Who Killed Marcus Welby?

The insurance middleman has taken a toll on the family doctor. One Seattle upstart wants to change that.


Thank you for your excellent article. Garrison Bliss, the founder of Qliance, was also the second president of SIMPD, the national society of direct practice doctors that I now head.

Many of the problems of high cost and poor access have to do with the virtual destruction of primary care over the past forty years. That resulted from well intentioned but misguided activities of government, employers and some insurance companies hoping to “fix” health care without ever asking doctors and patients in the trenches how that might be done. The beginning of a solution is the restoration of adequate primary care. The question is how to do this.

Most now agree that patient centered primary care medical homes for all Americans are indeed the solution, but how do we pay for them? Thousands of doctors have learned the way to do just that. By limiting our practice size to 1000 patients or less and charging a periodic fee around $100 per month to each of these patients directly (direct practice) the patient centered primary care medical home becomes a vibrant reality. I know. I run one and have the honor of heading a national organization of doctors who run such direct practices.

In these practices patients are seen immediately when ill, on time and at length. They stop going to emergency rooms because they can find their doctor and get care from him or her directly at any time 24/7/365. Our data demonstrates up to 80% reductions in hospitalizations, which if applied to all Americans would mean our hospitals would work again without having to build more ER rooms and inpatient beds. This results in huge savings

Most patients today with multiple medical problems have multiple doctors, one for each problem. Direct practice primary care medical homes take care of most of these problems in one place and all at once, eliminating the need for many of these consultants entirely and reducing the frequency of visits to many more, resulting again in more huge savings.

Students who see how cheerful, well paid and professionally fulfilled are such direct practice doctors gain hope that they too can have such a practice. We need 400,000 such practices if we are to care for our population properly. Currently the numbers of primary care doctors are rapidly dwindling and only eight percent of medical students elect any primary care pathway. Not long ago that figure was 50%. Short of coercion no system except direct practice primary care medical homes will draw the students we need.

My national organization SIMPD is having its annual meeting at the Marina Marriott Hotel in San Diego May 6-9 and I invite you to come to discuss these ideas. One of our board members Steven Knope, MD recently authored an excellent book titled "Concierge Medicine--The New System to Get the Best Healthcare" and I recommend it to you highly.


Thomas W. LaGrelius, MD, FAAFP
President SIMPD, The Society for Innovative Medical Practice Design, http://www.simpd.org
Owner, Skypark Preferred Family Care, Torrance , CA http://www.skyparkpfc.com
Thx to Garrison for his vision and mentoring. The time has come for physicians to change their practices to a business model where Docs have a direct financial relationship with their patients. "Direct practices" are emerging across the US as the solution to our primary care systems problem.
It's fun to practice again...

Chris Ewin, MD, FAAFP
Past President, SIMPD
Drs LaGrelius, Ewin , and Bliss are pioneers with the courage to swim upstream to improve health care in our great nation. Good job good doctors!
Gary Price MD FACP
Is a reality that patient is not the most important thing, neither for the Govermment, nor for the health insurance agencies. This situation makes you feel like a number or that your value is established in dollars and cents. Is not your condition, what guides the physicians actions, is how much you have to pay the fees. It's that humanity?
Dr. Pura J. Cruz-Oliver (Puerto Rico)
I joined Qliance a few months ago and LOVE their service. I came down with the flu yesterday, called my doctors and got same day care. They assured me it wasn't swine flu, I went home and went to bed. All without paying a co-pay, I just pay $54 bucks a month. If for some reason I had to see my doctor every day, the payments don't go up. So much better than paying a huge fee for insurance each month, just to have the option to then go pay my doctor for each visit.

I recommend this type of service whole-heartedly.