Chapter 13 Excerpts

Chapter 13 - Funding Medical Care with Skin in the Game Preserving and Protecting the Patient-Physician Relationship - excerpts


​In the previous pages, I have explored the nature of the professional relationship between a patient and physician. Preferably, this relationship includes the physician, patient, and the patient’s extended network of support. From my point of view, the ideal patient-physician relationship will happen when both parties have skin in the game in a direct-pay independent practice model.

I am also a pragmatic person and realize that for most Americans, medical and mental health care will be delivered by “providers” attached to a managed care system. For physicians in private practice that rely on third-party reimbursements, the insurance companies and government will set the rules with which the patient and physician must comply. For a physician employed by a health system, the rules under which he or she practices will be set by his or her employer.

Considering the incredibly broad, complex system of what we call “U.S. healthcare,” I believe a place must be carved out to protect the independent physician’s practice from encroachment by third-party payers and government administrators. Especially in psychiatry, I believe that a large segment of psychiatrists should consider independent practice as essential to ensure that patients receive necessary therapy.

In this book, I have discussed how, as a matter of practice priority, placing the patient’s interest first means more than a physician spending a few minutes with an individual no matter the quality of their abbreviated dialogue. Good medicine takes time. It also includes a patient’s extended support network that help him or her in the journey to find a path to a healthier, happier life or to find ways to manage the realities of chronic disease or death.

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