October 23, 2018 by Dr. Kyle Varner in Direct Primary Care , Policy

Imagine if you saw Meryl Streep out on the street with a big sign selling tickets to her latest movie. That would seem pretty ridiculous, wouldn’t it? All those years at acting school honing her craft, completely wasted at a job she’s not meant to be doing.

The crazy thing is, that’s exactly the case for physicians across America. Doctors report that two-thirds—yes, two-thirds!— of their days are currently being spent on administrative paperwork.

This not only cuts down on the number of appointments they can take, it even bleeds into the time that they’re with patients.

I’m sure you’ve experienced this, when you’re in an appointment and nearly the whole the time the doctor has his eyes on his computer screen… not you. How can you possibly be getting the care you need this way?

Why do Doctors Have So Much Paperwork?

Like so many problems that Americans face with healthcare, the culprit is your insurance company.

In any industry, service providers have to focus on the needs of their customer if they want to make any money. The problem is, when it comes to health care in America you are not the customer. Your insurance company is. They’re the ones paying for you.

Thus, instead of being focused on you—the patient—doctors are much more focused on satisfying the needs of your insurance company.

That’s the real reason your doctor is looking at his computer screen so much. He has to be able to take good enough notes and tick off all the right boxes to be able to bill your insurance company after. Your satisfaction doesn’t really matter. Neither does your health. He just needs to fill out the form well enough to get paid.

Why Do Insurance Companies Demand Paperwork?

Since payment for healthcare services comes from third-party payers, there’s little to no incentive for doctors and patients to control spending. Doctors can prescribe lavish treatments and patients can go for more check-ups than necessary.

As long as it’s covered by insurance, they don’t think twice.

Insurance companies can’t easily reject treatments and prescriptions as a whole. So in order to help control costs, they instead give doctors a pile of paperwork as discouragement.

I get this all the time. Insurance companies try to twist my arm on a prescription by telling me that if I prescribe a certain drug, I’ll have to go through a lengthy prior authorization process.

For example, if I want to get a Medicaid patient on Entresto, a drug that will lower the risk of death for almost any heart failure patient, I can expect to spend at least 45 minutes filing paperwork and I can expect to get multiple phone calls. On top of that, I have to make sure I document several annoying and specific things I wouldn’t ordinarily document.

The result? Entresto isn’t prescribed nearly as much as it should be, and it is due to the indirect incentives created by third-party payers. They don’t tell us what to do, they just drown us in paperwork and phone calls if we do things they don’t like.

And as doctors’ administrative burdens increase, they hire more staff to handle the admin, raising costs even further.

How Can We Reduce Doctors’ Administrative Burdens?

The costs of such a system are no joke. 87% of surveyed physicians report chronic burnout from the sheer volume of paperwork that they have to deal with.

What can we do about this?

It’s simple. People need to start paying directly for their healthcare. Before you panic at the thought, the truth is that this will actually lower your healthcare costs and vastly improve the quality of the care and service that you receive.

Putting cash back into the doctor-patient relationship is essential to turning patients from beggars into valued customers. Because only when you are a paying customer can you get the service you deserve.

We’re already starting to see a movement towards this in the US, through what’s called Direct Primary Care (DPC). This is an option created by doctors who have opted out of the third-party insurance system to work directly with patients. Instead of going in with your insurance, you pay directly pay the doctor a set monthly fee to get unlimited access to them.

What are the Benefits to Taking Insurance Companies Out of the Equation?

When you take insurance companies out of the equation and the excessive amounts of paperwork they demand, more patients get seen, waiting times decrease, prices fall, and patients start getting better quality healthcare.

Compared to the average clinic that accepts insurance a DPC business can assign just a third of their revenue to overhead. In fact, a DPC business can break even by seeing just four patients a day, whereas clinics under an insurance scheme need to see on average 32 a day.

The local government of Union County, New Jersey tested this. Switching just under half of their 2,000 covered patients to DPC, they were able to save $1.28m in a year in overall healthcare expenses.

Efficiency and lower costs are great, but the most important benefit of DPC is that direct doctor-patient relationships can be restored. This focuses doctors’ incentives on their patients’ overall health. This means not only treating people when they’re sick, but preventative care that keeps them from being sick in the first place.

Paying upfront for your healthcare is not just for the wealthy or the healthy. In most cases, direct primary care comes out cheaper than paying for insurance. And even if you are paying for it on top of your regular insurance, this is an investment in your long-term health that will pay off significantly down the line.


Thanks to third-party insurance companies disrupting the doctor-patient relationship and destroying economic incentives, the US healthcare system is severely inefficient and overly expensive. Worst of all, it discourages doctors from giving their patients real care.

For those looking for better healthcare solutions in their own lives and for the US overall, the answer is direct primary care and other cash-based solutions. If you’re ready to take your health back into your own hands, read on to learn how to pick the best direct primary doctor for you.

This information is intended to help readers be more informed about their health options when speaking with a professional, but it should not be used alone to diagnose, treat, prevent or cure any disease or condition. Be sure to speak to a qualified doctor before taking any action to make sure that your choices reflect your actual health situation.

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