A New Model for Affordable & Accessible Healthcare | Paul Thomas | TEDxDetroit 

Bravo, that was an incredible presentation, and you hit the nail on the head regarding the problems with the American Healthcare System. I wish you continued success as a trailblazer, changing medical care, one patient at a time.

Fantastic talk, Dr. Thomas. I have learned a lot from the work you are doing!

I think it is so amazing that Dr. Thomas schedules an hour for new patient appointments. His passion for what he does and his desire to help his patients is very apparent. My heart sunk when he said that in Detroit there is about one family doctor per 100 people. I wonder how much this statistic has changed since he gave this talk. I can’t help but think of the medical ethics principle of justice, in which fair and equal healthcare is the goal. I think that the direct primary care model is great because it alleviates the financial stress for patients. I just wonder what more can be done to incentivize physicians to practice in areas with severe physician shortages. I always thought that the areas most affected by physician shortages were the rural areas where typically no one wanted to move to. Detroit is a large city, is it common for big cities to have physician shortages? I always thought these bigger cities were typically more desirable areas to live and were more saturated with physicians. I also wonder how much of the family medicine shortage is caused by the popularity of other medical specialties. Go to any medical school and ask the students what specialty they want to go into and the majority will say some sort of surgical specialty. Again, I wonder what can be done to incentivize medical students to go into family medicine and to practice in areas known to have a shortage of physicians. I know that one of the biggest deterrents for medical students is that family medicine, or any primary care specialty, typically has a lower salary than other specialties. I would also imagine that working in a direct primary care model would result in less of an income for the physician. I know that while not all medical students are trying to go into medicine for the money, they do have large student loans that they need to take into consideration and this may persuade them to aim for a different specialty with higher wages. I wonder if there is any type of loan forgiveness plan currently for those who decide to specialize in family medicine. I’m sure that implementing something like this would greatly help ease the shortage of family medicine physicians and ease some of the burden for current physicians that may be experiencing high rates of burnout.

He is the nicest doctor!!

Fantastic presentation. This is my proposal as a primary care general internist as to how this can be financed: A bipartisan TRUE free market, very cost-beneficial, community need focused reform of rural health care: 1) activation by the Executive Branch of the provisions IN the ACA (ObamaCare) for Direct Primary Care (DPC) with wrap around catastrophic health insurance funded by monies available to counties from COVID care to unite Primary Care with Public Health, Mental Health, Long Term Care & by subsidized Health Savings Accounts with incentives for wellness + rural, national Comparative Effectiveness Studies 2) Rural Care Teams reinforce teaching students to this MAXIM starting in ninth grade Human Biology with an emphasis on pathophysiology (very lacking in the fight against COVID - the fault of the CDC): "Everyone is a caregiver and community health worker" 3) implement very cost-effective pathways for students to become health professionals: A) certification as a multi-lingual home care giver and/or community health worker by the 13th grade of Early College High School B) 500 hundred dollar a semester college tuition (e.g., at Elizabeth City State University) to become qualified to serve as a Psychiatric Social Worker & a Continuity of Care + Comparative Effectiveness Study Facilitator C) higher health profession training integrated with non-profiteering County Care Teams 4) patient need / health professional /community-value centric EMR software derived from VA VisTa/CPRS software at Central Regional Hospital, Butner NC. 5) focus on prevention & outcome disparity

Fantastic! Thank you so much for this presentation, Dr. Thomas. A breath of fresh air in the midst of so much turmoil in healthcare.

Very good points and he seems very kind. However I do want to point out that he said there is one primary doc per 6000 people in Detroit. In the DPC model, I believe he said the panel size is 500 patients versus an average PCP panel of 2500. So while DPC docs can spend an hour per patient, they're panel size is smaller. The only way this will fix the void, is if more medical students go into primary care, and then do the DPC model. Perhaps that was his point.

Healthcare access is a major topic of concern in the recent years. Fundamentally healthcare access is a right that all should have regardless of relation, socioeconomic status and race. With this, healthcare rates have skyrocketed over the past years making it difficult and often inaccessible to most of the population. Providers and healthcare administration alike need to implement the principles of justice and beneficence to ensure that healthcare is not only accessible but affordable to the community. The principle of justice states that every person is entitled to be treated equally and fairly. Meaning individuals should not be discriminated based of gender, race, socioeconomical status or any other factors that can lead to implicit bias. Denial of healthcare services are unjust and should be excluded from practice. One-way providers can help in this area is to help to implement policies to ensure affordability and accessibility to healthcare, thus helping us to ensure the principle of justice is fulfilled. Onto beneficence, it states that all healthcare providers have a moral duty to do good and not prevent harm to any of their patients they encounter. Meaning providers should do everything in their power to provide the best possible care possible to their patients without compromising the patient health or well-being. Problems here can arise when patients cannot access services due to the financials constraints. Yet access to healthcare is more than just ensuring the principles discussed previously are upheld but it is also a matter of public health. When communities are unable to access healthcare services, this can result in delayed need of medical attention. Thus, resulting in more severe health issues that often times can result in increased cost and determent to the patient. Moreover, delay in care can also lead to increased exposure of contagious diseases that can put the entire community at risk. It is evident that healthcare should be accessible and affordable to everyone in the community regardless of any potentially implications based of biases. Focusing on the principles we all swear to uphold helps to ensure equal access to people of all cultures. Making healthcare more accessible and affordable is not just a matter of social justice but also applies to the matter of public service as a whole. Ensuring that everyone has adequate access can help us to improve the overall health of the country overall and help to promote better lifestyles.

That's unusual, he didn't say the n word once

Great job!

this sounds like a wonderful model in theory. I guess technically it is not Siri since it is currently in practice right now. Future position myself, I think it’s true inspiring. I am only in medical school and I feel the stress of not having enough time and I know he’s feeling is perpetuated into practice. Not having enough time for patients and not creating great relationships with my patients is a fear I have. I want to be able to give them all the time they deserve so they feel I am taking care of them to the best of my ability. Therefore, this model sounds great. I do have one concern though. I seeing only five patients a day, how does a physician make a living to be able to pay back their student loans? Are they memberships that expensive doctor’s salary? And I don’t imagine the family practices have their own imaging, on laboratory, and other testing abilities. My question is, if these are referred out, do the patients have to pay for this out-of-pocket since they do not have health insurance? The compensation models in existence today I feel like her on ethical. Fee-for-service type of reimbursement naturally encourages positions to order every testament book, the classic “shotgun” approach is considered services that are reimbursable. There have been changes to reimbursement models in attempts to make them more ethical but I think the healthcare model described by this speaker is a way to reinstate ethical behavior in health care. I personally would like to see more of these types of practices but I would need to see that it works. I am sure there are sacrifices and after all, we did not get into this profession to make money. Rather it was to help those in need.

Very inspiring Doc, im following this lead myself.

It's worth noticing that life expectancy American healthcare system has achieved with $8000 per capita spending Cubans have achieved it with $800 per capita spending. Not that I am suggesting Americans to become socialists or communists but what I am saying that there are examples right under the nose to learn from.

the Beto O'Rourke of medicine

This is a horrible talk. He just states a name of something without any explanation. The details of the talk are his grandfather's toenails. I still have no idea what is direct primary care.