I want to start this blog at the beginning, which for me was a Tuesday in November. I was running forty minutes behind, which had become so normal that my medical assistant didn't even mention it anymore. She just quietly shuffled patients into rooms and gave them apologetic smiles. I had fourteen patients left on my afternoon schedule, each slotted into fifteen-minute blocks that had never once in my career been sufficient for the kind of medicine I wanted to practice.
There was a woman in room three, a retired schoolteacher named Margaret, who had come in because she'd been having headaches for two months. She was scared. I could see it in the way she folded and unfolded her intake form. I sat down, opened my laptop, and as I started asking her questions, I realized I was typing more than I was looking at her face. The EHR demanded my attention like a jealous partner. Click here, document there, select a billing code, satisfy a quality metric. Margaret deserved my full attention, and the system made that nearly impossible.
That night I sat in the hospital parking lot for twenty minutes after my shift and cried. Not dramatic, heaving sobs. Just a quiet leaking of something I'd been holding in for years. I had become a physician because I wanted to take care of people, and somewhere along the way the system had turned me into a data entry clerk who occasionally got to practice medicine between administrative tasks.
I should back up. My name is Sarah Chen. I'm a family medicine physician, board-certified, eight years out of residency. I trained at a program that genuinely believed in the patient-doctor relationship, in longitudinal care, in knowing your patients as whole people and not as a collection of ICD-10 codes. When I joined Meridian Health Partners straight out of residency, I thought I'd found a home. They talked about patient-centered care in every orientation meeting. They had posters about it in the hallways. It turns out posters are not the same thing as practice.
Over eight years, my patient panel grew from 1,200 to 2,400. My appointment slots shrank from twenty minutes to fifteen, then to twelve for follow-ups. The documentation requirements multiplied. Prior authorizations consumed hours of every week. I spent more time arguing with insurance companies about whether my patients deserved their medications than I did actually seeing those patients. And every quarter, the administration would roll out a new "efficiency initiative" that somehow always meant more clicks and less medicine.
I started having Sunday night dread sometime around year five. By year seven, it was every-night dread. I gained weight. I stopped exercising. My husband started asking if I was okay with a frequency that told me he already knew the answer. I was burning out, and I knew it, and knowing it didn't make it stop.
The final straw was not dramatic. It was bureaucratic. In October, Meridian announced they were implementing a new "productivity-based compensation model." The memo was full of corporate language about "aligning incentives" and "rewarding high performers," but what it meant in plain English was this: see more patients or make less money. The physicians who were already drowning were being told to swim faster.
I went home that night and told my husband James that I was done. Not done with medicine. Done with this version of medicine. I told him I'd been reading about something called Direct Primary Care, a model where physicians charge patients a monthly membership fee and skip insurance entirely. No billing department. No prior authorizations. No fifteen-minute visits. Just a doctor and her patients, the way it was supposed to be.
James, who is an accountant and therefore constitutionally inclined toward caution, asked me approximately forty-seven questions about financial viability. I didn't have answers to most of them yet. But I had something I hadn't felt in years: excitement about practicing medicine.
So here I am, in January 2024, writing the first entry in what I'm calling my DPC Journey. I've given my ninety-day notice at Meridian. I have a rough idea, a supportive spouse, a modest savings account, and absolutely no idea what I'm doing. I'm terrified. I'm also more alive than I've felt in years.
If you're a physician reading this and you recognize yourself in what I've described, I want you to know two things. First, you're not alone. The burnout rates in our profession are unconscionable, and they are not your fault. Second, there might be another way. I don't know yet if DPC is the answer for me, but I'm going to find out, and I'm going to document every step of it here.
Next month, I'll write about what I've learned so far about the DPC model. For now, I'm going to close this laptop and go have dinner with my husband, who has gamely agreed to support his wife's midcareer crisis. Wish me luck.