Why Are So Many Doctors Going “Cash Only”?

Why Doctors are Going "Cash Only"
“Cash Only” Medicine is On the Rise

It is 9:45 pm on a Tuesday night and I am in the hospital elevator with my head down trying to keep a low profile and avoid eye contact with the world.  I’m totally embarrassed to be in the hospital so late.   Why am I not at home with my family?   I get into the Doctors’ Parking Lot and there are at least 15 other physicians parking or discussing cases with each other on their way to see patients in the hospital.  The lot is full of cars at this hour?  Unbelieveable.  Is working after 9:00 PM routine for that many physicians?  I run into Dr. Avery–one of the most brilliant physicians I know–who is walking to his car to go to another hospital to admit a patient.  Avery has dark gray festoons under his eyes and his skin looks rough and pale.  His suit is wrinkled from overuse and his back looks kyphotic at his young age.  His beard is untrimmed and uneven.

He looks at me and says, “I’m done with medicine.  I’m done.  This is not what I signed up for.  I have yet another hospital to go to and my night is not over.  This is not atypical for me.  I feel overworked and I feel abused.  I am in debt.   I still have student loans to pay…… I have no time to date or to meet people.”


A week later, I am on call and arrive at the hospital at around 9:30 pm.  Avery is there and offers to help me carry heavy equipment I need to evaluate a patient in the Emergency Room.  His skin is even paler than I remember.  He has purple bags under his eyes.  Drops of moisture drip down his sunken cheeks and unruly beard as he opens up to me:

“I am exhausted.  I worked my tail off in college…I worked my tail off in med school…I worked my tail off in residency….and I worked my tail off in fellowship.  I saw the light at the end of the road—a more balanced and manageable workload.   I am working harder and longer than I ever did.  I am not even getting compensated for it.  My job is wearing me down to nothing.”


Two weeks later, I leave my office at 9:00 PM—embarrassed again to be seen by anyone at this hour.  Avery is getting something to eat at the cafeteria.   He hadn’t eaten breakfast, lunch, or dinner.  He had eaten one banana all day until that hour.   He is about to go see a patient in the ICU.  He tells me that he was delayed at work because he had to call numerous patients back regarding their test results, and he had to dictate dozens of consult notes for referring doctors.  He had prior authorizations to dispute.  He had to call back several physicians to discuss his recommendations.  He had a meeting with his medical biller to find out why one insurance provider hadn’t paid him for several of his procedures and why another insurance provider had not reimbursed him for numerous diagnostic tests.  He had to determine whether to send almost a dozen of his patients to collections for not paying their balances.   His skin looks pasty and ashen.  His eye bags are more black, blue, and purple than before.  His back is hunched and he has a slight limp.  He has deep furrows between his brows which I hadn’t noticed before.


Eight months later…. I leave my office at 5:30 PM one afternoon—the earliest exit in years.  I run into Dr. Avery.  He has a wide grin on his face.   I am confused as to why he is in the elevator on his way to the Doctors’ Parking Lot at such an early hour.

“What is new Avery?  I ask urgently.

He responds without hesitation.  “I decided to bag insurance completely.  No joke.  I cancelled all of my insurance contracts.  My patients just pay a set fee up front  for their office visits, tests, or procedures.   I am finally earning what I feel I deserve.  I am passionate again about practicing medicine.  I have time to call patients back, consult with other physicians, take great care of my patients, go to valuable medical seminars, and get home at a decent hour.  I went to a gathering last week and met an amazing woman.  What the hell was I doing before?”


Four months later….It is 6:00 PM on a Thursday evening.  I see Avery at Starbucks having an espresso and studying The New England Journal of Medicine.

“How are things going?” I ask.

“Excellent.  I’m working hard, but I am not working myself to death or disillusionment. I’m in a great relationship with an amazing woman.  I am earning 2-3 times as much as before, and my patients are happier than they ever were.   I feel fulfilled.  I am no longer at the mercy of third party payers who feel I deserve less than nearly everyone else in the world with the same amount of training.  I do not need to jump through a thousand hoops to care for patients, and I no longer need to see up to 50 patients a day to make ends meet.  I give patients my full attention.  They have time to ask questions.  I have time to really get to know them and their medical histories.  I have time to research complicated cases…… I don’t need to pay tens of thousands of dollars to hire a medical biller to haggle with insurance companies anymore.”


Avery’s words whipped me hard in the face that day.   His transformation was so dramatic in such a short period of time.  He was secure and confident.   His posture had improved; his complexion was pink.  His facial furrows had softened.  His suit was wrinkle free, his smile spanned his entire face, and his beard was carefully groomed.  How could saying “no” to insurance companies transform someone’s wellness, peace of mind, sense of personal satisfaction, relationship status, complexion, self esteem, and presence so dramatically?  I was stunned.

I owe a lot to Avery for teaching me an important lesson: Being bound to the rules, regulations, limitations, and low reimbursements of insurance companies is making many of our caregivers—our most talented physicians—physically and mentally sick.

A recent Forbes article outlines yet another doctor’s satisfying personal decision to go “cash only” and leave insurance company provider networks.  He writes a carefully researched article about why this growing trend is beneficial for both doctors and patients.

Colleagues. …..Please……. Sit back and think twice about renewing or even continuing your contracts with health insurance providers.   Don’t let them determine your happiness.  Saying “no” could be the best decision you will make in your life.

Dr. Bill Ford

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