Random Thoughts from a Restless Mind

1) Fall. Next week we” fall back” and undo the 2026 version of daylight savings time. Does it matter? For that matter, should the fact that almost no other country brooks such a fancy, that we can have a meaningful effect on all aspects of daily life as we know it by changing the time on the clock when we feed the livestock? I’m doubtful the pigs notice when the slop appears.

They so rarely check their emails, let alone the time on their watch.

2) Jack O’Lantern. Beth and I had the most joyful day you can imagine yesterday. On a brilliant, blue sky October day we went to a pumpkin patch with our grandchildren and picked out the canvases for this years Jack O’Lanterns. Throw in a hayride into and out of the patch and a lovely little trick or treat set up at the grocery store, the front end of the afternoon just couldn’t have been nicer.

When’s the last time you dug your hands into the innards of a fresh pumpkin? You know, up to your elbows inside. While Beth helped with the artistry involved I was all about the “heavy labor” on the front side. It helped that the temp got into the mid-60’s and the sun stuck around for the whole shebang; cleanup on a porch is a much less arduous process than it would be in the kitchen. Three kids, three very different ideas about what a pumpkin should look like after it’s been carved. And three kids aglow at their creations. Add in the simplest of dinners and top it off with S’mores on the deck and it adds up to a day for the ages.

And the perfect gift to give their Grammy and Papi.

3) Space. As in “Third Space”. I’ve been thinking about this a ton lately. We all have 3 spaces: home, work, and our 3rd space, that place we spend a substantial amount of the rest of our time. Howard Schultz, CEO of Starbucks, is quite famous for declaring that his coffee shops thrive because they become the 3rd space for so many of their customers. Having just spent a couple of hours killing time in a Starbucks waiting for a meeting I can certainly attest to this, at least in that rather large one. Each time Beth and I stop in for a cuppa on the way to the barn I get it.

For my folks and many in their generation the 3rd space was a club of some sort. My Mom and Dad had belonged to the same country club for 40 years and the majority of their social life has revolved around friendships made there. This kind of 3rd space need not be as fancy as a country club, though. Beth and I were once invited to a birthday party for one of our associates at a VFW outpost. When our friend walked in it was like a scene out or “Cheers”: everyone knew them there. Like my folks, that VFW has been a gathering place for this couple, a place for them to make and commune with friends.

Indeed, one of the essential characteristics of a CrossFit Affiliate gym is that it very often becomes the 3rd space for its members and trainers. While we certainly miss the friendships we made across the country during our time within the larger CrossFit community, what we really miss is what our family created in the CrossFit gyms we once had.

My closest friend out side of family and I chatted this morning for quite awhile. Rob shared news of how his various interests have been evolving since he retired 4 or so years ago. We spent a lot of time talking about our expanded families. Rob and Rosemary are very engaged with their grandchildren, too, and had a big family Sunday last week. What will stick with me about this conversation is our instant agreement that finding our third space and populating it with a group of like-minded folks remains one of our top priorities as we enter the last 3 or so innings of our long game.

We agreed that the space itself is much less important than the people who fill it.

4) Dreams. All I ever dreamed of was to be Dr. Roy.

The most difficult question I ever had in my medical school interviews was the “why do you want to be a doctor” question. Honestly, I can’t ever remember being anything other than a doctor. More exactly, what I really wanted to be was Dr. Roy. How could I possibly give that answer during an interview taking place in 1985? But that was, and continues to be the most accurrate answer to this day. I not only wanted to be a doctor, I wanted to be the kind of doctor I knew when I was a kid.

Dr. Roy was the only pediatrician in my hometown of Southbridge, MA. There weren’t a whole lot of doctors at all, but for a youngish town filled with families he was the only game in town. Heck, there were more general surgeons on staff and living in Southbridge. Dr. Roy wasn’t just the most respected doctor in town, he was one of the most respected humans in town. Everyone looked up to him. Looked to him for answers when a particularly thorny issue came up, whether or not that issue involved anything related to healthcare. And not just patients, everyone.

Why was the town pediatrician held in such high regard? Well, I have to think that at least a part of it was Charles Roy the man, but a major part of it was the fact that, like almost every doctor in America at the time, he was in private practice. He owned his practice, set his fees, paid his staff and kept the lights on in what was in effect his own tiny family business. And as the only pediatrician in town he was pretty much always available. I’m sure the guy took a vacation some time, but no one could ever tell you when that was. He was always on call. My brother had rheumatic fever and couldn’t be around other kids; Dr. Roy came to the house. I had some kind of weird GI thing and ended up in the hospital for a week; I saw him in my room twice a day for a week.

Anybody over the age of 40 or so has memories of a doctor like Dr. Roy. Maybe every doctor of the era wasn’t quite as devoted to quite as significant a population, but pretty much every doctor reported to the same boss everywhere they worked: the patient. No one ever wondered which side the doctor was on or whether they needed to check with an administrator or supervisor to make sure they were covering an institutional imperative or preserving a profit margin. Your doctor was just that: YOUR doctor. He or she went to work for you. They took you home with them after work and your problems kept them up at night. Sometimes there was a price to pay for this kind of dedication. Usually it was a price paid not just by the doctor but by their family as well.

But you knew that when you needed them your private practice doctor was going to be there.

Why bring this up now? I mean, I’ve been in private practice for my entire career. Who could ever say about themselves that they had become a modern version of Dr. Roy, but I sure know that I have strived to be that every day of my career. As I write this I am having a little text side bar with a close friend and colleague in another city about the complexities of our modern medical world, the barriers that have been erected between us and our patients and kept more doctors from having any chance to become Dr. Roy. the why of that is the answer to the questions “why now”: private practice has been systematically targeted for destruction.

When I was a newly minted, wet behind the ears doctor right out of residency at least 75% of the doctors in the United States were in private practice. Might have been more, actually. Almost all doctors who didn’t work at large academic medical centers like the Cleveland Clinic or the Mayo Clinic or Sloan-Kettering either worked for themselves, or worked along with other physicians who together owned the practice that collectively took care of their patients. No outside money guys. No investors who managed stuff so that profit could be maximized. No hospital-employed middle managers monitoring whether or not the doctor had added the adequate amount of data, real or otherwise, so that the hospital could bill at a higher rate.

Nope, more than 3 quarters of doctors worked in an office where the person answering the phone and making your appointment set less that 20 feet from the exam room where you saw your doctor. Not some phone center out of state or even overseas, you saw the person who answered the phone when you checked in for your appointment. The nurse was in the same PTA group from your kids’ school and the lady who took your check as you left the office sang in the choir. Heck, you knew where your doctor lived, but no one ever dreamed of dropping by because you didn’t have to. You had a problem your doctor saw you in the office.

So what happened? In the late 1990’s and early 2000’s the knock on doctors and hospitals was that they needed to become MORE like Dr. Roy. To make the experience more like your last best experience at a boutique or restaurant. This movement lasted until 2008, a very short interlude between Dr. Roy and today. What happened? The Affordable Care Act, more commonly known as Obamacare happened. Perhaps the biggest lie ever laid on the table in any discussion of national healthcare has got to be “if you like your doctor you can keep them.” Whether intended or not literally every actionable item in the ACA has resulted in an economic environment that rewards large, consolidated organizations like…wait for it…the Cleveland Clinic, the Mayo Clinic, and Sloan Kettering, as well as every academic institution in the country. Not only do they get to not have to pay taxes, they get to charge more for everything they do because they don’t have to pay taxes!

And what has become of the Dr. Roy’s of today? In my little world of ophthalmology only 18% or so are still in a traditional practice setting where the business is owned and operated by the doctors who work there. If he exists Dr. Roy’s great grandson is 72% likely to be employed by either a large hospital system or a money-management firm than by s/he and his/her partners. Those of us who are still holding out and on are doing our best, but it’s a rough world out there if you still want to be like Dr. Roy. Unlike the large medial institutions, a private practice doctor’s office receives a lower payment for every visit and treatment, and each year those payments go down.

So why keep doing it? That’s the thing. It’s still better in every doctor stuff way when you get to work for your patient and not your non-MD manager. It’s still better when your first 4 of 5 priorities is making your patient better, and making it as easy as you can while doing so. It’s still better when everyone else in the office has the same exact goal because they all work for the doctor/s who own the group. When you see your neighbor or your neighbor’s child or your spouse’s best friend’s neighbor and you know it, that’s better. When they call the office and the person who answers the phone when they have an urgent problem, and the person who answers the phone walks back to the clinic to ask for advice from the nurse who is 20 feet away, that’s better still.

And in the end, why tell you? Well, that’s both the best and the worst part about it. It’s still all about you. Dr. Roy was right. He, and all of the doctors like him were always right. That’s the best part. The worst part is that those of us who remain are essentially defenseless. At some point even Dr. Roy wouldn’t be able to keep the lights on without your help. Did you like your doctor in 2007? Still got them now? Is it the same as it was then? No?

Private practice, what medicine once was can still be the way it may once again be. It was always about you. The only way it’s gonna be that way again is if patients ask for a return to the days when doctors went to work for you. If you want your care to come from someone who comes to work for you and you alone you have to ask for just that. No one knows if that will be enough, but we sure know that the folks who make the rules aren’t listening when those of us left in private practice ask.

It’s not for me to say if you did, indeed, like your doctor and want to keep them. But if you do I do know that it doesn’t have any chance of happening if you, the patient, don’t ask for a Dr. Roy.

I’ll see you next week…

This entry was posted on Sunday, October 25th, 2026 at 3:50 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.