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Speaker 1: As night Side with Dan Ray. I'm WBS Costin's new radio.

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Speaker 2: All right, Well, we didn't solve all the problems of

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Speaker 2: the m bt A in that hour, but I just

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Speaker 2: talked with Brian off here and we will do something

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Speaker 2: on the ride in the next month or so, Joe,

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Speaker 2: and I expect you to remind me and bother me

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Speaker 2: about it, which is fine, and I actually would appreciate

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Speaker 2: the reminder. Joe. We got to get the ride squared away,

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Speaker 2: and we have some we would just come up with

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Speaker 2: some ideas. I'll explain them when we have Brian Kane

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Speaker 2: back on. Brian, the executive director of the MBTA Advisory Board. Now,

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Speaker 2: since this is a holiday night, we've taken on some

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Speaker 2: subjects that I think are great and nine years ago. Well,

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Speaker 2: first let me strike that I'm reading the Boston Globe

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Speaker 2: today and I read an article by Shira Schoenberg about

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Speaker 2: why more patients are paying doctors directly and what it

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Speaker 2: says about our health system. And as I read the article,

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Speaker 2: in the first paragraph, there's a reference to family physician

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Speaker 2: Jeffrey gold Well. That rang a bell because back in

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Speaker 2: March of twenty and seventeen was the last time I

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Speaker 2: had doctor Gold on my program, and at the time,

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Speaker 2: doctor Gold, we were talking about a new type of

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Speaker 2: medical practice that you were opening up. Believe it was

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Speaker 2: in marbleheaded if I'm correct. Welcome back to night Side.

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Speaker 2: It's been way too long.

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Speaker 3: Well, it's great to be back. And I don't know

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Speaker 3: what we're going to fix first, the MBTA or healthcare,

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Speaker 3: but hope its healthcare. We'll give it a go. But

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Speaker 3: thank you so much for having me back on. It

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Speaker 3: has been too long, and certainly a lot has changed

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Speaker 3: since we last spoke, and hopefully we can do it

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Speaker 3: more regularly.

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Speaker 2: You bet you. I'm looking forward to it. You are.

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Speaker 2: You provide what is called direct primary care. Now. Look,

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Speaker 2: I think we all can agree, and I hope people

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Speaker 2: agree with consensus that our healthcare system in America needs

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Speaker 2: improvement a lot in a lot of ways. That is

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Speaker 2: that a fair way to start the conversation.

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Speaker 3: Oh, without a doubt. You know. The statement I hear

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Speaker 3: a lot from people is that the healthcare system has broken.

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Speaker 3: And my response to them is it's actually not. It's

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Speaker 3: working exactly the way. The people that are extracting a

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Speaker 3: lot of money but providing very little value want the

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Speaker 3: system to be and I think that the only way

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Speaker 3: we fix it and correct the things that are wrong

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Speaker 3: with it, which really is we have a sick care

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Speaker 3: not a healthcare system. And I think you know, the

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Speaker 3: other issue when you listen to policymakers or you read

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Speaker 3: on the media or watch the news, is that over decades,

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Speaker 3: people have equated health insurance to healthcare, and they're two

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Speaker 3: very different things, and unfortunately they've been kind of misconstrued

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Speaker 3: to be the same. So I do think there is

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Speaker 3: a lot that needs to be done differently, but I

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Speaker 3: think it's going to be up to the people that

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Speaker 3: are actually providing the care, whether it's doctors, nurses, therapists,

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Speaker 3: and patients and constituents. You know, anything good that's really

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Speaker 3: ever changed in this country has been because there's been

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Speaker 3: a few crazy people like myself that have decided, you know,

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Speaker 3: we're going to rebuild something different because what we're doing

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Speaker 3: is just not working.

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Speaker 2: You're not crazy whatsoever. Look, I believe that the biggest

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Speaker 2: problem we have right now is that the health insurance

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Speaker 2: companies own the politicians. Correct As a consequence of that,

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Speaker 2: the group of people who are benefiting most from you know,

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Speaker 2: the American medical system are not the doctors, they're not

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Speaker 2: certainly the patients out are the insurance companies. How do

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Speaker 2: we unwind that? If the analysis and that shorthand analysis,

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Speaker 2: and I believe that when I talk to you in

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Speaker 2: twenty seventeen, and I believe it today, I probably believe

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Speaker 2: it more today, and I can explain to you that.

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Speaker 2: But do you buy into that shorthand quick analysis.

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Speaker 3: Well, one hundred percent, because I think the main way

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Speaker 3: that you fix it is you stop feeding the beast.

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Speaker 3: And you know this is really a David versus Goliath's situation.

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Speaker 3: And I think the way that we do that, and

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Speaker 3: you know a lot of my colleagues across the country

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Speaker 3: doing this model feel the same way, is why are

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Speaker 3: we using health insurance as a payment model for every

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Speaker 3: single thing we do in healthcare? We don't use our

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Speaker 3: home insurance to fix a window. We don't use car

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Speaker 3: insurance to get gasoline. If we used insurance the right way,

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Speaker 3: meaning I get cancer, I have a stroke, I'm having

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Speaker 3: a heart attack, I need the emergency room, I'm in

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Speaker 3: a major car accident. Those are all insurable events. But

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Speaker 3: coming in to see me for a half hour to

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Speaker 3: talk about your diabetes, your high blood pressure. What is

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Speaker 3: insurable about that? We should ensure that every American with

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Speaker 3: an E, not insure with an I insure with an E,

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Speaker 3: that every again has access to control over their healthcare

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Speaker 3: and their healthcare dollar and right now. And it's happened

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Speaker 3: unfortunately for decades is people have given the control and

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Speaker 3: the money to the insurance companies and the government and

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Speaker 3: then including doctors too. And then we sit there and

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Speaker 3: we wonder, you know, why is this not working the

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Speaker 3: way we want? Well, it's not working the way you

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Speaker 3: want because you're letting the wrong people have control.

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Speaker 2: Okay, So I want to carry your analogy because I

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Speaker 2: think it's a brilliant analogy. If you own a home,

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Speaker 2: and there's a lot of people in our audience who

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Speaker 2: don't own homes, so they may never have owned home.

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Speaker 2: Maybe they have no clue what we're talking about. But

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Speaker 2: if you own a home, you'd be a fool if

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Speaker 2: you don't have home insurance. And the most important thing

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Speaker 2: and if I'm wrong here, doctor Goll, please tell me

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Speaker 2: that you want to ensure against is some cataclysmus event.

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Speaker 2: The one that you think of.

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Speaker 4: Is a fire. Very few homes have fires, but when

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Speaker 4: a home has a fire. If it's not put out quickly,

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Speaker 4: the home can be destroyed or virtually destroyed, which is

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Speaker 4: the similar to a medical emergency, as you said, cancer,

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Speaker 4: a stroke.

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Speaker 2: Or whatever. And one of the ways you don't, as

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Speaker 2: you said, ensure if you break a window, if you

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Speaker 2: scratch your door carrying something out of there, you get

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Speaker 2: the door of repainted maybe, or if you need to

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Speaker 2: fix a broken stare, you don't go to the insurance company.

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Speaker 2: And one of the ways you lower your insurance cost

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Speaker 2: is you have a high deductible on your home insurance.

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Speaker 2: So you may say, okay, I have a deductible of

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Speaker 2: ten thousand or twenty thousand dollars, so it makes the

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Speaker 2: home insurance policy that prevents that protects you from a

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Speaker 2: cataclysmic event in your home. Why can't we do something

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Speaker 2: like that in terms of medical insurance, if we need medical.

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Speaker 3: Insurance, we could, you know, It's it's the reality, though,

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Speaker 3: is you know no one ever stops and says, why

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Speaker 3: is my three dollars generic prescription covered under insurance? Why

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Speaker 3: do they cover that? But then when I need a

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Speaker 3: life saving drug, you know, my doctor and me have

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Speaker 3: to jump through multiple hoops to get it covered and

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Speaker 3: The reason is it's because of what they call the

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Speaker 3: medical loss ratio, which basically is for every hundred dollars

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Speaker 3: a premium you pay an insurance company, eighty of that

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Speaker 3: hundred has to go to claims, twenty can go to

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Speaker 3: their administrative cost. But the issue, the issue is it's

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Speaker 3: a percentage. So the more claims that they file and process,

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Speaker 3: the more money they make, the bigger.

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Speaker 5: Their pie is. So if we stop.

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Speaker 3: Using insurance as a form of payment and actually use

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Speaker 3: it for what it really was intended for. I always

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Speaker 3: laugh when people say catastrophic insurance, I'm like, that's redundant.

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Speaker 3: That's what insurance is for. It's supposed to make sure

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Speaker 3: that you're protected, you know, if the crap hits the fans,

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Speaker 3: so that you don't go broke. And unfortunately, what's happening

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Speaker 3: is people have become so addicted to this insurance model that, well,

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Speaker 3: my insurance doesn't cover it. Well, what do you do

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Speaker 3: when you go to a restaurant and they don't take

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Speaker 3: ms use a different form of payment. So people have

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Speaker 3: just become so brainwashed, and it's not their fault, you know,

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Speaker 3: this is I was one of them, you know. I

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Speaker 3: always say I'm a recovering health insurance addict. You know,

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Speaker 3: it's the only service industry in the country where the

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Speaker 3: provider and the consumer at the time of service had

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Speaker 3: no idea what anything costs.

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Speaker 2: Well, okay, so here's a question. Here's a question. Most companies,

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Speaker 2: when you seek employment, they'll tell you one of the

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Speaker 2: great benefits that they provide you is health insurance when

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Speaker 2: you work for major company. And most people look at

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Speaker 2: it and say, wow, I'm going to get health insurance free. Well,

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Speaker 2: health insurance is not for free because the company calculates

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Speaker 2: into what they pay you for your salary how much

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Speaker 2: they're going to pay for your insurance. So you might

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Speaker 2: make seventy thousand dollars a year as a school teacher, hypothetically,

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Speaker 2: and the company is also paying thirty thousand dollars a

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Speaker 2: year to cover you know, your health insurance, so they're

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Speaker 2: carrying you on the books. Is a one hundred thousand

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Speaker 2: dollars a year employee.

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Speaker 3: Correct, correct? And they get tax benefits for, you know,

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Speaker 3: providing you know, insurance options. And the reality is, and

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Speaker 3: a lot of my friends will probably you know, spear

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Speaker 3: me for saying this, but I think one of the

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Speaker 3: best things that could happen to our system is getting

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Speaker 3: employers out of health insurance. I mean, they don't pay

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Speaker 3: for my car insurance, they don't pay, you know, for

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Speaker 3: my home insurance. I'd rather see the money in the

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Speaker 3: paycheck and give people the ability to have a market

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Speaker 3: for insurance that they want and need, and a public

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Speaker 3: option for the people who you know, really really struggle

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Speaker 3: financially that they could get. You know, we give EBT

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Speaker 3: cards for food and groceries, which I would argue is

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Speaker 3: even more important to someone's health than anything I do.

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Speaker 3: And yet we regulate, you know, healthcare to the point

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Speaker 3: that why can't we give people an HSA card with

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Speaker 3: taxpayer dollars to say, hey, if you want to go

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Speaker 3: to a community health center, great, if you're happy there,

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Speaker 3: you like your doctor, here's your card. You can use

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Speaker 3: it for any medical expense. I don't understand why it's

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Speaker 3: the only thing that people think we can't that patients

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Speaker 3: can't make choices for themselves based on what they need.

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Speaker 3: The hard part for patients is right now, there is

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Speaker 3: no transparency. You know, you need gas, you can drive

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Speaker 3: by a gas station and see what cost what sure

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Speaker 3: in healthcare and healthcare you need a doctor like mirror

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Speaker 3: a colleagues of mine that are not only going to

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Speaker 3: take care of you, you know, based on our oath,

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Speaker 3: but also take care of you in a way to

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Speaker 3: do no financial harm. You know, if I order a

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Speaker 3: test or a medication that someone can't afford because they're

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Speaker 3: on a three thousand dollars deductible and they're playing against

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Speaker 3: the casino and the house always wins. Are they going

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Speaker 3: to go do it or are they not going to

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Speaker 3: do it? Is that going to end up in a

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Speaker 3: bad outcome?

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Speaker 5: You know?

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Speaker 3: We help people navigate the complexity of this system by

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Speaker 3: getting insurance out of our practice.

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Speaker 2: Okay, and when we get back, I want to talk

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Speaker 2: about your practice, and I want to talk about what

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Speaker 2: you call direct primary care. It is a totally different model.

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Speaker 2: It was a different model in twenty seventeen when we

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Speaker 2: talked last, and it's a different model certainly today from

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Speaker 2: what it was then. But people can't get a doctor anymore.

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Speaker 2: They may have all the health insurance that they can find,

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Speaker 2: but they can't find a primary care physician. We'll get

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Speaker 2: to all of this with doctor Jeffrey Gold. We need

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Speaker 2: a revolution in this area, and I mean that seriously,

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Speaker 2: the uber wealthy can pay so called concierge doctors. You

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Speaker 2: pay a lot of money and they're they're at your

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Speaker 2: back and call. You have a situation where with direct

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Speaker 2: primary care that's not involved nearly as much money as

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Speaker 2: a concierge doctor, but provides very much a similar service.

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Speaker 2: They need to be more direct primary care doctors, in

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Speaker 2: my opinion, Doctor Jeffrey Gold, Back on night Side, if

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Speaker 2: you like to join the conversation six one, seven, two, five, four, ten,

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Speaker 2: thirty six, one seven nine Back on Nightside with doctor

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Speaker 2: Jeffrey Gold.

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Speaker 1: Night Side with Dan Ray. I'm telling you BZ Boston's

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Speaker 1: news Radio with us with.

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Speaker 2: Us as doctor Jeffrey Gold. Doctor Gold was a guest

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Speaker 2: in this program several years ago, almost nine years ago,

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Speaker 2: and he was probably mentioned today in an op ed

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Speaker 2: piece by Shier Schoenenberg in the Boston Globe, why more

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Speaker 2: patients are paying doctors directly? In what it says about

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Speaker 2: our health system? Doctor, if you could, if you could

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Speaker 2: explain to us as simply as possible, how your office works.

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Speaker 2: It's a direct what you call direct primary care. How

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Speaker 2: is it different from we'll certainly cost year's doctors. How

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Speaker 2: it's different from any other form of direct of primary

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Speaker 2: care PCPs. Primary care physicians feel free go right.

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Speaker 3: In sure, So the typical primary care practice, most of

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Speaker 3: them right now are owned by big hospital systems. The

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Speaker 3: doctors are employed. They're expected to usually see about eighteen

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Speaker 3: to twenty people a day and code and bill for

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Speaker 3: you know, to insurance for every visit, interaction, that type

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Speaker 3: of stuff. Most of them, whether they admit it or not,

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Speaker 3: or not happy they don't get to spend time with patients.

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Speaker 3: You know, they're making a decent living, but at what cost,

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Speaker 3: you know it just I was in it for the

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Speaker 3: first part of my career. And then there's concierge medicine,

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Speaker 3: which you know again, I don't begrudge patients or doctors

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Speaker 3: that do this because I think anything is better than

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Speaker 3: the current model. But basically, you pay an annual membership

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Speaker 3: fee to be a member of the practice, which is

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Speaker 3: usually smaller, you know about I mean, the doctors in

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Speaker 3: the system carry about two to three thousand patients on

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Speaker 3: their panel. The concierge doc, depending on what they charge annually,

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Speaker 3: can get away with a couple hundred patients, but they

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Speaker 3: also still bill insurance, so for every visit interaction you have,

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Speaker 3: they're also filing a claim. So if you have a

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Speaker 3: high deductible health plan or co pays co insurance, you're

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Speaker 3: going to get billed on top of the fee. The

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Speaker 3: way that we work in direct primary care is again

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Speaker 3: getting back to the principle of why are we using

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Speaker 3: insurance to pay for the most affordable, routine part of healthcare,

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Speaker 3: which is primary care. It's the foundation of our system,

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Speaker 3: which unfortunately a lot of people don't know. Out of

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Speaker 3: the whole healthcare spend in the US, whether you look

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Speaker 3: at private insurance or public, about six percent of the

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Speaker 3: spend is on primary care mental health, and then we

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Speaker 3: wonder why our system is broken.

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Speaker 2: That's only six.

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Speaker 3: Percent.

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Speaker 2: Yep, that's increable. I thought you were going to say sixty.

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Speaker 3: No, So when you're valued at six percent of the spend,

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Speaker 3: you have to see more and more people, order more tests,

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Speaker 3: refer to more specialists, because that's how the system makes

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Speaker 3: money or your employer makes money. With direct primary care,

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Speaker 3: what we do is we see people regardless of their

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Speaker 3: insurance status. We have people that are uninsured, we have

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Speaker 3: people on Medicare, we have a handful of people that

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Speaker 3: are even on Medicaid that you know want better care

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Speaker 3: and better access. And the analogy I use is like

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Speaker 3: we're a combination of Netflix and Costco. For primary care,

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Speaker 3: you pay a flat monthly fee, which we do age

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Speaker 3: based pricing on a family dot so I take care

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Speaker 3: of newborns all the way up to geriatrix. Our average

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Speaker 3: monthly fee is about ninety dollars a month, and that

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Speaker 3: includes all of their primary care, so telehealth in person visits,

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Speaker 3: annual check up, any procedure we do in the office,

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Speaker 3: like a skin biopsy EKG. All of that is included

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Speaker 3: in the monthly fee. My patients get my direct email

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Speaker 3: where they can you know, email a question and I

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Speaker 3: get back to them. They have access to my work cell,

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Speaker 3: and nights and weekends. If anything urgent comes up, if

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Speaker 3: I can prevent them from going to an emergency room

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Speaker 3: or an urgent care safely, I do it. And then

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Speaker 3: we're like Costco in the sense that by being a

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Speaker 3: member of the practice, we get people access to what

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Speaker 3: things in healthcare actually costs. So you know, for example,

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Speaker 3: our lab work a guy at my age, I'm fifty

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Speaker 3: for an annual set of labs, it's about fifty bucks total,

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Speaker 3: where if you go to the hospital, you may get

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Speaker 3: hit with a bill for six hundred. But we tell

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Speaker 3: people right up front. We're very transparent about everything we do.

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Speaker 3: There's no hidden seas and unfortunately, you know, well fortunately,

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Speaker 3: because we don't take insurance and bill insurance, we do

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Speaker 3: have to carry a little higher of a panel to

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Speaker 3: make the economics work compared to a concierge physician. So

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Speaker 3: right now I'm about you know, six hundred and eighty

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Speaker 3: seven hundred patients is kind of you know, the happy spot,

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Speaker 3: because if I get greedy and I take more on,

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Speaker 3: then I end up going right back to what I

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Speaker 3: was doing before, and I can't give people the access

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Speaker 3: and time they need. Our annual physicals or an hour

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Speaker 3: we spend an hour with patients. They can go over

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Speaker 3: whatever they want. They don't have to worry about, oh

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Speaker 3: if I bring up an issue, am I going to

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Speaker 3: get hit with another bill? You know, we see people

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Speaker 3: same day, next day, latest for urgent issues, and we

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Speaker 3: just try to take care of people is individuals and

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Speaker 3: based on what their needs are.

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Speaker 2: This sounds like you're doing what the family physician of

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Speaker 2: old dead. I can still remember doctors making house house calls,

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Speaker 2: so when you say tell.

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Speaker 5: We do that.

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Speaker 3: We do that too if needed.

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Speaker 2: Yeah. So so, so let's assume that someone needs to

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Speaker 2: get an appointment with you. Uh, and not everybody's going

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Speaker 2: to live. You're based in Salem, as I understand it,

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Speaker 2: but you have a broad range of patients geographically. So

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Speaker 2: if someone wants to check in with you, because I

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Speaker 2: don't know they have they have a sty in their

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Speaker 2: eye or something like that, you can do a if

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Speaker 2: they're set up for it, you can do a zoom call.

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Speaker 3: I assume yeah, or they can even take a picture,

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Speaker 3: you know, have their family member take a picture of it,

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Speaker 3: send me a text or an email. And if it's

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Speaker 3: a sty, I'm going to treat the sky. Why the

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Speaker 3: only reason people are made to come in in the

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Speaker 3: current system is so that insurance can be built. It's ridiculous.

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Speaker 3: The only time we bring people in is if it

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Speaker 3: is medically necessary for me to see them, or they

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Speaker 3: want to come in, you know, if they prefer to

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Speaker 3: do a face to face, we do it and you.

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Speaker 2: Do as part part of that that monthly fee. Annually,

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Speaker 2: everybody is scheduled for annual physical which I think is

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Speaker 2: critical for healthy as well as people who are not

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Speaker 2: all that healthy?

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Speaker 3: Correct?

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Speaker 5: Yep?

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Speaker 3: And it basically it's it's Netflix. It's you know, there

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Speaker 3: may be a month where you don't need anything, you know,

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Speaker 3: but you pay, you pay the monthly fee. Sure, there

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Speaker 3: may be a month where you need to interact with

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Speaker 3: us five times and is the same.

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Speaker 2: Okay? What about if let's say someone says they have

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Speaker 2: some sort of a circumstance and they say, well, I

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Speaker 2: need an annual physical, but i'd like to get a

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Speaker 2: quick check up with you six months, you know at

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Speaker 2: halfway point. Is that an additional cost?

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Speaker 5: No?

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Speaker 3: No, we you know some of our you know, older

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Speaker 3: patients that have a lot of chronic, you know issues,

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Speaker 3: they can come in you know, once a month, or

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Speaker 3: check in with me over email once a month and

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Speaker 3: let me know how things they're doing. You know, it's

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Speaker 3: really this isn't rocket science. You know, it doesn't have

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Speaker 3: to be this complicated.

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Speaker 2: Sounds it sounds quite simplified. So let me ask you

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Speaker 2: and then we we got to take a quick news

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Speaker 2: break here I'm actually passing. We'll open up phone lines

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Speaker 2: and people have questions. So what percentage if you know

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Speaker 2: of people in America today are small enough or adept

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Speaker 2: enough to have to be benefiting from direct primary care.

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Speaker 2: How many other doctors like you are around America today?

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Speaker 2: Is there a growing number of providers? Oh?

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Speaker 3: Yeah, it's I mean since we last spoke. At the time,

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Speaker 3: I think there were only maybe you know, five of

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Speaker 3: us in the state that we're doing it, and now

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Speaker 3: there's about twenty to twenty five across the state, and

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Speaker 3: I'd say nationally it's probably up to about four or

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Speaker 3: five thousand. It's still a very small, you know, percentage

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Speaker 3: compared to the regular, you know, insurance based primary care doctor.

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Speaker 3: But I think primary care, if it continues the way

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Speaker 3: it is, is going to be extinct. You know, it's

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Speaker 3: going to be all urgent cares and you're not gonna

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Speaker 3: You're not gonna have a primary care physician and urgent.

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Speaker 2: Urgent care is fine. If you wake up someday and

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Speaker 2: you're not near your doctor and I don't know, you

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Speaker 2: have a rash, well you could still do a ration

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Speaker 2: and tell do it. Tell. Yeah. It seems to me

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Speaker 2: that that you're the future of medicine. I don't know

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Speaker 2: how else to describe it. My guest is doctor Jeffrey

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Speaker 2: Gold phone call six one seven two five four ten

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Speaker 2: thirty six, one seven nine three, one ten thirty. Here

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Speaker 2: comes the news. We're a little bit late. I think

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Speaker 2: this is an extraordinarily exciting form of medicine and practice.

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Speaker 2: Uh and I hope you appreciate the time that doctor

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Speaker 2: Gold is giving us tonight, explaining it simply and clearly

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Speaker 2: that all of us can understand it. Back on Nightside

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Speaker 2: right after.

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Speaker 1: This, You're on Night Side with Dan Ray on w BZ,

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Speaker 1: Boston's news radio.

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Speaker 2: All right, my guest is doctor Jeffrey Gold. He's based

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Speaker 2: in Salem. However, he has been a pioneer in the

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Speaker 2: concept of direct primary care, which costs the patients less

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Speaker 2: money and basically sidelines the insurance companies that are basically

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Speaker 2: running the American medical system today. I would suggest you

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Speaker 2: read an op ed piece in Today's Boston Globe by

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Speaker 2: Shirah Schoenberg, why more patients are paying doctors directly and

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Speaker 2: what it says about our health system. It's a great article.

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Speaker 2: I want to get to callers doctor Gold, and I'm

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Speaker 2: sure they have plenty of questions. So let's start off

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Speaker 2: with Wayne and Wooburn. Wayne, you were first this hour

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Speaker 2: with doctor Jeffrey Gold.

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Speaker 5: Go right ahead, Wayne, thanks Dan, in a healthcare system

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Speaker 5: that just makes so little sense, Thank you, doctor Gold,

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Speaker 5: because you are making so much sense. And thank you

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Speaker 5: you just said that there have been there were five

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Speaker 5: direct primary care docs and now increased fivefold to twenty five,

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Speaker 5: which is amazing, except we need more like several thousand

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Speaker 5: direct primary care family docs. Are you familiar with the

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Speaker 5: primary care legislation called primary Care for You that essentially

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Speaker 5: is a direct primary care for all model in the

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Speaker 5: state of Massachusetts.

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Speaker 3: I one hundred percent m and I am very dear

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Speaker 3: friends and colleagues with the person who initiated the bill,

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Speaker 3: doctor Wayne Altman, And it is based basically on a

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Speaker 3: direct primary care type of chassis, where you know, it's

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Speaker 3: a flat sea to take care of people. Now, the

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Speaker 3: pushback I always give and is you know, the money

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Speaker 3: coming directly from the patient, and in that model it's not.

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Speaker 3: But it is certainly better than what the current established

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Speaker 3: system is because it allows physicians, particularly primary care physicians,

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Speaker 3: to practice at the extent of their training, and have

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Speaker 3: time with patients, and have the resources for mental health, nutrition,

436
00:27:39,200 --> 00:27:42,800
Speaker 3: you know, all the things that really make up effective

437
00:27:43,160 --> 00:27:49,639
Speaker 3: primary care. And as you know, the dollar amount that

438
00:27:49,680 --> 00:27:52,639
Speaker 3: we spend on primary care is just not acceptable. No

439
00:27:53,119 --> 00:27:56,480
Speaker 3: one would build a house and spend that little on

440
00:27:56,520 --> 00:27:59,640
Speaker 3: their foundation, but yet.

441
00:27:59,400 --> 00:28:00,320
Speaker 2: We do it day.

442
00:28:00,560 --> 00:28:06,240
Speaker 3: So I really appreciate the work you do and your

443
00:28:06,280 --> 00:28:07,920
Speaker 3: comments as well. Thank you.

444
00:28:11,119 --> 00:28:14,680
Speaker 2: Wayne and Woolburn. Are you the doctor that that doctor

445
00:28:14,720 --> 00:28:15,600
Speaker 2: Waters referring to.

446
00:28:16,720 --> 00:28:21,040
Speaker 5: Yes, I am, yes, Well you know what.

447
00:28:21,200 --> 00:28:26,120
Speaker 2: Somenight, Rob will give you my direct line, Doctor Altman,

448
00:28:26,320 --> 00:28:29,480
Speaker 2: and we will. I we'd love to have you on

449
00:28:29,600 --> 00:28:32,159
Speaker 2: as well, because I want to get people thinking about

450
00:28:32,160 --> 00:28:34,880
Speaker 2: this system. I mean, doctor Gold has made so much

451
00:28:34,920 --> 00:28:38,600
Speaker 2: sense tonight in terms of when you compare it to

452
00:28:38,760 --> 00:28:44,920
Speaker 2: auto insurance and health insurance and all sorts of insurance

453
00:28:44,960 --> 00:28:48,400
Speaker 2: systems that we know about. You know, it just makes

454
00:28:48,440 --> 00:28:52,120
Speaker 2: all the sense in the world. And I, for one,

455
00:28:53,120 --> 00:28:57,400
Speaker 2: I had a personal care physician for many years thirty

456
00:28:57,440 --> 00:29:00,600
Speaker 2: five years who was an extraordinary doctor, Doctor and Cole

457
00:29:00,680 --> 00:29:03,560
Speaker 2: out of Natick, and at the beginning of COVID he

458
00:29:03,720 --> 00:29:08,920
Speaker 2: chose to end his practice, which I understood, But it's

459
00:29:09,000 --> 00:29:16,320
Speaker 2: been to try to find a PCP today is almost

460
00:29:16,320 --> 00:29:23,040
Speaker 2: impossible for the average person, and I think there are

461
00:29:23,080 --> 00:29:25,240
Speaker 2: a lot of people out there who are relying upon

462
00:29:25,440 --> 00:29:28,280
Speaker 2: urgent care and not seeing doctors on a regular basis.

463
00:29:28,680 --> 00:29:33,120
Speaker 2: Can either of you comment on that belief? That's what

464
00:29:33,160 --> 00:29:35,680
Speaker 2: my sense tells me that the situation is so confusing.

465
00:29:37,320 --> 00:29:41,000
Speaker 5: Well, Dan, one thing, primary care doctors in Massachusetts are

466
00:29:41,040 --> 00:29:44,000
Speaker 5: over the age of sixty and likely to retire soon.

467
00:29:44,640 --> 00:29:51,400
Speaker 5: And the primary care access issue is horrendous and it's shameful.

468
00:29:51,440 --> 00:29:55,880
Speaker 5: We can do better, and we don't need to vilify

469
00:29:57,640 --> 00:30:00,680
Speaker 5: insurance health insurance, and doctor Gold was not doing that.

470
00:30:01,160 --> 00:30:03,400
Speaker 5: But what he's saying, and what I'm saying, is that

471
00:30:03,520 --> 00:30:06,880
Speaker 5: health insurance does not belong with primary care. It doesn't

472
00:30:06,880 --> 00:30:10,920
Speaker 5: make any sense. Insurance is for unexpected and catastrophic results.

473
00:30:11,120 --> 00:30:13,600
Speaker 5: Primary care is neither unexpected nor catastrophic.

474
00:30:16,160 --> 00:30:20,720
Speaker 2: Doctor goldquick comment on my observation that things are so

475
00:30:20,840 --> 00:30:24,600
Speaker 2: confusing that my suspicion is, I mean, the people who

476
00:30:24,680 --> 00:30:28,560
Speaker 2: are on Medicaid are pretty much taking care of in

477
00:30:28,600 --> 00:30:31,000
Speaker 2: this country, I guess in Medicare, but I think the

478
00:30:31,080 --> 00:30:34,200
Speaker 2: average person who's trying to to raise a family, work

479
00:30:34,360 --> 00:30:37,120
Speaker 2: work out, you know, work for a living. I think

480
00:30:37,160 --> 00:30:39,120
Speaker 2: they're the ones who are who are paying the worst

481
00:30:39,120 --> 00:30:39,880
Speaker 2: price right now.

482
00:30:41,680 --> 00:30:44,600
Speaker 3: Yeah, and I completely agree with doctor Altman, and I

483
00:30:44,640 --> 00:30:47,440
Speaker 3: think that the issue and he and I have spoken

484
00:30:47,480 --> 00:30:52,520
Speaker 3: about this numerous times, is how do we build a

485
00:30:53,160 --> 00:31:00,640
Speaker 3: system starting with medical education, that encourages and leads people

486
00:31:01,320 --> 00:31:07,200
Speaker 3: to pick primary care as their career. And right now

487
00:31:07,360 --> 00:31:12,840
Speaker 3: the system encourages people to go into specialty care. There's

488
00:31:12,920 --> 00:31:17,280
Speaker 3: more money, they've got student loans to pay back. They

489
00:31:17,440 --> 00:31:22,640
Speaker 3: see more value and prestige in it than being, you know,

490
00:31:22,720 --> 00:31:25,600
Speaker 3: the primary care doc like the two of us are.

491
00:31:25,880 --> 00:31:30,600
Speaker 3: And I think we need to start educating medical students

492
00:31:30,600 --> 00:31:34,360
Speaker 3: from day one of medical school that there are other

493
00:31:34,480 --> 00:31:38,640
Speaker 3: viable options for primary care out there. It's not going

494
00:31:38,720 --> 00:31:43,040
Speaker 3: to happen overnight, but I think the urgent care stuff,

495
00:31:43,080 --> 00:31:46,800
Speaker 3: it's just the systems completely fragmented and no one talks

496
00:31:46,800 --> 00:31:51,920
Speaker 3: to each other. It it just doesn't work. It just

497
00:31:52,000 --> 00:31:53,040
Speaker 3: works with the wrong people.

498
00:31:54,240 --> 00:31:58,640
Speaker 2: You know. I recently had the dean of the University

499
00:31:58,680 --> 00:32:02,840
Speaker 2: of Michigan Medical School law because I am convinced, to

500
00:32:02,920 --> 00:32:10,080
Speaker 2: be really honest with you, that the AMA has tried

501
00:32:10,120 --> 00:32:13,719
Speaker 2: to keep down the number of medical schools in this country.

502
00:32:13,760 --> 00:32:19,280
Speaker 2: I know a lot of really good physicians across Massachusetts

503
00:32:19,400 --> 00:32:23,240
Speaker 2: who have gone to so called offshore medical schools, and

504
00:32:23,280 --> 00:32:28,200
Speaker 2: they're great doctors, but there aren't enough seats at medical

505
00:32:28,200 --> 00:32:31,560
Speaker 2: schools in Massachusetts, we only have one hundred and twenty seats.

506
00:32:31,960 --> 00:32:35,360
Speaker 2: Speaking to doctor Albman's comment about people retiring in the

507
00:32:35,680 --> 00:32:39,440
Speaker 2: over the age of sixty, why in Massachusetts we in

508
00:32:39,480 --> 00:32:41,520
Speaker 2: our state medical school do we only have one hundred

509
00:32:41,560 --> 00:32:47,000
Speaker 2: and twenty seats for medical students school students. They are

510
00:32:47,000 --> 00:32:49,160
Speaker 2: a lot of bright college kids who would love to

511
00:32:49,160 --> 00:32:52,200
Speaker 2: become doctors. They can't get into medical schools in the US.

512
00:32:52,280 --> 00:32:54,160
Speaker 2: They're going off offshore.

513
00:32:56,280 --> 00:32:59,880
Speaker 3: Yeah, I wish I could tell you the answer to that.

514
00:33:00,000 --> 00:33:06,080
Speaker 3: At I think it's a lot of bureaucracy and money.

515
00:33:07,440 --> 00:33:10,960
Speaker 3: But you know, I I don't I'm not really in

516
00:33:11,240 --> 00:33:15,960
Speaker 3: any organized type of medicine medical group other than the

517
00:33:16,000 --> 00:33:20,200
Speaker 3: American Academy of Family Physicians and mass Academy of Family Physicians,

518
00:33:21,280 --> 00:33:24,239
Speaker 3: So I don't really follow the AMA closely. But I

519
00:33:24,280 --> 00:33:27,520
Speaker 3: know I know people that are members of the AMA

520
00:33:27,920 --> 00:33:32,120
Speaker 3: that are really trying hard to fix these issues. But

521
00:33:32,480 --> 00:33:37,000
Speaker 3: overall as a group, I don't know, you know what

522
00:33:37,160 --> 00:33:39,080
Speaker 3: what they do or don't do, to be honest with you,

523
00:33:39,160 --> 00:33:39,640
Speaker 3: so I'll.

524
00:33:39,920 --> 00:33:43,200
Speaker 2: Please Doman, Do you want to comment on that observation

525
00:33:43,320 --> 00:33:45,520
Speaker 2: or know? Sure?

526
00:33:46,280 --> 00:33:49,240
Speaker 5: So, there's four medical schools in Massachusetts, each have about

527
00:33:49,480 --> 00:33:52,400
Speaker 5: two hundred students per class plus minus.

528
00:33:52,680 --> 00:33:56,040
Speaker 2: So there's you mass is one twenty. Doctor.

529
00:33:56,480 --> 00:33:59,480
Speaker 5: I know that it's increased. It's recently increased.

530
00:34:00,120 --> 00:34:00,760
Speaker 2: That's good to hear.

531
00:34:01,280 --> 00:34:05,800
Speaker 5: Ad and and toughs where I'm chair of the Department

532
00:34:05,840 --> 00:34:09,920
Speaker 5: of Family Medicine has also has a class size of

533
00:34:10,360 --> 00:34:15,520
Speaker 5: over two hundred and would love to increase, except you

534
00:34:15,640 --> 00:34:19,680
Speaker 5: have to have enough teaching sites hospitals and primary care

535
00:34:19,760 --> 00:34:23,600
Speaker 5: sites to teach the students, and that's kind of the

536
00:34:23,680 --> 00:34:25,840
Speaker 5: rate limiting step. Your theory about the A M A

537
00:34:26,440 --> 00:34:28,440
Speaker 5: may be true. I don't know anything about that.

538
00:34:28,800 --> 00:34:31,759
Speaker 2: Okay, fair enough, all right, gentlemen, thank you so much,

539
00:34:32,640 --> 00:34:35,040
Speaker 2: doctor Albman. We'll have you on tonight if you'd be

540
00:34:35,160 --> 00:34:37,960
Speaker 2: if you'd be interested, because I think this is an

541
00:34:37,960 --> 00:34:39,520
Speaker 2: important conversation to have.

542
00:34:40,440 --> 00:34:42,560
Speaker 5: I'm a longtime fan of hers and I'd be honored.

543
00:34:42,840 --> 00:34:46,160
Speaker 2: Well, thank you very much. I'm gonna have Rob leave

544
00:34:46,239 --> 00:34:49,720
Speaker 2: you my direct number. Rob give them, uh, Doc Alban

545
00:34:49,840 --> 00:34:53,239
Speaker 2: my cell phone number. Please, we'll be back finish up

546
00:34:53,239 --> 00:34:56,520
Speaker 2: our conversation with doctor Jeffrey Gold. This is important if

547
00:34:56,560 --> 00:35:02,120
Speaker 2: you are in the need of medical care. You don't

548
00:35:02,120 --> 00:35:06,960
Speaker 2: want to end up in emergency rooms. You know intensive

549
00:35:07,000 --> 00:35:11,319
Speaker 2: care units, you need to have a doctor, and the

550
00:35:11,400 --> 00:35:14,120
Speaker 2: system makes it difficult for people to get doctors. At

551
00:35:14,120 --> 00:35:16,360
Speaker 2: this point, we'll take a break. Coming back on Nightside

552
00:35:16,360 --> 00:35:17,359
Speaker 2: with doctor Jeffrey Gold.

553
00:35:19,040 --> 00:35:23,680
Speaker 1: It's Night's Eye with Boston's News Radio.

554
00:35:23,760 --> 00:35:25,600
Speaker 2: I'm gonna get one more caller in here, Bob and

555
00:35:25,640 --> 00:35:29,880
Speaker 2: Cambridge for doctor Jeffrey Gold. Bob and Cambridge next with

556
00:35:29,960 --> 00:35:30,520
Speaker 2: doctor Gold.

557
00:35:30,520 --> 00:35:34,400
Speaker 6: Go right ahead, Hello Dan, Hello doctor Gold.

558
00:35:34,680 --> 00:35:36,120
Speaker 5: Thank you for taking my call.

559
00:35:36,280 --> 00:35:36,760
Speaker 2: You're welcome.

560
00:35:37,160 --> 00:35:42,440
Speaker 6: My course to both of you is, do either one

561
00:35:42,480 --> 00:35:45,200
Speaker 6: of you know anything about what's called the hill Burton Act.

562
00:35:46,480 --> 00:35:49,080
Speaker 2: I'm not familiar with that, doctor Gold. I am not

563
00:35:50,360 --> 00:35:51,239
Speaker 2: explain it to us.

564
00:35:52,160 --> 00:35:54,960
Speaker 7: Okay, I can explain it to you. He is back

565
00:35:55,280 --> 00:35:59,600
Speaker 7: when I didn't have insurance in my younger days. Uh,

566
00:35:59,760 --> 00:36:03,400
Speaker 7: and I have to go from any care medical care

567
00:36:04,080 --> 00:36:06,200
Speaker 7: from Cambridge. I used to go to the Model and

568
00:36:06,280 --> 00:36:09,920
Speaker 7: Hospital and in the emergency room there was a plaque

569
00:36:10,000 --> 00:36:12,360
Speaker 7: right on the wall that said what the hill Burton

570
00:36:12,440 --> 00:36:16,960
Speaker 7: Act was. The hill Burton Act is some sort of

571
00:36:17,040 --> 00:36:20,600
Speaker 7: compensation that your bill gets paid in the emergency room

572
00:36:20,640 --> 00:36:22,040
Speaker 7: if you don't have any insurance.

573
00:36:22,200 --> 00:36:24,920
Speaker 2: Yeah, any person can call it can show up at

574
00:36:24,920 --> 00:36:28,279
Speaker 2: an emergency room in any hospital in America, whether they

575
00:36:28,360 --> 00:36:32,040
Speaker 2: are a citizen here legally, illegally, or whatever, and they

576
00:36:32,080 --> 00:36:34,799
Speaker 2: have to be treated if they go to an emergency room.

577
00:36:34,880 --> 00:36:37,720
Speaker 2: They that's that's I think what you're talking about.

578
00:36:38,080 --> 00:36:40,120
Speaker 6: Yeah, that's what the Hillburton Act was.

579
00:36:40,520 --> 00:36:41,560
Speaker 2: Okay, so what's your point.

580
00:36:41,680 --> 00:36:44,600
Speaker 6: Well, my point is what all the problems about. I

581
00:36:44,640 --> 00:36:47,000
Speaker 6: have a primary care. Thank god, I've had her for years.

582
00:36:47,000 --> 00:36:50,640
Speaker 6: I hope she don't retire. My thing is this, then, right,

583
00:36:50,640 --> 00:36:53,719
Speaker 6: if you can't get a primary care, because you know

584
00:36:53,800 --> 00:36:55,960
Speaker 6: they are, you want five between, why don't people just

585
00:36:55,960 --> 00:36:58,319
Speaker 6: go there? And that's it is what it is.

586
00:36:59,640 --> 00:37:03,919
Speaker 2: Well, I don't have an answer for that. I can

587
00:37:03,960 --> 00:37:09,400
Speaker 2: only tell you that, in my opinion, most people in

588
00:37:09,480 --> 00:37:14,840
Speaker 2: this country assume that they want to have a doctor,

589
00:37:15,520 --> 00:37:19,680
Speaker 2: and I don't think people being in an emergency room,

590
00:37:19,880 --> 00:37:24,480
Speaker 2: particularly if you're there, it can be unpleasant to be

591
00:37:24,520 --> 00:37:27,120
Speaker 2: honest with you, by and you avoid going to emergency

592
00:37:27,200 --> 00:37:31,520
Speaker 2: rooms by having a regular doctor who has a relationship

593
00:37:31,600 --> 00:37:33,640
Speaker 2: with the doctor Gold I assume you'd agree with that.

594
00:37:34,840 --> 00:37:37,680
Speaker 3: Yeah, I think he's one hundred percent right, And sadly

595
00:37:37,920 --> 00:37:42,560
Speaker 3: that's part of the problem is you know, I can

596
00:37:42,600 --> 00:37:46,440
Speaker 3: take care of the UTI for you know, under fifty

597
00:37:46,520 --> 00:37:50,359
Speaker 3: bucks where if you go to an emergency room, god

598
00:37:50,360 --> 00:37:52,480
Speaker 3: only knows what the bill is for just walking in

599
00:37:52,520 --> 00:37:56,560
Speaker 3: the door, never mind the testing and the weight. And

600
00:37:56,680 --> 00:37:59,800
Speaker 3: I get it, you know that people feel they don't

601
00:38:00,120 --> 00:38:04,600
Speaker 3: have any other option. But I just say, for the

602
00:38:04,719 --> 00:38:07,399
Speaker 3: cost of a cell phone bill of months, which ninety

603
00:38:07,400 --> 00:38:10,560
Speaker 3: eight percent of Americans have a cell phone, they can

604
00:38:10,640 --> 00:38:13,920
Speaker 3: afford me if they want, if they see the value

605
00:38:13,920 --> 00:38:16,920
Speaker 3: in it. And I think you know the word you

606
00:38:17,000 --> 00:38:20,200
Speaker 3: just use, dan that I think is really important is

607
00:38:20,280 --> 00:38:26,040
Speaker 3: primary care is relationship based medicine. It's not transactional, using

608
00:38:26,080 --> 00:38:30,520
Speaker 3: the er as a transaction. You know, having a major

609
00:38:30,560 --> 00:38:32,840
Speaker 3: surgery as a transaction. You want it to go well,

610
00:38:33,480 --> 00:38:36,239
Speaker 3: but you don't want to be there again. You know,

611
00:38:36,360 --> 00:38:41,880
Speaker 3: we've turned primary care into this fragmented series of transactions,

612
00:38:42,200 --> 00:38:44,280
Speaker 3: and then we sit and wonder why it doesn't work.

613
00:38:44,400 --> 00:38:48,440
Speaker 3: And the reality is we have a very simple economic

614
00:38:48,480 --> 00:38:53,759
Speaker 3: issue of supplying demand. We have a growing population that

615
00:38:53,840 --> 00:38:57,799
Speaker 3: wants healthcare, needs health care, wants it when they want

616
00:38:57,840 --> 00:39:00,000
Speaker 3: it from who they want it from, and a huge

617
00:39:00,160 --> 00:39:03,319
Speaker 3: portion don't want to pay for it. But yet we

618
00:39:03,400 --> 00:39:06,560
Speaker 3: have a supply side that is dwindling and what is

619
00:39:06,600 --> 00:39:11,399
Speaker 3: there is hanging on by a threat. I mean ers

620
00:39:11,440 --> 00:39:16,600
Speaker 3: are overrun. The nurses' staff are completely overworked, the doctors

621
00:39:16,640 --> 00:39:20,640
Speaker 3: are overworked, and that's when mistakes happen and accidents.

622
00:39:21,200 --> 00:39:24,080
Speaker 2: Absolutely, Bob, thank you for your call. Unfortune, we're flat

623
00:39:24,080 --> 00:39:26,959
Speaker 2: out of time. I appreciate your question. It's a good one, Bob,

624
00:39:27,400 --> 00:39:32,040
Speaker 2: Thank you very much. I want to doctor Gold, thank

625
00:39:32,080 --> 00:39:34,080
Speaker 2: you very much. How can folks get in touch with

626
00:39:34,120 --> 00:39:37,600
Speaker 2: you if they're interested in getting more information on your

627
00:39:37,640 --> 00:39:39,920
Speaker 2: direct primary care practice.

628
00:39:40,480 --> 00:39:45,720
Speaker 3: Sure, they can go to my website www dot goldirectcare

629
00:39:45,840 --> 00:39:50,400
Speaker 3: dot com. All are pricing everything on there is transparent.

630
00:39:51,480 --> 00:39:54,440
Speaker 3: They can call the office. We have typical office hours

631
00:39:54,440 --> 00:39:57,319
Speaker 3: seven eight one, eight four two three nine six one,

632
00:39:58,280 --> 00:40:02,040
Speaker 3: or they can email me directly Doctor Gold, d R

633
00:40:02,160 --> 00:40:06,560
Speaker 3: G O L D at Goldirectcare dot com. And you know,

634
00:40:06,600 --> 00:40:10,560
Speaker 3: we do a free thirty minute info session for anybody

635
00:40:11,280 --> 00:40:13,879
Speaker 3: you know that's interested in learning more. We help them

636
00:40:13,880 --> 00:40:18,719
Speaker 3: with the insurance side of things. We explain everything and

637
00:40:18,800 --> 00:40:20,880
Speaker 3: then we leave it up to them to make a decision,

638
00:40:21,400 --> 00:40:22,719
Speaker 3: you know, if it's a good fit for them. But

639
00:40:22,800 --> 00:40:27,600
Speaker 3: at least ask, you know. But I really appreciate you

640
00:40:27,640 --> 00:40:29,000
Speaker 3: having me on again, Dan, and.

641
00:40:29,239 --> 00:40:32,080
Speaker 2: Have you back. We'll have you back. The email is time.

642
00:40:32,400 --> 00:40:37,520
Speaker 2: The email is Golddirectcare dot com. That's the most important one,

643
00:40:38,000 --> 00:40:40,440
Speaker 2: Doctor Gold. As always. Thanks, we'll talk so thank you

644
00:40:40,560 --> 00:40:41,200
Speaker 2: very very much.

645
00:40:41,840 --> 00:40:43,279
Speaker 3: All right, thanks Dan, have a good night.

646
00:40:43,480 --> 00:40:47,200
Speaker 2: You bet you you too. When we get back, we

647
00:40:47,239 --> 00:40:51,000
Speaker 2: will a couple of calls called in laid unfortunately changing topics.

648
00:40:51,400 --> 00:40:55,879
Speaker 2: Go to talk next hour about this demonstration in Minneapolis

649
00:40:55,920 --> 00:40:58,600
Speaker 2: that I watched over the weekend, which was quite troubling.

650
00:40:58,920 --> 00:41:04,839
Speaker 2: Demonstrators went in to a church and disrupted religious services

651
00:41:04,840 --> 00:41:08,160
Speaker 2: in a church thinking that the pastor of the church

652
00:41:08,360 --> 00:41:12,520
Speaker 2: was somehow an ice officer. It's getting crazy in Minneapolis,

653
00:41:12,520 --> 00:41:15,839
Speaker 2: and I think it's so crazy that the folks in Minneapolis,

654
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Speaker 2: the protesters, are losing their momentum. We'll be back on

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Speaker 2: night Side after this