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Your voice: Mostashari’s DPC take is ‘absurd’


In one of your articles, Dr. Farzad Mostashari (“Mostashari’s biggest Meaningful Use regret and health IT’s future,” August 25, 2016) gave some advice to physicians on how to avoid burnout:

“The key is two things. One, if you’re in a kayak in the rapids, you have to lean in and dig your paddle in and push ahead. If you lean back, you’re done. You’re going to flip over. So be more active. Don’t be passive. Take control. Step two is join together with others to increase your power, increase your control, increase your ability to have someone else help you deal with that crap, deal with the quality reporting, deal with the EHR optimization, deal with the ACO regulations.

So I think that’s the solution-not to retreat into some direct primary care model.”

I am a family physician who has operated a direct primary care (DPC) practice for nearly five years. In that time, I have met hundreds of physicians planning or operating DPC practices, many of whom I now consider good friends. While they each have a unique story and perspective, your comments are not remotely reflective of the mindset of doctors opting for DPC. I honestly wonder whether you have ever talked to a single one of them.

These DPC physicians are among the most courageous, creative and determined men and women I know; the exact opposite of what you describe. They have each taken huge risks-professionally, personally and financially-in an attempt to “take control” as you suggest. Most have sacrificed hundreds of thousands of dollars in pursuit of becoming the caregivers they envisioned while in medical school.

Despite giant obstacles and an uncertain future, DPC physicians forge ahead. Our vision for the future of primary care may be naive to you Dr. Mostashari, but to claim we are passive or “retreating” is flatly absurd. I do agree that a major driving factor behind the DPC movement is physicians feeling powerless to deal with an ever growing pile of “crap.” Can you blame them? Older physicians have lived through many decades of initiatives purporting to improve the practice of primary care-only to realize the newest barrage of alphabet soup was keeping them even more distracted from patient care.

DPC physicians have bravely climbed back in their vessels and are now trying to rescue others, hopefully before we all go over the waterfall.


W. Ryan Neuhofel, DO, MPH

Lawrence, Kansas



ABMS has become too powerful for its own good

It is good as, pointed out in “Physicians take MOC fight to state level” (August 25, 2016), that Oklahoma, Missouri, Kentucky and Michigan are fighting to limit the powers of maintenance of certification (MOC). It is necessary and to be expected in our democratic society.

Clearly, the power of the American Board of Medical Specialties (ABMS) has extended far beyond what the founding fathers of the boards had intended. They intended the boards to be voluntary and never meant for them to threaten physicians’ livelihoods or to be a source of unhappiness and anxiety.

Concentrated power has always created distrust in our American way of life.  This is why our Constitution has a Bill of Rights. The founders of our country could not foresee all the possible ways that citizens’ freedoms could be limited or taken away. And the Bill of Rights and the amendments that followed were added to protect the rights of all citizens that might in certain instances be restricted.

The lack of any restrictions or “amendments” to the powers of the ABMS is probably its biggest defect, though I doubt that its leadership would ever admit to that.

The present furor against the ABMS should be used by its leadership to rethink its place in physicians’ lives and reconsider what its founding fathers had in mind when they established the boards.


Edward Volpintesta, MD

Bethel, Connecticut


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