When I moved to Las Vegas from the Bay Area two years ago, my tourist-grade fanny pack was stuffed with the usual 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 on.

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 shaved dome on a pretty nasty rock outcropping. I had the requisite peaceful out-of-body moment of zen, followed by a way less peaceful re-entry into my body. Blinking through the blood, my first thought as a doctor was, “That’s gonna leave a mark.”

My second thought? “OMG, what 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…and the concussion didn’t help with mental clarity, either. When I had previously asked locals where they went for great medical care, they recommended some facility called “McCarran¹.” I was pretty sure that would be out of network.

I knew I needed about three sutures and a solid tetanus shot, and a good family doc could do that in their sleep (although I’d prefer they were awake). But I didn’t know anyone, so I went to the nearest hospital ER (check the maps, folks, you’ll find it…rhymes with Bummer-lin). They did a great job, and my wife assured me that my new scar made me look sexy. The face I made when I got the $3500 ER bill was considerably less sexy, however. For the math-challenged (i.e., Americans), that’s $1000 per stitch and another $500 for a $30 tetanus shot. Let’s just say in the ER, the House always wins.

It’s a favorite local pastime to bash the state of healthcare in Las Vegas. And with good cause: here in Sin City 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 than most other places in the country.

It might be tempting to blame doctors for this, but don’t. Your cosmetic plastic surgeon might have a private jet and a manservant named Jeeves, but the docs responsible for keeping you healthy—the primary care crew among others—are suffering miserably. Particularly so in Vegas where there is a desperate shortage relative to demand. In a fee-for-service mill dominated by huge players who squeeze reimbursements like a drunken python, PCPs are forced to see a patient every few minutes just to pay overhead and debt, and the vast majority of their day is spent dealing with administrative nonsense designed to please no one but the bean counters. They went into medicine to help alleviate suffering; instead, they are slaves to and forcibly complicit in a broken system. No wonder so few of our medical students and residents want to do primary care. Would you?

But the prescription to fix primary care is simple: Get rid of fee-for-service reimbursement and use a membership model, like a gym. One fee for an all-you-can-treat buffet—what could be more Vegas? A team of docs, nurses, social workers, and health coaches can support one another, focus on the whole patient, and make education (via classes and group visits) a priority. Leverage members of the team so everyone is practicing at the top of their license. Elevate the core human relationship that is at the heart of good health care, and focus on prevention while taking responsibility for the wellness of the entire population under your care. The result? Decreased costs and improved quality throughout the system, which go along with concurrent improved patient satisfaction. Boom.

Having lived pretty much everywhere, Las Vegas is the first place that’s truly felt like home. We embrace innovation and risk here, and we’re not particularly fond of authority—fertile ground for true healthcare reform that can only come from a ground-up partnership between physicians and patients, not from government or industry or some bureaucrat or Wayne Newton (well, I shouldn’t rule Wayne out just yet). That’s why we built Turntable Health in the heart of Vegas. I just wish we’d been open when I cracked my dome. As a member, I’d have gotten immediate care from a team who knows me…for no extra charge beyond my membership fee.

In my humble opinion, the answer to our healthcare woes may be to double down on great, relationship-based primary care—it’s the only way to beat the House.

Are we all in?


¹McCarran is the airport in Las Vegas.
A version of this story originally appeared in Las Vegas BLVDs magazine.


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