians come together to overthrow the current order — to start a movement to, say, Occupy Medicine?” We say, yes, we can, and we are. When he asks, “What would be the unifying cry? Down with health insurers?” We say, no, not exactly: up with entrepreneurship, up with cutting the red tape, up with emergency insurance, and up with more docs adopting direct care. When he asks, “Would it begin by expressing the thing that is most precious to them that has been lost: the opportunity to practice medicine in a way that is worthy of their dedication and love?” We say yes and yes, till we’re hoarse. Direct care is reclaiming the sense of purpose in practicing medicine. And it’s doing it with a grounding in business, not just head-in-the-clouds idealization.