Why I encourage patients to fire me

Fire Doctor

Not all relationships work out.

My prescription: if a relationship isn’t working, end it. Now.

Recently an insurance plan told me they were sending a nurse to my office for a chart review that would take 3 hours. After 24 years of education, state licensure, board certification, and over 50 hours of continuing medical education each year, I’m not trusted to provide Pap smears or treat sinusitis without monitoring. OMG. I’m a solo doc. No staff. I can’t spend 3 hours being micromanaged by a nurse. I’m busy treating patients—and helping suicidal doctors struggling with the same insurance B.S. My solution: terminate contracts with all insurance companies.

Then—I gave my patients the option of terminating me. I even wrote the “Dear John” letter for them.

Love me? Love me not?

Dear Patient,

You may have received a letter from your insurance company indicating that I’m no longer an in-network provider with your health plan and that you will “need” to select a new participating provider in order to receive your plan’s benefits at the highest level. Is this true?

The truth is I will be out-of-network with all insurance companies as of June 1, 2015. This means that you may be responsible for a higher percentage of your office visit (call your plan for specifics). Ten years ago, I opened this clinic so that I could be a real doctor. Many insurance plans are making rather burdensome demands on in-network “preferred providers” so I’ve chosen to preserve my sanity—and still care for you. At this time, I will continue to submit your claims and expect nothing significant to change—other than your copay.

Let me assure you that I will continue to be your doctor regardless of your insurance plan—even if you have no insurance. I’m honored that you have chosen me to be your doctor and my commitment to you and to our relationship is lifelong. Since I never plan to retire, I will be here for you—until one of us dies. As in any relationship, it’s good to “renew our vows” with one another. I’m writing to find out if you wish to continue having me as your doctor—or not. If you value having a lifelong relationship with a doctor off the assembly line and believe my care is worth more than a $20 copay, I encourage you to say “yes.” 🙂

Please respond to this email with a “yes” or “no.”

Sincerely,

~ Pamela

P.S. If you’re uninsured, ignore the first two paragraphs. I welcome you, as always, with open arms. Please also indicate your intention to continue under my care.

And the results are in . . . 

“YES! Abby and i have been down that road of Doctors that frankly wanna push pills and don’t care, we love you!”

“I am not interested and have asked to stop getting emails . . . I have had a new provider for over a year . . .”

“Uninsured, would still like to be under your care, please. I want to start having babies in the next few years, I need you! ~ Peace & love, Dakota”

“Yes! You betcha babycakes! U R my MD. XOXO”

“I don’t belong to a big insurane company plan—thank goodness. I get to see any doctor I want—and that’s you! ~ Blessings, Lynn”

“Hi Pam, I’m Yours. ~ Love, Roni”

“no”

“YES . . . till death do we part. I will always be your patient and you my doctor. Love, Sheri”

“Yes! THANKS for preserving your own sanity in a weird world!”

“Yes, yes, yes.  One thousand times yes . . . I am so happy you are my doctor and proud of the work you are doing to improve the way medicine is practiced. Rock on, Dan”

“No.”

Honesty is the prerequisite to all successful relationships. When patients and physicians have the courage to be honest with one another, healing begins.

Pamela Wible, M.D. is a family physician and pioneer in the ideal medical care movement.

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31 comments on “Why I encourage patients to fire me
  1. Jim Anderson says:

    I have fired three docs in my life. Either we didn’t communicate well or they ignored my questions.

  2. Stephanie says:

    Do you discuss and find an agreeable fee for your clients that are uninsured and those that will choose to keep you even after their insurance no longer has you in-network? In another words, have you been able thus far to earn a living and see clients that do not pay a very large out of pocket amount?

    I admire what you speak of. I am a RN, attending graduate school to earn a Master’s as a NP in family psych/mental health. I find these ideas interesting. I ask because so far, my life experience has been one I have sought out the “better professionals”, say in autism (as I have a son with autism) and I have afforded higher co-pays, some total out of pocket costs, yet I cannot imagine making a living to provide for myself and my family if I could have some clients that could not pay much.

    Faith has taught me about how we all give from what we have …. just do not see many life applications of such, especially in this way.

    Thanks for your answer and, again, for making change and leading others to think,
    Steph

    • Pamela Wible MD says:

      I have never turned anyone away for lack of money in 10 years. Amazing how much people will pay when they value your service. I even started getting TIPS!! Guess who gives the tips? The uninsured and poor. Never got a tip from an insured patient. And yes, I give 30% off if folks pay at the time of service. I always make things work.

      • Stephanie says:

        I certainly understand that those with less would tip 🙂

        Your positivity and hope seem to feed your spirit and attract good to you and I would suspect good goes out from those to whom you provide care to others.

        We are all really interconnected.

        • Pamela Wible MD says:

          Law of attraction. The healthier I get = the healthier my patients get.

          • Soma says:

            Every time I come to this website, and read your blogs and comments and replies, I admire you more and more! Thanks for being you! From one female doctor who care about her patients and doesn’t care for the non-patient-care bull****, to another!

  3. This is a great idea. We often reevaluate our situations each year, that should be something that we do for our family’s healthcare. This year I had to change two of my doctors in order to finally be diagnosed.

  4. Chantal says:

    Wow, you are quite radical in your approach. I am currently with an outfit that doesn’t take insurance, however, they are not giving me any kind of discounts. Then again, I haven’t asked. 🙂

    Is it me, or are there more and more physicians ditching insurance altogether? Is this a trend?

    • Pamela Wible MD says:

      It’s a trend. I still take insurance. I am just out of network so they will reimburse at a lesser rate. Patients have more out of pocket. But I never turn anyone away for lack of money.

  5. Kathy says:

    I absolutely love you.

    Your honesty is breath-taking. And you are so right: “Honesty is the prerequisite to all successful relationships”. All kinds: spousal, parental, frienship and healthcare ones.

    I commend you for a very bold and formal move that can only benefit your patients’ lives and your own.

    Thank you for this blog. It has given me permission to let go of relationships that are not working. In the end, this can only benefit both parties.

    • Pamela Wible MD says:

      Yes. Please let go of ALL the dead weight in your life. You will feel SO MUCH BETTER! Now that’s a great prescription! Better than any drug 🙂

  6. Kathy says:

    Also. Question: Have you ever fired a patient?

    • Pamela Wible MD says:

      Yes. Patients who lie, forge prescriptions. One guy wouldn’t stop yelling at me. I just got out of a bad marriage with a guy who had anger management issues. Geez. I’m not a punching bag. I’m a healer.

  7. Joe Stolfi says:

    Thank you, I love what you’re doing. .. .

  8. Fabiola says:

    Dear Pam
    Thank you for your message. The system in UK is very different than US, the fatigue the same though. Just last week a colleague of mine committed suicide.
    I enjoy reading your updates and admire your courage. Many thanks.

  9. Laura says:

    Good work. Thought of your practice last week when I “fired” the health system I work for, outpatient group. I’d been referred to the group as preferred providers by my PCP for a gynecological procedure. First they didn’t contact me to set up an appt., second when I called them they couldn’t locate my referral for quite awhile and also smacking loudly obviously taking a break and eating while talking on the phone, third they refused to schedule me with the female MD I knew and my PCP “preferred(too busy);they chose a male I did not know. The procedure can be pretty uncomfortable. I asked what kind of pain management they offered and eventually after explaining my sensitivities was told just “take some Ibuprofen before you come”. “If u want anything else you will need to pay for it yourself”. Their attitude was not one of compassion, but rather flippant. That said I may have been talking to a receptionist with limited training or understanding? but was not offered an alternative or opportunity to speak to anyone else. By now I was pretty anxious about the care I would receive and expressed that to the PCP. She encouraged me to “man up” and talk to the male provider about my concerns during my appt. scheduled 2 weeks out. I didn’t really want 2 appts. or risk a conflict at the time of the procedure, so talked to an out of town OB/GYN friend about her approach so I could be educated and ask for these “options”. I was pretty stressed out at the prospect of convincing someone I didn’t know about what I needed to be comfortable when they expected to “get in and get out” quickly on the day of my appt. Day of appt. my badge entry parking lot was full so I called and said I was in the parking lot with 5 minutes to spare and would be there soon-they replied “sorry you’ll have reschedule it”. My schedule is difficult and I wasn’t late yet so I said “please no I’ll be right there”. There were only a few people in the waiting room when I arrived exactly 3 minutes “late” with my completed forms in hand. The receptionist said I’d have to wait to see if I could be seen. I waited 1o minutes for the nurse to come out and say “you’ll probably be mad but we can’t see you and have no openings the rest the day-reschedule your appt”. The last straw for me with zero confidence this was where I wanted my care regardless of any savings my health plan offers to use their clinic. Of course another delay and my PCP office not too happy to have to do more work to start the referral process all over while I locate another doctor at another clinic…but no other option far as I could see. I’ve spent a lot of time, energy and anxiety attempting to get a necessary diagnostic procedure done. The system is very challenging and stressful for me to navigate even though I work in healthcare. I definitely do not feel my needs and interests are even heard, let alone a priority. Its a numbers game and not much incentive to personalise or care at all about the individual patients. I realize the obstacles and challenges providers are facing from all angles, but something has got to shift so there is incentive to invest in caring for the people who need healthcare. It’s not like entrusting your body to someone is a casual encounter. I am frustrated by how little choice everyone has in our current set up as it stands. I wish there were more providers who have made the choice to make service, choices and relationship a priority when providing people health care. It makes a huge difference to feel like a respected partner rather than another insignificant number on the assembly line…without question I’ll pay more but I’m fortunate enough to be able to make that choice-not everyone can.

    • Pamela Wible MD says:

      More real doctors and nurses are coming back. We are getting back to basics and leaving assembly-line medicine behind. Not good for anyone.

  10. elise d. resnick,d.o.,m.p.h. says:

    congratulations pamela! you have great courage and are providing wonderful and compassionate and healing care to your community,clearly. of course we know that not everyone we tend to is appreciative of how much we give and how much we care but we keep on doing so because it is meaningful to us. i have been in practice for 24 years and continue to accept insurance although this becomes more difficult each year; i continue to assess the situation. at some point in the near future, i may decide to close my practice and go back to public psychiatry,as an employee. looking back, i feel grateful overall to have been fortunate to work with so many wonderful people. i wish you and your patients all the best.

    • Pamela Wible MD says:

      You can design your own destiny in medicine. Take all, some, or no insurance. Take patients who are a good fit. Be happy and you will have a long and wonderful life as a doctor. We must be happy & healthy to be the role models our patients deserve. Plus it’s just more fun!

  11. Patricia says:

    Pamela,
    Recently I was referred to a podiatrist/surgeon (I have disabling foot pain and have seen many podiatrists and get many different analyses so I wanted to see the one my doc recommended). That office doesn’t take my insurance. I asked what it would cost out-of-pocket. I was told that it would be illegal for me to pay out-of-pocket because I have insurance. What?? How can this be? I’ve heard this twice this year! So I wonder if this would affect your patients in Oregon (I am in MA).
    ~ Patricia

    • Pamela Wible MD says:

      If you are on Medicare and the doctor has not opted out of Medicare then he/she can not accept payments outside of insurance.

  12. Julie Greene says:

    I don’t think the following will lead to good health, nor do they mean health:

    Health insurance
    Health care
    Health plan
    Health management
    Appointment
    Follow-up
    Treatment plan
    Prescription
    Diagnosis
    Prevention
    Compliance

    To me, I am my own best and most qualified doctor. I have taken my body back from assembly line medicine and am suddenly a lot healthier! If I ever go back to one it’ll be because I need something that requires the use of expensive or fancy equipment I cannot obtain myself nor properly use. I am expecting to go get an eye exam, for instance, and new glasses. That, for me, will significantly improve the quality of my life. I’ll even be able to read street signs again! As I figure it, I have no reason to have “insurance.” These companies love to keep you sick and charge more money.

    I now define “illness” as follows: Someone else owns your body. Take it back and be well.

    Julie Greene, escapee from psychiatric tyranny

  13. Marv Brilliant says:

    Insurance companies should stay out of medicine! They are nothing more than MINDLESS ROBOTS

  14. John Bechtel says:

    Pamela, as always you are outrageous and courageous! How wonderfully delicious to know someone who both thinks and lives outside the box. Harry Browne once said there are no real traps in life (outside of prison, at least); just people unwilling to pay the price to leave them behind. Or as another friend of mine put it: those who have not the will to impose their terms on life must be willing to accept the terms life imposes on them. I have never read anything you have ever written without wanting to give you a big hug, and we’ve never met.

  15. Jeff Kane MD says:

    Pamela, you’re exactly the medicine the healthcare mess needs. No economic scheme–not Obamacare nor Single Payer nor any other–will ameliorate the situation. We’ve come to this sorry state because the once quasi-sacred practice of medicine has become totally dominated by business interests. An insurance carrier wants to send a nurse to monitor your practice? Outrageous, and you said so. In fact, an increasing number of docs are just saying no. The only effective remedy for sick healthcare is insistence by both doctors and patients (now scandalously called “providers” and “consumers”) on reviving and making central their therapeutic relationship, as you’ve done. I explain this in my new book, “Healing Healthcare.” Hats off to you!

  16. I fired a doctor once, but it was for a good reason. I know longer needed them:
    http://southgeek.blogspot.com/2011/11/personal-growth.html

    I actually sent this letter to my doctor.(names here are changed of course)
    How would you have responded to something like this? I was a bit saddened to get no response from what I thought was something any doctor might like to receive. Oh well…

  17. “know”=no ugh.

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