Every man and woman is a unique miracle, physically, spiritually, and at a molecular level; the specific reality of every person's day-to-day life adds another layer of complexity to effective medical decision-making. For all these reasons, high-value medicine requires an individualized treatment plan and lifestyle modification; to that end, the doctor must spend enough time and attention in devising a practical treatment plan, which is not possible in a ten-minute visit in which the doctor is primarily concerned about completing an electronic note to bill the insurance company. Additionally, how would Doctors give their best when they're getting paid for only 10% of their work, which is what insurance companies are paying them?
Many doctors today practice in settings that prioritize the financial health of their employers, the commercial insurance company, or the government. These are managed care settings where "health insurance" is financing the health service. I started my private practice in 2018 with a different goal – prioritizing my patients' and myself' mental and physical health. I wanted my patients to see and feel results that improved the quality of their lives so that they saw the value in what I did and then valued me in return. Please make no mistake: A therapeutic doctor-patient relationship must be mutually nurturing; after a couple of years of accepting insurance, I quickly realized that in these settings, the doctor-patient relationship is most often parasitic, in which the doctor is either providing ineffective, low-value care or the patient and the third party payer are abusing the doctor, which is why the health of our citizenry is in decline and also why I don't accept insurance.
Here is the truth about HRT: It is effective and safe only when done between an actual doctor and a small community of patients through comprehensive evaluations, regular supervision, and patient specific treatment planning, all through an open channel of communication with the doctor. Instagram and multi-state franchises are banking on shoveling HRT to the masses through mid-level practitioners such as nurse practitioners and physician assistants under the guise of perceived convenience and affordability but without legitimacy and effectiveness. They call their cadre "providers" to hide that they're not doctors. Hospital systems and large private equity owned primary care practices on the other hand are also trying to scale up and shovel HRT to the masses, but through insurance and poorly staffed retail pharmacies.
Remember what happened the last time this country scaled up healthcare for the masses? Yup, we got the current state of ineffective and low-value primary care, as reflected by the rising prevalence of obesity, mental disease, colon cancer, polypharmacy, the opioid crisis, accelerated aging, regression of women's reproductive health, rising doctor-patient distrust, and undiagnosed and untreated hypogonadism among both men and women.
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