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Why Patients Should Pay Doctors Directly

If you want to find the very best doctor for your shoulder problem (or any medical problem for that matter) you won’t find much helpful information by calling your insurance company or even your regular doctor in most instances.  Why?  Well, it’s the same reason why no real problems are solved in our political system; the incentives are not aligned appropriately.  In the political process, the individuals that are drawn to serving the public are less concerned with solving real problems than with self-enrichment.  The primary role of any elected public servant is to raise enough money to fund the next campaign and make sure that all the markers and favors given out along the way are fulfilled.  There is really no room left for real public service and real problem solving.  This leads to a level of corruption that is not often highlighted but is very well recognized.  Several recent articles highlight this issue further:

(Harvard Business Review Article)

(Rolling Stone Article)

(New York Times Book Review)

Free Market Medicine

How does this relate to medicine?  Well, medicine in the United States of America is as far from a free market or market drivenenterprise as one can imagine.  With the advent of employer driven healthcare and third party insurance companies, costs have skyrocketed, while the ultimate consumer, the patient is increasingly removed from the decision making process.  Costs can’t be reigned in until the person paying for care is also the person receiving care, which nicely reflects the current political conundrum-everyone wants something for nothing, but no one wants to pay for it.

Several articles that highlight this issue:

(Forbes article regarding Drug Companies)

(Ron Paul Article on Health Care)

(Excellent article from The Atlantic on Health Care)

So if you are a typical patient with shoulder pain that has not responded to conservative measures including activity modification, perhaps a steroid shot by your regular doctor, and a course of physical therapy, where to turn?

For many patients, this means a visit to an orthopedic surgeon often recommended by you doctor, neighbor, or friend.

(British Medical Journal: Gatekeeping, effective filter or failed experiment?)

(US News article on finding the best doctor)

(NY Times article on the developing issue in urban centers)

(NY Times article on how to find the best doctor)

Trust But Verify Your Medical Care


Well, if you are someone who gets 3 or more quotes for any work you have done around the house, be careful and TRUST BUTVERIFY.  Do the same sort of due diligence when you seek out the best physician for your shoulder or other subspecialty problem.  An ounce of prevention is truly worth a pound of cure, meaning there is no substitute to doing the right procedure the first time.

We see many patients that have had multiple failed operations and while they are extremely happy with the results this isn’t the same as having avoided all the time and headache altogether.  Insurance companies do not rank physicians based on skill and outcomes, but rather on how much profit margin a physician generates for the insurance company.  No one will protect your interests better than YOU!

Research Your Doctor

So do your homework.  Unfortunately, the American healthcare system has gradually moved towards a commodity rather than a meritocracy, meaning for most patients and the public, all physicians are essentially the same and one is just as good as another.  This is NOT TRUE in any field of endeavor and even more so in medicine.  However, it is much easier to price a commodity than a unique skill that can’t be easily reproduced.  As health insurance has grown over the past century, so has the level of APATHY grown among the American consumer regarding what constitutes stellar health care.

This unfortunately has led to wildly exaggerated costs for healthcare delivery while at the same time not creating any incentives for improvement in quality.  Because there is no objective measureable definition of quality in healthcare, the void is filled by a lot of advertising and marketing and thinly veiled pitches that lead more to an improvement in the insurance company profit margin that true improvement in health for the patient.

(Very popular site outlining the same issues)

(Wall Street Journal Article outlines the fact that lack of quality transparency is KILLING us)

So, if you are faced with the prospect of having a shoulder surgery or some other

surgical procedure, do your homework and find the very best surgeon for you personally:

(Read Online Reviews with a grain of salt: NYTimes)


Because we see patients from around the country and around the world that have not had satisfactory results with conventional treatments we are uniquely familiar with the challenges faced by our patients. For our patients with insurance, we perform many cutting edge procedures that have years of evidence and support in the peer reviewed medical literature, but are typically not recognized by insurance companies:

(NY Times article on appealing insurance denials)


At the same time, we see many patients without insurance that travel to Indianapolis to significantly improve their chances for an excellent outcome without regard for insurance coverage.

So take an active role in your own care and choose the best option for you personally, even if it means “PUTTING YOUR MONEY WHERE YOUR MOUTH IS.”

Vivek Agrawal, MD

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