Bringing Trust and Transparency Back to Medicine
“How much is this gonna cost me, doc?”
As she’s peeling electrodes from an EKG off a patient’s chest Dr. Manvinder Kainth hears her least favorite question — and that’s saying a lot. She sees patients every 15 minutes, so she gets hundreds, maybe even thousands of questions per day.
Questions about boils, coughs, aches, or fevers are usually a breeze. Dr. Kainth can find an answer somewhere between her training, her decades of experience, her peers, or the medical literature. When the question comes to cost, however, there’s nowhere to turn.
“Honestly, I have no idea,” she responds with a shrug. “I’m not sure what kind of insurance you have and whether they’ll cover this. But the good news is that your EKG read looks great! Here’s to your healthy heart.”
There’s no doubt in Dr. Kainth’s mind that the EKG was worth ordering. She knows she is operating in her patients’ best interest. But she also knows that, despite giving her patient her full attention and a clean bill of health, she’s unable to offer him full transparency and peace of mind. It’s possible that he’ll leave the building feeling more anxious than when he arrived.
After all, the visit might render him broke.
Learn What Not To Do
During a time when hospital billing — and really, the American healthcare system at large — is notoriously opaque, it’s easy to understand why many patients end up losing trust in their doctors. But trust, Dr. Kainth believes, is a prerequisite for quality care.
That’s why she got out from under the healthcare system she says increasingly prioritizes profits over patients. She believes every doctor is accountable for their patients’ well-being over their employer’s bottom line. Similarly, she believes every patient deserves to be able to trust that their physician is acting in their best interest.
The best way to build that trust? Set the rules yourself. Start your own clinic.
That’s exactly what Dr. Kainth did when, in 2017, she launched Maple Primary Care in Plano, Texas. She says the Direct Primary Care (DPC) clinic solves nearly every problem she faced as an employed family medicine physician, including the patient-physician trust problem, price transparency, long wait times, personalized care plans, and more.
Before she could go her own way, though, it took 10 years of learning what not to do. After earning her medical degree from Baylor College of Medicine in Houston, Texas, and completing residency in family medicine at Valley Medical Center in Seattle, Washington, Dr. Kainth spent tenures at three different large health systems. As she moved from one to another, she hoped the shortcomings of the previous employer would be solved at the next. However, she found that there were eerie similarities between all three.
She believes every doctor is accountable for their patients’ well-being over their employer’s bottom line.
“When you’re an employed physician and your employer is getting paid by an insurance company, the goal will always be the same: See as many patients as you can,” Dr. Kainth says.
That goal suggests that health systems are primarily interested in a numbers game, according to Dr. Kainth — how many patients you could see and how much money they could make from those patients. However, she believes the quantity of patients a doctor sees doesn’t correlate with the quality of care those patients receive, and rushing patients in and out of the clinic, overbooking their appointments, and forcing them to face long wait times only further erodes trust between patients and their doctors.
As Dr. Kainth sped through patient visits early in her career, hospitals compounded the issue with new record-keeping and billing technologies, which quickly began sweeping through the medical world, hoovering up patient data and physician time. If the numbers game was an annoyance before, all of a sudden it became career-defining.
“Now we were no longer looking at individual patients. Instead, we said, ‘Let’s gather data from large pools, and let’s make judgments based on that.’ So we found that as employed physicians, we were treating numbers instead of patients,” Dr. Kainth explains. “We spent about 80 percent of our time in front of the computer, making sure numbers and data were in the correct place, rather than actually talking to patients.”
The situation wasn’t ideal. It didn’t align with Dr. Kainth’s vision of how medicine should look and feel. “For the first 10 years of my career, I thought I just had to work within the system and do the best I could for my patients,” she says. “But it wasn’t working.”
After trying again and failing to find a more patient-focused employer, Dr. Kainth knew it was time to go her own way and launch a clinic that reflected her personal values.
Get Clear on Your Values
What would those values be? Dr. Kainth thought back on her life, looking for inspiration.
Her first experience with healthcare was in Canada, where she lived with her family until they moved to Texas while she was in high school. Canadian healthcare was a far cry from the structure in place in the U.S.
The discrepancies between systems became obvious during her family’s journey southward to Texas. Dr. Kainth’s brothers both suffered from a chronic health condition that required frequent treatment. In Canada, that treatment was always just a short phone call away. But when her family arrived in Texas, the phone calls got a lot longer.
“I remember my mom being on the phone for hours with insurance companies trying to get prior approvals for my siblings to be able to see a specialist. It almost became a second job for her,” Dr. Kainth says. “It was definitely frustrating because we had to learn a whole new system. It sounds terrible, but it was almost like a game. ‘How the heck do we get the care we need?’”
“When you’re an employed physician and your employer is getting paid by an insurance company, the goal will always be the same: See as many patients as you can,” Dr. Kainth says.
From her point of view as a sister, the insurance company was the only barrier between her brothers getting the treatment they needed and her family going bankrupt. Years later, from her point of view as a physician, insurance companies were the culprits behind her inability to answer that pesky question — “How much is this gonna cost me, doc?”
Dr. Kainth decided that her new private solo practice would be built on a foundation of fair and transparent pricing. No more surprise billing, no more unanswerable financial questions, and no more insurance companies building barriers to care with copays and deductibles. On top of that, she’d run her business lean and with low overhead so she could pass off any savings to her patients.
Once financial matters were settled, what else remained to be improved? She thought back to her 10 years as an employed physician at a hospital and was instantly inspired.
First, no more overbooking appointments. Instead of setting patient appointments every 15 minutes and running 20 minutes behind each one, Dr. Kainth sees patients in hour-long windows. Not only does it keep schedules honest, it allows more time to build doctor-patient trust. “If I’m only spending 15 minutes with a patient, I’m not really making much meaningful change in their life,” she says. “In an hour, I’m able to home in on nutrition, exercise, decreasing stress, adequate sleep — all the important things that I didn’t have time to address before.”
Moreover, there would be no more delayed care. Dr. Kainth keeps availability in her schedule to see patients who need to book same-day appointments and uses telemedicine to reach patients who can’t make it in. As an employed physician, if she didn’t have room in her schedule, she would either have to double-book patients or push them to a later date. As a result, they would often resort to other healthcare providers.
No more surprise billing, no more unanswerable financial questions, and no more insurance companies building barriers to care with copays and deductibles.
Most importantly, Dr. Kainth would offer fully personalized, superlative quality care. Rather than treating them like a number or turning her back to the patient to play with data for 80 percent of the visit, she takes the time to listen to her patients’ deepest concerns and build personalized plans to help them forge ahead. “If I want to see my patients every two weeks, I do. I make sure that they’re accountable for the changes that they say they want to make. That’s not something I used to have the luxury of doing,” she says.
Make Your Vision Your Reality
Now that Dr. Kainth has built a life she believes in at Maple Primary Care, she isn’t shy about admitting that direct primary care has changed her outlook on the medical profession. “I love being a doctor again. I actually feel like a doctor again,” she says. “Instead of treating the computer, I’m treating my patients. That’s why I went to medical school. That’s why I chose this career.”
In just three years of practice, Dr. Kainth has already made a big splash in the Plano, Texas, community. Her practice’s 27 Google reviews are all a perfect five stars. “The level of service and care that I have received is extraordinary,” one patient writes. “She not only got me feeling better after I got sick, but opened my eyes about my health and the choices I was making. She was easy to get scheduled with and my appointments were always on time.”
“I love being a doctor again. I actually feel like a doctor again,” she says. “Instead of treating the computer, I’m treating my patients. That’s why I went to medical school. That’s why I chose this career.”
Acclaim for the service she provides means the world to Dr. Kainth. Still, one review sticks out among the rest.
“Dr. Kainth is the best doctor I have ever seen,” a patient writes. “Since I do not have health insurance, I always dread getting sick. She has set up her practice to be extremely affordable for people like me.”
Never again will she have to hear that dreaded question — “So what’s this gonna cost me, doc?”
