An article I originally wrote for Las Vegas magazine.

zdoggmd gets stitches

When I moved to Las Vegas from the Bay Area 2 years ago, my tourist-grade fanny pack was overstuffed with the usual stereotypes and misconceptions. Would I burst into flames during my first summer? Nope — it turns out a shaved head radiates excess heat marvelously. Was the Carrot Top show any good? Yup. Another pleasant surprise! And so forth.

But my greatest Vegas-induced revelation hit me while hiking in Red Rock Canyon…and I mean literally hit me. I mis-stepped while rock scrambling and cracked my freshly-shaven dome on a pretty nasty rock outcropping. I had the requisite out-of-body peaceful moment of zen, followed by a way less peaceful re-entry into my body. As a doctor, my first thought (as I blinked through the blood) was, “That’s gonna leave a mark.”

My second thought? “WTF do I do now?”

Like so many Las Vegans — and despite being an internist myself — I didn’t have a primary care doctor whom I could call. Previously, when I asked locals where they went for the best, quality healthcare, they recommended some place called McCarran*. I was pretty sure that was out-of-network.

Judging by the iPhone selfie I took after I fell, I knew I needed about three stitches and a tetanus shot. A good family doc could do that in his/her sleep (although I’d prefer they were awake). But I didn’t know anyone, so I went to the nearest ER — a rather posh-looking facility called Summerlin Hospital. They did a great job, and I got my three stitches and tetanus shot, and my wife said the scar made me look sexy. She found the face I made when I got the $3500 ER bill considerably less sexy. That’s $1000 per stitch and another $500 for a tetanus shot. Let’s just say in the ER, the House always wins.

It’s a local pastime to bash the state of healthcare in Las Vegas. And with good cause: In Las Vegas we wait longer in the ER, are far less likely to get cancer screenings and other preventative care, and are twice as likely to die of preventable illnesses.

It’s tempting to blame doctors for this, but don’t. Sure, some TV plastic surgeon may a have private jet and a manservant named Jeeves, but the docs responsible for keeping you healthy — the primary care folks — are suffering miserably, particularly in Vegas where there is a desperate shortage. In the fee-for-service mill, these docs need to see a patient every few minutes just to pay their overhead and debt, and they spend the majority of their day (and often night) doing paperwork to please the bean counters. Physicians went into medicine to alleviate suffering; instead, they have become slaves in a broken system. It’s no wonder so few medical students want to do primary care. Would you?

But the prescription to fix primary care (and by extension, the rest of healthcare) isn’t that complicated. Get rid of fee-for-service and use a different payment model. A membership model, like a gym, is one approach: one fee for all-you-can-treat access to a buffet of care, much of it preventative. Employers, health plans, or government programs could pay the fee. Incentivize healthcare, rather than just the sick care treadmill of procedures and constant referrals. A team of docs, nurses, social workers, and health coaches to support one another and focus on the whole patient, while prioritizing education/accountability via classes and group visits. Elevating the human relationship that is at the heart of medicine would improve outcomes, decrease costs, and increase access across the system. #BOOM

I’ve lived pretty much everywhere, but Las Vegas is the first place that’s truly felt like home to me. We embrace innovation and change here, and we’re not particularly fond of authority. It’s fertile ground for the true healthcare reform that can only come from a partnership between physicians and patients, not from government or industry or some bureaucrat. That’s why we built Turntable Health in the heart of Vegas. I just wish we’d been open when I cracked my head. If I was a member then, I could have gotten my stitches and tetanus shot from someone who knew me well…for no added cost at all.

In my humble opinion, to double down on relationship-based primary care is the only way to beat the House in healthcare. Are we all in?

*McCarran is the name of our airport.

12 Responses to “An All-You-Can-Treat Buffet”

  1. Crystal Smith

    Turntable Medicine: I love the entire concept… as a former SICU nurse and nurse educator in NYS I have seen a lot of changes in Healthcare over the past 10 years and… yeah a lot of them are not so good. How can this be duplicated and how can nurses help this to grow?

    • ZDoggMD

      Excellent question Crystal. Our partners Iora Health are now building similar model clinics across the country, so what happens in Vegas doesn’t need to stay in Vegas. Check them out:

  2. Super Lung

    Let’s DO this (future Family Physician)! *War face*

  3. Kyle Varner

    Removing third party payers really is the key to making health care more affordable. I’m an internist–not a family doc–so my suturing skills leave something to be desired. But three sutures and a tetanus shut, I can do. In fact, for $250, I’d make a damn house call to do all of that. ($100 extra if you want me to come after 11 PM). I bet you could get a 3rd year medical student to do it for $30, and he’d be just as good as me. Hell, why can’t a LPN with a two day suturing course do that? \n\nER care is so expensive for two reasons: 1) EMTALA requires ERs to provide unreimbursed care and this gets abused flagrantly. 2) A toxic combination of lawyers and insurance companies creates the perfect storm for moral hazard to drive up utilization of services that no one would actually pay their own money for. \n\nThe solution is painful: we need to let people buy bare bones insurance that covers catastrophes and doesn’t cover primary care or minor emergencies, we need to repeal EMTALA, and we need to alter the tax code to strip away tax incentives for employer provided health care (so people end up buying real insurance rather than the pre-paid all-inclusive plans that naturally get bought when the tax advantages are considered).

  4. The Usability People

    Zdogg .. Where can we get the cool Turntable Health Hoodies? I bet a lot of people will also want them at HIMSS16.. btw looking forward to seeing you in Vegas next month. Can I buy you a beer/wine/etc?

    • ZDoggMD

      Working on the hoodies, gonna be totally swamped at HIMSS but hopefully will see you there!

  5. Paula Peterson

    Do NPs fit into the model? I know I do a whole lot of teaching in my role.

  6. Celine Moris

    I live in Jamaica, i was a bout to get married when i found that I’m hpv positive i was so scald because my partner would have brake up the marriage if he knows. we haven’t be together for a while he live in new york. i was about traveling to visit him when my doc told me i have hpv, it was true because there was lot sign in my body, doc told me no cure he only gave me some tablet but i was not encouraged with the tablet i can’t be taking tablet without getting cure, some days after i searched online if i can get the cure or anything els and i found [email protected] a lady testify how she got hpv cure from the herbalist, after that i email dr galiga for speedy help luckily i was the right side of it and he gave me some information on how to get his natural cure online, and i got the cure after taking it for three weeks i went for a checkup i tested negative, i just want to shear this testimony to everyone of us with this virus to let you know there is total cure for hpv You can get it online email [email protected]

  7. scott

    Hey Zdogg! I’m a Physician Assistant in the ED and couldn’t agree more. We see so many uninsured patients in the ER and this inturn is leading to massive debt for the hospitals. This then leads to the hospitals making cuts, usually in the form of staffing and providers. Less staff and less providers means decreased customer satisfaction, which will now lead to decreased compensation. A vicious cycle. I believe in your idea of a membership program as we need ways to get people treated and preventative care to the forefront. Oh…I’d love one of your shirts!?

    • ZDoggMD

      Stay tuned on the shirts 😉

  8. Cathy Naghitorabi

    “All you can treat buffet” is a line I’ve used for years to describe patients that come in for one thing, and then another comes along, and another…. but hey, you can use it, no charge!