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I Got My Freedom Back


I decided to take a great leap and get my freedom back. I started a cash-only practice.

After decades in a private practice focused on thyroid surgery, my wife and I decided we needed a better quality of life. We moved ourselves and our two children to a small town outside of Austin, Texas. I left 22,000 patient charts behind.

That was a lot to give up, but I began to realize that, over the course of many years, I had become an involuntary employee of the government and the insurance industry. I was working harder and longer for less and less, and I had ceded much of the control of my practice to third parties.

When I set out to start my new practice in a new town, with no patients and no referring doctors, it immediately became clear to me that I could not afford to accept insurance. Their reimbursement rates -- often covering as little as 20 percent of a truly reasonable and customary fee -- could not begin to pay for all the employees and overhead that comes along with the paperwork and hassles of accepting insurance. Instead of giving up, I decided to take a great leap and get my freedom back. I started a cash-only practice.

Running a cash-only practice

How does it work? We have zero contact with third-party payers, but we will give patients the code numbers they will need when they apply for reimbursement from their health plan. We charge a modest fee for surgery. We accept cash, checks, credit cards, IOUs, and extended payment plans. We charge the very wealthy a little more, and we offer to care for the truly poor for free.

Everyone's first consultation with us is free, and we spend whatever time is necessary to thoroughly examine the patient and answer each and every question they might have -- something they cannot get in the $10 copay system.

People come to us because they like our care, and they like the concept -- not because some bureaucrat at an insurance company told them to come. This makes a huge difference and has a positive effect on the doctor-patient relationship. It is no wonder that once in this unhurried, patient-friendly environment, few patients ever leave the practice. Younger patients say that this is the way medicine ought to be, and older patients say that this is the way medicine used to be.

There is virtually no overhead for the practice except for a salary for a part-time office manager, rent, and insurance. The entire layer of bureaucracy needed to handle insurance is completely eliminated. If the phone rings, it is either a patient, another doctor, or my wife. And there are no billing expenses because patients pay their bills in advance; what used to be a monthly postage expense is now profit.

You can do it, too

More and more doctors are sending us patients as they see that our strategy is working, and we return their patients to them, healthy and exceptionally happy. Some doctors are cheering us on, glad to see someone fighting for a more reasonable healthcare system. A couple of physicians have come to us for advice on how they, too, can get back to practicing medicine instead of filing forms.

On rare occasions, I sense a little resentment from physicians who are still trapped on the insurance treadmill. It takes some bold decision-making and some short-term financial sacrifice, but they, too, could reinvent their practice. I was fortunate that a change in geography literally forced me to take the plunge. I might not have had the courage to do so on my own.

I do know that I'm doing what I love and enjoying it once again. I have real time to spend with my family, and my patients are very grateful to get the benefit of some good old-fashioned medical care. And isn't that what we all want?

This article originally appeared in the September 2004 issue of Physicians Practice.

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