Independent Medicine vs. Healthcare Consolidation | Dr. Lovelace on the Future of Patient Care 

Cullen: Welcome to the Publisher Series of HealthLinks Podcast, where we talk with the people building and challenging the future of healthcare.

I’m Colin Murray Kemp, and we’re focused on where the system is misaligned, where it’s breaking, and what leaders on the ground are doing to improve how healthcare is delivered for our community There’s a shift happening right now that deserves more attention.

We’re starting to measure healthcare based on patient experience, on access, on trust and responsiveness.

At the same time, consolidation is accelerating.

Independent practices are shrinking.

Systems are expanding.

And in South Carolina, with major acquisitions and the repeal of the Certificate of Need, we’re at an inflection point, one that should open the door for more independent care, not less.

So the question is, are we building a system that actually delivers what patients and providers deserve, or one that prioritizes finances, control, and scale? And if those two things continue to diverge, who steps in to close this gap? I want to start by talking about the ever-evolving landscape, uh, healthcare landscape in South Carolina.

Um, you know, consolidation has been happening really, really rapidly.

Most recently, we saw MUSC buy Palmetto Primary Care.

They were the largest independent group of primary care physicians left in the state, uh, deciding to go under the corporate healthcare tent of MUSC, a $111 million transaction, 30, uh, plus positions.

You know, talk a little bit about how consolidation, um, affects, uh, the overall healthcare delivery system.

Dr. Lovelace: Well, let me say, um, that I would have never imagined what has taken place in healthcare when I finished my residency, uh, in Charlottesville in 1988.

Um, I’ve seen a lot of things come and go, um, from the whole HMO phase, where was invited to Columbia to attend a meeting where a very large primary care group in Lexington was partnering with FICO- Physicians Corporation of America.

And the way that conversation went was, “Well, you know, we really would to encourage you to join us.

And PS, if you don’t, you know, we’re probably gonna put a practice, like, right next door to you.”

Um, and I had not been in practice quite that long then, and it was a little scary, you know, to think about, “Well, what happens if they come here? FICO.”

They got assets I don’t have.

Cullen: Yeah.

Dr. Lovelace: And then the next thing that happened was hospitals started calling and wanting to partner and wanting to talk about, “Well, the best way for us to partner is to acquire.” Unfortunately, my experience with vertical integration is higher cost, lesser, less patient satisfaction and physicians leaving practice early.

Cullen: I want to talk about patient satisfaction.

Uh, so there was a Newsweek study that came out at the beginning of this year, and it had this map.

And on this map, there were two states that were dark red, and dark red represented, uh, the lowest satisfaction of hospital care by patients.

Dr. Lovelace: Hm.

Cullen: Um, can you guess what one of those two states was?

Dr. Lovelace: Probably South Carolina.

Cullen: South Carolina and New York.

Dr. Lovelace: Yeah …

Cullen: you know, I think it’s, I think it’s really interesting looking at the dichotomy between, uh, independent, uh, rural healthcare or even suburban independent, um, primary care.

Um, can you talk a little bit about what the patient, and even the provider experience is, um, in, in a practice yours, an independent practice, versus what a patient or a provider may experience in a corporate healthcare setting?

Dr. Lovelace: Well, it’s really interesting you mention this because I am now 66, and so I’m getting emails about, uh, institutional quality scores- Sure … uh, from CMS.

So that if I’m interested as a Medicare shopper, I can see what the quality ratings are, and I was very happy to see that we had a high inpatient patient satisfaction at our little county hospital.

Um, and this, I’ll try to summarize for you, but there was a point, there was an inflection point in our h- our community hospital where our s- our CEO said he was gonna bring in a hospitalist group.

And the medical staff, uh, decided at that point that, um, we did not want that to happen.

Uh, we felt it would be the death of our hospital, primarily because the core mission statement of the hospital is quality care with a personal touch.

And who better, who’s better able to provide that personal care than the community physicians? Sure.

We know our people.

Cullen: Yeah.

Dr. Lovelace: What happened was I was chief of staff of the hospital, and I was at a loss, like, “What in the he- you know, this, this, we can’t stop this train.”

And, you know, surgeons are orth- orthopedics and surgeons, they’re, they’re surgical.

Cullen: Yep.

Dr. Lovelace: And he said, “Let’s, let, let’s just do something real simple.

Let’s just take a vote of confidence on the administrator, up or down.”

Do we have confidence in the, in the hospital administrator to do the right thing?

Cullen: We the physicians.

Dr. Lovelace: We the physicians- Sure … at a, at a, at a medical staff meeting.

And over 90% of the physicians said we have no confidence in him.

We just wrote a letter to the board, said we have no confidence in the hospital administrator.

They fired him the next week.

Here’s how that’s playing out today, okay? There’s a crisis.

All the hospital, all the physicians are owned by the hospital.

How’s that play out? How, how do the physicians meet and say, “I have no confidence in my boss”?

What can happen? Do physicians even show up to the hospital physician staff meeting?

Cullen: Well, it seems that communication and dialogue, the, the water cooler time or the physician- Yeah communication, um, it’s disincentivized by the hospital systems.

Right.

Dr. Lovelace: Well, it, it, there’s so, there’s so many issues, layers and layers of issues behind that.

But what I will say is that, um, someone really wise once told me that healthcare should be personal and community-based.

Another person told me that at its core, being a community physician is leveraging the community’s assets, not their liabilities-

obviously, but their assets to improve the quality of healthcare.

Cullen: Can you gi- give me a real-world example of how that plays out in your community, in Prosperity with, uh, Lovelace Family Medicine?

Dr. Lovelace: Real easy.

So one of the reasons that I chose to do family medicine was that I didn’t the idea if I delivered a baby, I had to hand off the baby to someone else.

I wanted to be their family doctor.

But you can’t do that, um, in most communities, especially urban areas, because healthcare has become so fractionated.

What happens is that I came to Prosperity, I wanted to deliver that type of care, and we could go through the iterations of crises that have happened during that time, these last 38 years, but there was a deep well of that heritage in Newberry County.

There were family physicians that had been delivering babies in that county over 100 years, and the whole concept of obstetrics and gynecology, I know this sounds crazy, but was even a little bit new when I got there.

So I was leveraging an asset of trust that family doctors had built with mothers to deliver babies and was able to continue that.

Cullen: It’s interesting, we see that trust dissolve in real time, right? Um, you know, I think about, uh, Dr. ChatGPT or Dr. Google and, uh, this is a conversation that I’ve had, um, previously with a couple of your colleagues, um, Hugh Durrance included, uh, who founded Liberty Doctors- Right which is at this juncture, one of the last large independent, uh, physician groups in the state.

Uh, you know, and we talk about how his patients come in and, um, you know, he’s down here in Charleston, and they already, they already know what’s going on.

You know? Right.

They, they, they, they, they’ve Googled it.

Uh, they have their diagnosis just right to ph- Right? When, a- and maybe it’s, um, devolved or unraveled over time, but, you know, how can we reestablish that trust between…

And I’m sure physicians are feeling it, and maybe less so in your community because you have those roots and you have those personal connections through personal care.

You know, how can physicians and providers in, in South Carolina work to reaffirm and reestablish that trust?

Dr. Lovelace: The problem is not the doctors, in my opinion.

The problem is the system.

And there’s gonna have to be systemic change to address that if we wanna get back to, to real trust in medicine and patient satisfaction.

Most important ingredient to quality primary healthcare is continuity.

There’s absolutely no systemic value placed on continuity.

Let me give you some examples on the evaluation and management codes.

I get paid more if I see a new patient.

I think I should get paid more for every successive year I see the patient If the system did not discourage continuity the way that it does, especially large vertically integrated systems, which are mainly telling patients often, “Go to the ER.

Just go to the ER.” And I’m aware of many practices where even once they’re acquired by a hospital, the community loses access to their doctor over simple little things minor lacerations because the other big argument against continuity is the facility fee.

When CMS reimburses more for the use of the emergency room than the doctor walking in the room and saying, “You know, you really don’t need to be here.”

You need to go see your primary care doctor.” Or I’m gonna put some couple stitches in this or, you know, Steri-Strips, um, and the charge is $250 as opposed to 60.

It makes a big difference, and the last time I checked, the average ER visit is somewhere around 10 grand.

So I’m very aware of rural communities in South Carolina.

Saluda’s a great one, where the county, many of the citizens in that county next door to us are very upset because their physician workforce, the majority of it, has been sold out to hospitals.

And now when they call after hours or they have a, a w- what used to be called an office emergency is now a hospital emergency visit.

Cullen: The, the challenges are deeply, deeply systematic.

You know, some of the things that we’re trying to do with this podcast is raise awareness and pinpoint where those issue, systematic issues lie.

Um, I think it’s a good segue to policy.

Dr. Lovelace: Yeah.

Cullen: Right? Um, you know, we work pretty regularly with the South Carolina Medical Association.

I know you have, um, a background in, um, you know, being involved in influencing, uh, policy for the better of the providers and the patients.

Um, you know, there’s some interesting things happening over the last couple of years.

The CON was repealed, the Certificate of Need, which, y- you know, should be a segue to more entrepreneurship, um, in healthcare.

I hope it will be.

Um, you know, we’ve seen independent physicians start to build ambulatory surgery centers and, um, you know, create better access, which I think is an important part of this discussion with, in particular with the CON.

Uh, right now the, um, non-compete just passed the House, so in theory, right, that maybe opens up the doors for physicians to leave a hospital system a- and hang their own shingle, as we say.

Um, talk a little bit about healthcare policy and, and particularly how and why physicians should be as involved as possible with healthcare policy and help drive change and improvement in policy for the better of themselves and their patients, but furthermore, how policy can affect and slow vertical integration.

Dr. Lovelace: You did a great job talking about some of the things that are current.

I will start by saying physicians do need to be involved.

If you’re not at the table, you’ll be on the table.

But I am convinced that what you’re doing is so important because while doctors being involved can make a difference, we’re really a pretty small group of people.

And it’s gonna take patients being engaged and aware and knowledgeable and demanding change.

Under Governor Carroll Campbell, whom I thought, think is one of the best governors South Carolina’s had, um, he had appointed Gwen Power to be, to be health, head of Health and Human Services.

And we’re talking about back in the ’90s.

I’d been in practice for about five years, and I was asked to sit on a committee with 30 other South Carolina physicians at the behest of Carroll Campbell and the he- head of Health and Human Services to develop South Carolina’s answer to Medicaid managed care.

And the basic premise behind this was big out-of-state corporate entities were coming into South Carolina writing big checks to key political figures to say, “Let us take care of your poor.”

Run it through our managed care company, and you can quit all this ineffective, inefficient government Medicare, and we’ll take care of your people.”

Cullen: Why would they do that in the first place?

Dr. Lovelace: Because Medicaid is a huge economic engine for South Carolina, and they wanted a piece of it.

Cullen: Okay.

Dr. Lovelace: So, you know, it’s, it’s a crazy situation, but at that time, Medicaid, you know, it, it’s, it’s a multi-billion dollar healthcare entity.

And if you look at Medicare and Medicaid as a whole for the state and the nation, it’s a giant cost center or provider of services.

So the managed care companies ca- were coming in and writing big checks to politicians saying, “We wanna take care of your people.”

Dr. Lovelace: But Carroll Campbell, being a businessman-

Dr. Lovelace: knew, “Well, I don’t want them taking our federal and state dollars to Florida.”

Cullen: Mm-hmm, sure.

Dr. Lovelace: Or California.

Cullen: Right.

Dr. Lovelace: So it made sense, right? Let’s, let’s have South Carolina’s answer to Medicaid managed care.

We met for three years.

There were three practices in the state that piloted our program.

It was called the Physicians Enhance Plan.

And what it did was it said, we, we wrote a letter to all those pilot practices in the PEP, Physicians Enhance Plan, the PEP plan, wrote a letter to our Medicaid recipients smogged down to the third-grade reading level saying, “We are enrolling you in our Physicians Enhance Plan.” From this point forward, when you feel you need to go to the emergency room, if you show up, you will be quickly triaged by the emergency room staff as either being emergent, urgent, or elective.

Urgent is I’ve got a sore throat and my fever’s 102.

Dr. Lovelace: I think we can understand what emergent is.

You know, chest pain.

I’m bleeding, I’m hemorrhaging.

But simply, that TALA site saved the state a million dollars in one year.

I believe that the, the implementation year was 1994 or 3.

I, I have to go back and look, um, but I’ve got those graphs and I can show them with you, but show them to you.

But the point I’m making is if you think through this, where I just said today an average emergency room encounter can be $10,000 it doesn’t take many people to save a million dollars in a year’s time.

But if you look at those patients, that patient pool and, and do the math, that’d be a 20% across the board savings in Medicaid.

Cullen: So it was called PEP?

Dr. Lovelace: It was called, it was called PEP.

Cullen: Yeah.

Dr. Lovelace: But the big checks and the out-of-state money won.

So after about 12 years, when, and this is one of the reasons I ran against Sanford, he outsourced the entire Medicaid program to managed care companies.

Cullen: Well, it seems so logical, right? Like, you have this, this triage, right? And this is a, a, a cost savings mechanism, which, you know, we desperately need in healthcare.

Dr. Lovelace: also continuity.

If it’s urgent, and I should have said this if it was either urgent or elective, provi- the doctor in the ER calls and says, “Hey, I’ve got John here.” Yeah.

“He’s your patient.

He’s got a, a fever of 103.

You wanna see him or you want me to see him?”

Or, “John just came in with knee pain.”

Cullen: You know, I- So he’s not admitted to the hospital.

Dr. Lovelace: Exactly.

Yeah.

Not admitted to the hospital.

More importantly, not sent to a specialist that in today’s environment is owned by the hospital when it could have been managed in the primary care’s office.

Let’s put it this way, a 30-year-old male comes in with chest pain.

He doesn’t have hypertension, diabetes, he doesn’t smoke.

His blood pressure is 120 over 70, but his heart rate’s 94.

So a physician goes in, does the triage, and he hears that, you know, this chest pain is a sticky pain, and sometimes he feels it in his back, and sometimes he feels it in his neck, and sometimes the right shoulder and the left shoulder.

Probably not cardiac.

But in today’s environment, could quickly go to the cardiologist where an echo is done or whatever, additional non-continuity based care, or a call to the primary care physician who says, “You know, he just lost his mother last month.”

Cullen: It’s interesting, I, you know, while I was doing a little bit of due diligence on you, you, you were, uh…

This was years ago, I think.

They did a video on, uh, your integration, uh, of telehealth into your practice, right? Um, and so, you know, communicating with your doctor is not always easy.

Like, like, the accessibility of a, of a physician sometimes can be challenging.

You know, how, how did you take that approach from a communication with your patients standpoint? Um, you know, I know, uh, we talked a little bit about concierge medicine- Yeah …

um, but the truth is, uh, concierge care isn’t accessible to, to everybody, um, can afford $5,000 a year for that membership.

Right.

So talk to me about in your, with your patient population, um, how does communication flow?

Dr. Lovelace: Well, uh, that’s one of the values I think of, of independent practice because I make that decision.

Because every patient’s unique, and every situation is unique.

And frankly, many of my patients have my cell number.

Cullen: But, but how do you make money o- on that, o- on that?

Dr. Lovelace: Well, the beauty of, of that is that Medicare has begun to understand that.

Medicare has.

Private insurance has not.

They don’t reimburse for chronic care management.

Cullen: Yeah.

Dr. Lovelace: But chronic care management is billed based on the amount of time that I spend caring for this patient.

Cullen: Sure.

Makes sense.

Dr. Lovelace: And so I can now have that encounter by text or phone call and bill for my time depending upon how complicated it might be.

That chronic care management fee is really, really important to people who are wanting to manage all these chronic medical problems because if somebody doesn’t, can’t get their insulin They could die, you know?

Cullen: Yeah.

Dr. Lovelace: But, but if they can’t get through the system to say, “Would you- somebody please call in my insulin?”

You know, and there are many different examples that I could give.

Take the PEP example.

Okay? In that smogged down third, to the third-grade reading level it said, “If you feel you have a medical emergency, call us first.” And my associates, when I said we were gonna pilot this program, they said, “Oh my God, what are you doing?” You know, “They’re gonna be calling us when we’re on call.

We’ll never sleep.”

The truth is they didn’t abuse it.

We didn’t get people calling us all the time.

Cullen: It, it’s so interesting you say that, ’cause even the concierge doctors that I know, they all give their cell phones out.

My cell phone doesn’t ring.

Dr. Lovelace: Exactly.

Cullen: You know?

Dr. Lovelace: People are respectful.

You know, people, the vast overwhelming majority of people understand that doctors have- S- so- have a busy life.

Cullen: So when you have healthcare is like, to me, it could be so much simpler, right? When you start with the patient and the doctor, right? And you naturally have to evolve around that.

I do wanna evolve the conversation into networks, right? So you founded IndieDocs, Independent Doctors, um, South Carolina.

A really, really exciting group, growing membership, hundreds and hundreds of independent doctors are members.

I think there’s a big benefit, uh, from physician groups, right? You know, you have access to other minds, uh, that think alike i- in healthcare specific medical minds, right? You have opportunity to learn best-in-class business service.

You, you have opportunity to learn about how you can get paid correct chronic care management.

You have opportunity to build referral networks, which is huge for independent specialists, especially with the, uh, dissolving of primary care, independent primary care in South Carolina, this MUSC Palmetto Primary acquisition.

Tell me a little bit about the premise behind IndieDocs, the importance of the physician network group, and what, um, members, whether they’re employed…

‘Cause I don’t think we need to alienate employed doctors, right? Yeah.

Um, whether they’re employed or independent, what can they benefit being a part of these networks?

Dr. Lovelace: First of all, if you are still in independent practice, you are a rare breed because about 85% of all physicians are now, um, owned by some other entity, either private equity or a hospital network.

And so it, it makes sense that if you show up at a professional meeting of doctors, and 85% of doctors are employed, but you’re one of those 15% that is still independent, your issues and your concerns are probably going to be quite different So that was the impetus behind forming Indie Doc.

Because I, I’m a, I was on the board of the South Carolina Academy of Family Physicians.

And I saw, and I still am a member of the SCMA and the AMA, and, uh, the other larger corporate, uh …ization of medical, uh, practitioners.

But there was a need to get the independent little core group together so that we could talk about things that were most helpful to us.

And so the basic premise behind Indie Docs is to preserve and protect the doctor-patient relationship, and to hold out independent practice as the most cost-effective provider of medical care who achieves the highest patient satisfaction, and allows us to continue serving the patient unencumbered, which leads to long-term relationships.

And if you look at surveys for physician

Cullen: satisfaction

Dr. Lovelace: The ones that I’ve seen, the thing that they most say drives them to continue practicing medicine is the doctor-patient relationship, the relationship they have with their patients.

And unfortunately, this vertical integration is ripping patients away from their doctor.

I’ll give you a quick example.

Good friend of mine’s was, is an independent physician in North Carolina.

His daughter said, “Yeah, Dad, I know that’s the old way of doing things.

I’m gonna go to Atlanta.” She goes to Atlanta.

She’s an amazing physician.

She develops this new community, you know, in a suburb of Atlanta.

Five years into it, they came, patted her on the back and said, “You did such a great job.

We’re sending you 30 minutes across town to start one over here.”

Cullen: Well, they, they saw her as a, a, a business opportunity, right? Um-

Dr. Lovelace: And sh- and she thought she was building relationships.

The average person who would listen to that might think that the relationship might be, oh, well, she won’t get to deliver the next baby.

No, th- this is the relationship I’m talking about.

Someone moves into your community.

They have no social support system.

They’ve decided to retire to this community.

The husband of the couple has had a recurrence of cancer.

They try to treat the cancer through the oncology approach.

It’s not working.

He’s losing weight, 10 pounds every two weeks.

Flesh is falling off his bones.

His life is collapsing And yet they’re in a new community without any s- social support network, but now they are being served by a primary care physician that knows the assets of the community, is able to reach into those people’s lives and be there for them in the worst moment of their life But then an administrator comes in and says, “Uh, we’re going another direction.”

And can rip that relationship right out of the hands of that patient and that doctor in the middle of it.

Cullen: The dissolving of the trust in that scenario, I can see frustration with the doctor, but, like, the recognition from the patient and the community has to move to these are systematic changes that are out of the control of the physician, right? And so I think where I’d to kinda go is to talk about, uh, solutions.

You know, I th- we, we, we need as, as our friend, uh, Dr. Spence Taylor always says, we need a leveling of the playing field.

We need more competition in healthcare.

Competition’s gonna drive quality.

Um, we need opportunity for success for independent medicine.

Um, you know, we know that that’s better for the healthcare system, right? Because, uh, clinical auto- everything, the patient-physician relationship.

Forget everything else, the patient-physician relationship, preserving that sanctity, right? Um, how do-

Dr. Lovelace: And, and in a way, what we’re talking about is preserving the professionalism of medicine, meaning the quality of care of the whole American healthcare system is hanging in the balance.

Now, some people might hear that and think, “Oh, you’re just trying to protect your turf.” We’re trying to protect your healthcare.

Not only the quality, but the cost of the healthcare and the access.

For example, Prisma bought Lawrence County Hospital.

Lawrence County Hospital is right across the street from Presbyterian College.

Lawrence County Hospital no longer delivers babies.

They just stopped the OB service Now you could say, “Well, they don’t do bypass operations there.” Well, okay, they never did.

Um, but having a baby?

Cullen: So where do you go if you’re in Lawrence County to have

Dr. Lovelace: a baby? You get in the car and hope that your placental abruption doesn’t exsanguinate you until you get to a center.

Now think about this.

A hospital definition of a crash C-section means the baby’s gotta come out in 30 minutes.

What if from the time you show up in the ER to the time you drive to the next hospital is 30 minutes? It, it makes a difference in outcomes for mothers and babies, and that’s why I t- when I was sharing with you, I would’ve never imagined what would happen.

I mean, to think that America has the highest maternal, maternal mortality of any other developed country in the world? Yeah.

Having a baby?

Cullen: In particular in rural communities.

Dr. Lovelace: Yeah.

It’s, or it is definitely a bigger problem- Worse …

you know, where there’s no access, but but what I’m saying is that maternal mortality is a big problem for our nation.

Maternal mortality, really?

Cullen: Yeah I don’t even wanna theorize as to why they, uh, closed the delivery unit.

So let’s talk about, let’s talk about solutions, right?

I mean, that’s the goal of what we’re doing.

Um, I think we’ve come to an inflection point where the sentiment amongst healthcare providers, and physi- physicians in particular, has…

They’ve, they’ve realized that what they signed up to do, um, they’re no longer able to do it the way that they want to do it.

Dr. Lovelace: Unless we find that those few doctors that really feel called to practice independent medicine and get them trained in an environment that is free of the, of the large vertically integrated system it’s going to be hard to make that doctor successful.

And that is why I’m working with Integral Leaders in Health and the SDMA to start a private practice-based rural residency training track.

Cullen: So tell me a little bit about the, the GME program.

Dr. Lovelace: Yes.

As we’re trying to find our academic partner for the first year, but the last two years they’ll be trained in Newberry.

I will be teaching these residents how to embrace chronic care management, how to do office dermatology procedures, and if they choose to deliver babies, how they can integrate obstetrics within their practice.

So if they want to go and get all…

get that extra training to provide operative delivery services, we can show them how to do these important services that we offer to our community, which obviously improve our bottom line, but also improves our service line to our community.

Cullen: So this GME program is specific to, um, new physicians that want to become independent doctors?
Dr. Lovelace: Correct.

And what we’re really gonna be doing is trying to find those doctors me who I just felt called To practice and prosperity

Cullen: I’m a, um, I’m a new physician.

I go to the GME program.

I’m ready to hang my own shingle.

You know, um, maybe I’ve even grouped together with a couple, uh, primary care docs.

We wanna open a practice.

You know, we have a couple APPs signed up, you know, uh, nursing, their staffing’s put together.

Um, you know, who’s gonna help me with real estate? Who’s gonna help me with contracting? Who’s gonna help me with credentialing? Who’s gonna help me with, um, marketing? Who’s gonna help me with, uh, figuring out the business side? I went to school for clinical care, right? I didn’t go to business school.

I don’t know all these faculties.

What does that pathway look like, and how do I figure out how the heck to make money in this environment that is not set up for me to do so?

Dr. Lovelace: Medicine is not run by the typical business principles.

So I’m very excited about being able to bring in people that can mentor and grow these young doctors, and then when they leave, we’re not gonna wash our hands from them.

We’re going to continue to support them and be available to them, and partner them with entities Integral Leaders in Health.

Like the big dinosaur in the room today or elephant in the room is the electronic medical record.

And that’s a big cost center, but if someone else can take that and do it more efficiently and better than you can by having your own computer system or network- Mm-hmm …

in your office, which is what we’re still doing um, then wow, you get rid of a headache.

You got a good partner that’s doing a better job at managing that one specific thing.

Cullen: How to, uh, make money in healthcare, and it’s not making money to make money, it’s making money to sustain so you can practice.

And I think it’s so important, and it’s often not spotlighted.

Um, you know, there are a lot of services out there.

One that we’re actually working with called United Community Bank.

We’re actually looking at multi-year physician income assurances specifically for independent doctors, which is exciting, right? One of the reasons, I’ve had these conversations again and again with physicians, and why are there not more independent physicians? Why, why, why, why? End of the day, money.

It’s a guarantee of, uh…

It’s a safety net for you and your family.

You have these loans.

You’re up against, uh, big competitors.

You know, there’s primary care doctors in South Carolina making $75,000 a year, right? These are problems.

We were working with the bank to create a service line specific for independent doctors so they can compete financially with the income assurances that hospital systems are offering.

Dr. Lovelace: Exactly.

That’s- Offering all the time …

the return on investment for that relationship just has a longer arc.

But I say it has a much better long-term- Benefited.

In the employee situation, it’s a s- short cycle, right? Mm-hmm.

We’re gonna pay you a lot of money.

But then when you become the person who’s not the latest, greatest orthopedic surgeon because you haven’t done this particular joint replacement technique, “Well, we’re going another direction.

Sorry, you’ve lost your job.

You’re going to have to try to find something somewhere else.” Well-

Cullen: And there are these MSOs that will keep a physician or a group of physicians, um, in the, uh, have that business mentality working with them as opposed to taking away their name or their autonomy or their independent practice, working alongside them from a business perspective to make sure everything’s shored up so they can provide, uh, quality care.

And I think that is just not recognized maybe, um, because there is frustration.

I talk to employed physicians all the time.

There is frustration with corporate oversight, right? Um, and if we can promote these opportunities not just as, um, you know, what to do but how to do it, I think we…

There’s a lot of opportunity to move that needle from 85% employed, 15% independent, um, you know, back to a level playing field we talked about.

And if we can promote these opportunities not just as what to do but how to do it, I think we, there’s a lot of opportunity to move that needle from 85% employed, 15% independent back to a level playing field we talked about.

Dr. Lovelace: Truth be told, not everyone, uh, is going to want to be an independent physician, is going to feel called to be an independent physician.

But the pendulum has swung so far now that I, I truly believe that the future of medicine in America hangs in the balance.

And I think that the future of, of medicine means quality, cost, and accessibility.

And those are the, those are the three things.

And, and, and then you say patient satisfaction.

Quality, cost, sustainability, patient satisfaction outcomes.

I, I firmly believe that because of these large vertically integrated networks coming out of hospital systems, that if we don’t reach out into communities with opportunities we’re going to be providing and say, “We at least need to preserve and protect that doctor that feels called to go to Whitmire.” And they wanna go to Whitmire not because they see it as a place that they’re gonna make a half a million dollars their first couple years.

They wanna go to Whitmire because they wanna serve that community, for whatever reason.

In my case, I wanna go back to Prosperity because that’s where my grandparents are from.

I caught these little teeny bream with a cane pole.

I wanna teach my kids to catch that bream, you know?

Cullen: Yeah.

Yeah, yeah.

Dr. Lovelace: But the f- the fact of the matter is, it’s not so much that we are saying you have to be in independent practice as much as we’re saying we have got to find ways to leverage the wealth of knowledge that the independent physicians have to help those people that wanna do it.

And when they do it, they can have the same patient satisfaction that I have, and the financial security that I have, and have answered the call that they had on their life.

Cullen: It’s exciting.

I think we need to look at it as an inflection point, not only the provider, but the patient, right? The next decade in healthcare will be defined by how the makeup of independent healthcare and, and, and corporate healthcare exists.

Um, you know, if there’s one sort of, uh, thing that your colleagues, physicians, and, and even the patients don’t know that you want them to know or take away from this conversation, w- what is that?

Dr. Lovelace: It’s most important To live the life that you feel called to live.

And I firmly believe that most people who will go through the rigors of medical training, they go into it because they truly want to serve people in the field of medicine.

I mean, we may get excited about technology, we may get excited about the knowledge aspect of it, but if you wanna be a clinician, if you want to serve people in medicine, it is a calling.

The word profession, it comes from the Latin word to call.

And so what I want people to know is don’t give up on that.

Don’t give up on that.

And even though they may not, through their training, see as many examples of people who are able to, to be- go out and, and answer that call to serve in medicine in an area of need or, or to bring a service to a community that doesn’t have it, whatever that might be, whatever they feel called to do, don’t give up on it as soon as you step out of the residency.

Because if you do give up on it, it may be hard to ever get it back.

And so I, I think that’s the biggest thing.

And the, and the, uh, the other thing I’ll just say is that- You know, when you are independent in your mind about giving the gifts that you have to another person The ripple effect of that just gets larger I’m now the medical director of a local hospice organization I’m the chief medical officer of a biotech startup that I’ve been working with for 12 years I do a lot of medical-legal deposition work for attorneys.

Cause I learning from mistakes that other people make, or seeing what causes medical-legal crises.

Now, as an employed physician, I might not have the latitude to do a lot of the things that I do.

I get to schedule my day the way that I feel called to schedule it.

Cullen: Right.

What stood out to me in that conversation with Dr. Lovelace is how much independent medicine isn’t about resisting the system.

It’s about building something that actually works within it, often in ways that aren’t being talked about publicly.

The other piece that really stood out is alignment.

When incentives, relationships, and decision-making are structured correctly, the model becomes not just sustainable, but scalable for independent medicine in a very different way.

These are the kinds of conversations that matter as healthcare continues to evolve, because they move us beyond assumptions and into what’s actually happening on the ground.

Thanks for listening, and we’ll see you next time.

In good health, I’m Colin Murray-Kemp.