Advocacy

Plum Health serves a Health Professional Shortage Area

Plum Health serves a Health Professional Shortage Area, and we’re proud to do this. Part of our mission is to deliver affordable, accessible health care services in Detroit and beyond. This is important because we are passionate about making health care available to communities that have been traditionally neglected by the existing medical system.

Unfortunately, doctors and hospital systems choose to locate their practices in neighborhoods and communities that have higher income levels and higher rates of private insurance coverage. You see, doctors in the current fee-for-service system only receive what they are paid by third party payers, like Medicare, Medicaid, and private insurance companies.

And some of these payers pay more for services than others. For example, Medicaid reimbursement is much lower than Medicare reimbursement or Private Insurance reimbursement. This really hurts Detroit as a greater proportion of Detroiters rely on Medicaid for health insurance relatives to other counties in our region.

Therefore, the current fee-for-service system incentivizes doctors to locate their practices in higher-income communities, and thus leaves lower-income communities medically underserved. As an example, the ratio of primary care physicians to general population in Detroit is roughly 1 primary care physician for every 6,300 residents. In Oakland county, there’s about 1 primary care physician for every 683 residents.

Below are the medically underserved areas in Detroit as of 2017. We are proud to be practicing in the Southwest Detroit/Corktown neighborhoods and serving our neighbors, community members, and small businesses with high-quality medical services.

2018 Plum Health DPC serves a medically underserved neighborhood in Detroit.png

Thank you for reading and understanding this important issue,

-Dr. Paul Thomas, MD with Plum Health DPC in Detroit, Michigan

More on the above map: Health Resources and Services Administration (HRSA), a Federal Agency, develops shortage designation criteria to determine whether a geographic area, population group or facility is a Health Professional Shortage Area (HPSA) or a Medically Underserved Area/Population (MUA/P). HPSAs may be designated as having a shortage of primary medical care, dental or mental health providers. They may be urban or rural areas, population groups, or medical or other public facilities. MUAs may be a whole county or a group of contiguous counties, a group of counties or civil divisions, or a group of urban census tracts in which residents have a shortage of health services. MUPs may include groups of persons who face economic, cultural or linguistic barriers to health care.

Additional information on Medicaid rates in Wayne county, take from MLive:

Medicaid Rates in Wayne County.png
Michigan Medicaid Map.png

I had a blast speaking at the AAFP Direct Primary Care Conference

I cannot tell you how much fun I had speaking at the AAFP DPC Conference, I loved it this much:

 Dr. Paul Thomas speaking about Branding and Marketing your Direct Primary Care practice at the American Academy of Family Physicians Direct Primary Care Conference in Indianapolis, Indiana.

Dr. Paul Thomas speaking about Branding and Marketing your Direct Primary Care practice at the American Academy of Family Physicians Direct Primary Care Conference in Indianapolis, Indiana.

Seriously, I had an amazing opportunity to speak directly with my Direct Primary Care colleagues about Branding and Marketing your Direct Primary Care practice at the American Academy of Family Physicians Direct Primary Care Conference in Indianapolis, Indiana. 

I believe that our family physicians are the backbone of the health care system in America, and I am encouraged and enthused by their willingness to step into their own power and create ideal practices that optimally serve their individual patients and their greater communities.

I'm all in on helping my colleagues create their best practices and to become the doctors they were meant to be. One of the biggest challenges that doctors face is in the realms of branding and marketing as most family physicians have little or no training in these areas. 

What I conveyed in my lecture was how to create a brand, engage in branding your practice, and actively market your practice. I'm posting about this again because I'm that amped up and because the lecture is now live on the AAFP website, here

Thanks for reading and for watching! Below are some bonus screenshots from the talk. If you're an individual looking for this type of care for yourself, your family, or your employees, please call me at 313.444.5630 or send me an email at paul@plumhealthdpc.org. If you're a DPC doctor and you need help branding and marketing your practice, reach out to me because I'm happy to help.

Sincerely,

- Dr. Paul Thomas, MD, physician with Plum Health DPC in Southwest Detroit 

How to Find the Best Prescription Drug Prices in Detroit

As many of us are aware, the price of prescription drugs can be astronomical. People are paying for a retail markup at pharmacies, often paying 10 - 20 times as much as the drug actually costs at wholesale. Even worse, insurance companies often charge more for medications purchased via your insurance plan than the medication would cost if you bought it at the cash price. 

Why is this important to me? I'm a Family Doctor in Southwest Detroit and I took an oath to do no harm, and for me that oath also includes doing no financial harm. So, I am focused on lowering the cost of health care for my patients and the greater community. 

How to find the best prescription drug prices in Detroit

If you're like many people, you probably go to the pharmacy with your Rx card or prescription card from your health insurance company. You then have the pharmacist 'run the card' to find out if you get a discount when you purchase medication. 

What you should do instead is ask the pharmacist, "what is your cash price for this medication?" Also, you can ask for any coupons that the pharmacist might have. If you are dissatisfied with the price, then pull out your insurance card and ask for them to 'run the card'. This will ensure that you have a fair price point to start from. 

In addition, you can shop around for the best prescription drug prices in Detroit or in your local community by comparing prices online. Using tools like GoodRx.com can help you find the exact price for the medication you need. 

Using Direct Primary Care to Lower Drug Prices

There is another option to find even lower prescription drug prices. That option is called Direct Primary Care. In the Direct Primary Care model, doctors aim to provide as much value as possible for patients' health care dollars. In simple terms, we DPC doctors try to lower the cost of health care. 

What does this look like? It looks like 70% - 90% savings on prescription drug prices in Detroit and the Metro Detroit Area. Just check out this chart and see for yourself the actual, wholesale cost of the medication compared to the price you would pay at the pharmacy with the retail pharmacy mark up, or the inflated price. 

 Original image taken from  Consumer Reports .

Original image taken from Consumer Reports.

 

How do we do this? At Plum Health DPC, we buy the medications at a wholesale price and then we sell them to our patients at-cost. This means if we buy a bottle of 1000 blood pressure medications at $10, each pill costs 1 cent. Then your monthly prescription cost for that blood pressure medication is 30 cents.

In the above example, we are able to get Pioglitazone (Actos) for $4.30 per month, Celecoxib (Celebrex) for $6.47 per month, Duloxetine (Cymbalta) for $7.04 per month, Atorvastatin or Lipitor for $2.09 per month, and Clopidogrel or Plavix for $4.28 per month. The total monthly cost would be $24.18 for our patient, and that is a huge cost savings compared to the nearest retail pharmacy.

By lowering the cost of medications, we can improve access to primary care services, better control blood pressure and diabetes, and therefore decrease the risks of heart attacks, strokes, and complications of diabetes in our community. This will lead to lower rates of disability and death, or a healthier society. 

We are proud to make a difference in this way. Thank you for reading and learning about the cost of prescription drugs, and let me know if I can help you or a family member lower the cost of health care.

Sincerely,

- Dr. Paul Thomas, MD with Plum Health DPC

How is Plum Health Making an Impact?

Family Medicine Doctor Reaching Out in Detroit

 Dr. Paul Thomas speaking to elementary school students at Munger Elementary/Middle School on Detroit's West Side during Career Day.

Dr. Paul Thomas speaking to elementary school students at Munger Elementary/Middle School on Detroit's West Side during Career Day.

This week, I engaged in two outreach events, one at Munger Middle Elementary/Middle School on Detroit's West Side and one at the Northwest Activities Center in NW Detroit. The first event had me speaking to a group of about 30 elementary school students, sitting cross-legged on a gym floor. We talked about what it takes to become a doctor, the dreams that they had for their futures, and the steps that it would take to achieve those dreams. They even made me a nice gift for coming out - a small paper doctor. 

 Dr. Paul Thomas at Munger Elementary/Middle School on the West Side of Detroit.

Dr. Paul Thomas at Munger Elementary/Middle School on the West Side of Detroit.

The event at the Northwest Activities center had me speaking to about 100 senior citizens who had innumerable questions about health and wellness. They asked me about everything from high blood pressure, to diabetes, to nutrition, exercise, arthritis, and declining cognitive function. Also at this event, the community had organized fresh food distribution.

 Dr. Paul Thomas at the Northwest Activities Center in NW Detroit after speaking to a group of senior citizens about health and wellness.

Dr. Paul Thomas at the Northwest Activities Center in NW Detroit after speaking to a group of senior citizens about health and wellness.

Both were inspiring in different ways, and also showed how we can make a big impact by reaching out to the community and educating people from elementary age to senior citizens. I think a lot about impact, and how we're making a positive impact in the community, and I wanted to share an essay I wrote earlier this month:

How a Family Doctor Makes an Impact

The problem that I am solving is access to affordable medical care, not just for individuals, but also for small businesses and communities. On the individual level, I cannot count the number of people who have presented to our clinic to establish care with a family doc for the first time in years, sometimes even decades. They feel comfortable because the price point is understandable, services and charges are transparent, and we've created a welcoming environment for all people.

I’ll give the example of the lifelong Detroit resident who had a uncontrolled blood pressure, who avoided medical care because the cost was simply too high. She signed up for a membership with us, and we are managing her blood pressure with medication that costs under $2/month. She is now at goal, and cried in our office after reaching this critical threshold.

Next, we’re solving a big problem for small businesses. Small business owners want to provide services and benefits that will help them attract and retain employees, and often times traditional health insurance products are financially out of reach. Rather, they choose to provide Plum Health and our health care services for their employees: an affordable product that’s understandable and easy to access for their workers. We are now seeing small businesses that are proud to offer our service as a benefit to their employees as a mean of attracting and retaining talent.

Finally, we’re solving the problem of neighborhood-based primary care services in Detroit, a city that is critically underserved from a primary care perspective. There are fewer than 100 primary care doctors in the City of Detroit, equating to roughly 1 doctor for every 6,300 residents. We are meeting a significant need in our Southwest Detroit location by serving a community that otherwise would not have access.

Thanks for reading, and have a wonderful day,

- Dr. Paul Thomas with Plum Health DPC in Detroit, Michigan

Plum Health on Bonfires of Social Enterprise

Last month, I had the pleasure of being interviewed by Romy Kochan on her podcast, Bonfires of Social Enterprise. Bonfires of Social Enterprise is focused on highlighting social entrepreneurs and we were happy to be featured on this podcast!

I believe that Plum Health DPC is a social enterprise because we not only focus on growing the business in a traditional sense (revenue, profit & loss, etc...), but we also focus on making a positive impact in the community by providing a medical service that is much needed the SW Detroit community. 

Romy was a great interviewer and made me think differently about my own practice, prompting me to say something I've never said before. She asked if I could dream big, and envision a future for what I'm doing, what could this look like?

I responded by saying, "I think this could look like a nation where we get rid of these old notions of what 'good health care' looks like, and starting to realize that it doesn't look like a piece of plastic in our wallet. It looks like a relationship with someone in our community that is a healer, that can listen, and has time to address your concerns".

2018 Plum Health on Bonfires of Social Enterprise.jpg

The conversation had a broad scope from how we got started, to the impact we're having, to the reaction to our service from the community. Here's how Romy describes it:

We’re back with another episode here on social enterprise. We have a doctor on this show who has been making a big impact in Detroit. It is Dr. Paul Thomas of Plum Health Care DPC. He has a dream of changing the notion of health care from a plastic card in your wallet to true healing from a healing doctor!  What a concept!

This was a wonderful interview and I am so grateful to Romy Kochan for having me on her podcast. Check out the full episode here, and have a healthy week!

- Dr. Paul with Plum Health DPC

PS: you can find this episode on the podcasting platform of your choice:

I Tunes

TuneIn Radio

Stitcher

PRX.org (Public Radio Exchange)

Google Play

I Heart Radio

PPS: Follow us on Instagram!

A Sample of Lab Test Cost Savings

A friend posted this image on Facebook with the notation: "thank God for health insurance". 

2018 Prices for Lab Work.jpg

While it's important to have health insurance, it's also important to understand how it inflates and distorts prices for health care. In the above photo, the insurance price for laboratory testing is shown clearly. What's interesting is if these labs were obtained through our clinic, they would have cost a fraction of the amount reported. Here's a test by test comparison:

 

 

 A comparison of lab costs between typical insurance billing and our prices at Plum Health DPC

A comparison of lab costs between typical insurance billing and our prices at Plum Health DPC

What's crazy here is that the person is being billed at a 765% mark-up from the actual cost of the service. This is why health care in America is so much more expensive - hospitals and health care providers dramatically mark up costs and then 'discount' these costs for insurance companies.

This price 'gamesmanship' is bad for health care consumers. It's bad for folks with insurance and even worse for folks who are uninsured. For example, if this person had 80/20 insurance coverage for these labs, they would end up paying $162.20 - the insurance company would 'pay' $658.80 or 80% and the insured person would pay the remaining 20% of costs or $162.20. 

However, if this person were uninsured, they would bear the full brunt of these charges. The uninsured person would pay the entire $811 for labs that actually cost $106. 

Thanks for reading, and have a great day,

- Dr. Paul Thomas with Plum Health DPC

Plum Health DPC Mentioned in Business Insider

This week, I was delighted to see Plum Health DPC mentioned in two different publications. The first was an excellent, comprehensive piece on Direct Primary Care in Business Insider by Lydia Ramsey.

Ms. Ramsey and I have spoken over the phone about the Direct Primary Care movement, and she asked several insightful questions about our practice in Detroit, Michigan. She has spoken with roughly 16 other DPC doctors and synthesized a great summary of the movement in her article.

I loved the chart she used to compare and contrast traditional Fee-For-Service medicine with Direct Primary Care services:

Direct Primary Care vs Traditional Doctor's Visits.jpg

Next up, we were mentioned in the South Florida Sun-Sentinel article on Direct Primary Care written by Ron Hurtibise. The article discusses Direct Primary Care and the efforts in the Florida Legislature to make DPC 'legal' in that state. 

Fortunately, in Michigan, Direct Primary Care has been 'legalized' via the efforts of State Senator Patrick Colbeck and his Senate Bill No. 1033. I have placed legal and legalized in quotations above because practicing Direct Primary Care or retainer-based medicine is not illegal, but having laws on the books like Senate Bill No. 1033 in Michigan and the proposed HB 37 in Florida removes any potential legal challenges and allows doctors who want to practice DPC medicine a clear path.

And we need more doctors having a clear path to the type of medical practice that they can enjoy and sustain for the long term. We need more doctors practicing primary care medicine. One of the arguments against DPC is that the panel size is smaller in the typical DPC practice as compared to the traditional Fee-for-Service practice. In the Sun-Sentinel article, a part of my LinkedIn article was quoted:

"As to the charge that Direct Primary Care contributes to the shortage of primary care doctors, Paul Thomas, a doctor with Plum Health DPC, wrote in an essay published on LinkedIn.com last year that the model might actually encourage more medical students to become primary care doctors, rather than pursue higher-paying specialty fields.

"A Direct Primary Care practice with 500 members can provide a primary care provider with more income than some earn with 3,500 patients at a fee-for-service practice, Thomas wrote. And the increased time for personal interaction eliminates “role strain” and allows the provider to address patients as whole people, he said.

I believe that Direct Primary Care practices provide physicians and patients with a better primary care experience, and will allow doctors to practice for longer periods of time without retiring early or leaving the field completely because of burnout. I'm happy to see the DPC movement spreading across the country, and I'm happy to be quoted in these two publications.

Thanks for reading!

- Dr. Paul Thomas with Plum Health DPC

Guy Gordon Discusses Direct Primary Care on WJR

Today, Guy Gordon and Senator Patrick Colbeck discussed Direct Primary Care and the potential impact that it can have on the health and wellness of Michigan residents as well as the sustainability of the Michigan economy. The discussion was held on WJR News Radio (AM 760).

My name is Paul Thomas, M.D. and I am a family medicine doctor practicing in Southwest Detroit. I believe that healthcare should be affordable and accessible for everyone. I also believe that we can achieve this goal through direct primary care medicine.

It is a dream of mine to see and help more family doctors and primary care physicians transition from the fee-for-service model of healthcare to the direct primary care model. This will allow more doctors to deliver compassionate, truly patient-centered care with transparent pricing in our great state of Michigan. 

To this end, I will be speaking at the Michigan Academy of Family Physicians statewide conference in mid July in Kalamazoo, Michigan about this very topic.

Thanks so much for reading and watching, and have a wonderful day!

– Dr. Paul Thomas, M.D.

Last Day For Open Enrollment

Hello all! It's December 15th and the last day to sign up for health insurance. Health insurance is different from Health Care. What I provide at Plum Health DPC is health care - visits with the doctor, wholesale medications, at-cost labs, convenience, etc...

But you also need health insurance - this is a financial tool to protect you from bankruptcy in case of major accidents, illnesses, or injuries. If you have cancer, a heart attack, a stroke or are involved in an auto accident, you need health insurance to cover these costs.

The best way to get health insurance? Go to HealthCare.gov and choose a plan that's right for you. 

Thanks for your time, thanks for reading and watching! And, sincerely, if you need help with this, give me a call!

- Dr. Paul 313.444.5630

Healthy Aging in Detroit

Let me tell you about one of my favorite things: educating people in the community about how they can be healthier. 

Today I was invited to the Earnest T Ford Recreation Center at 10 Pitkin Street in Highland Park to speak with a group of older men. They had questions and concerns about their health and their health care, and it was a pleasure speaking with them.

This group of senior citizens wanted to know how they could better their lives, and they peppered me with as many questions as they could think of, and I loved it. I love sharing my knowledge as a practicing family medicine doc with the people in my community. 

I especially enjoyed seeing the 'aha!' moments when things started to click with those men in my audience. We talked about high blood pressure, diabetes, erectile function and dysfunction, the aging brain, exercise, osteoporosis and bone health, and the connections between these conditions. Below are some pictures from the event!

Thanks for reading, and have a wonderful day,

- Dr. Paul Thomas with Plum Health in Detroit, MI

Don't Further Entrench an Already Broken System

Dear Congressional Representatives, Leaders in the AAFP, and all of those concerned with improving the health of Americans,

I’ve recently become aware of a part of the Alexander-Murray health reform bill that is concerning for the Direct Primary Care (DPC) movement, my practice and the patients that I care for in Southwest Detroit.

The bill includes a provision that mandates all High Deductible Health Plans cover an allotted primary care benefit. As written currently, the Alexander-Murray bill will cover “3 office visits per year” but many organizations, including the American Academy of Family Physicians (AAFP), are pushing to expand that.

While this may sound like a nice perk for patients, it only further traps patients and their primary care doctors in a broken system that undervalues primary care. It reinforces the notion that government and insurance companies must micromanage our dollars and decisions.

Forcing patients to pre-pay for a “primary care benefit” with no out-of-pocket costs will have a few detrimental effects. First, it will almost certainly increase the up-front costs of already skyrocketing health insurance plans. It will also dissuade patients from taking a proactive approach to managing their own health and health care, instead pushing them to be managed by an insurance plan or government programs. Finally, this pre-paid primary care benefit will discourage people from joining Direct Primary Care Practices, a promising practice model that is already achieving the quadruple aim: improving population health, increasing patient satisfaction, reducing per-capita health care spending, and improving physician and staff satisfaction while practicing medicine.

Furthermore, the Alexander-Murray bill fails to address the Health Savings Account (HSA) issue with regards to Direct Primary Care membership fees, something that my DPC doctor colleagues and I have been advocating for over the last few years.

My recommendation at this time would be to advocate for the Primary Care Enhancement Act (SB 1358), which would address the above HSA issue and not further entrench an already broken primary care delivery model.

In closing, Direct Primary Care is an innovative health care delivery model that has promise for achieving the quadruple aim on a nationwide basis. There are nearly 1,000 primary care doctors already practicing or on the cusp of engaging in this model. This is an opportunity to help us grow this DPC movement, to help us better serve our patients in this innovative way, and to potentially heal a broken primary care system in America. Help us reach our goal.

Thank you for your time and consideration,

- Dr. Paul Thomas, MD with Plum Health DPC in Detroit, Michigan

2017 Plum Health Family Medicine Doctor AAFP.jpg

Direct Primary Care Conference 2017

Today I'm blogging from Orlando! The 2017 Direct Primary Care Nuts and Bolts 2.0 conference is ongoing! There are some heavy hitters in the room, and it's great to meet up with colleagues and learn best practices. Moreover, this is a call to action - it's inspiring being surrounded by 250 of the leaders in the Direct Primary Care movement!

These doctors have left a secure paycheck, given up on their employed gigs and pursued their dream of delivering the best care possible for their patients. I'm always inspired by their courage in the face of uncertainty and their dedication to lifting up the profession of primary care. 

One of the most inspiring talks of this conference was given by Dr. Doug Farrago. He received a standing ovation after sharing his truth about why he's a Direct Primary Care doctor. He detailed his trajectory from being a battered employed doctor, threatened with termination if he questioned his marching orders, to leaving the system and practicing in a DPC model with fulfillment. 

A big thanks to Dr. Lee Gross and the Docs 4 Patient Care team who have organized this conference. I'm looking forward to 'next time'!

- Dr. Paul with Plum Health in Detroit, Michigan

Mentoring Students at Wayne State University School of Medicine

Part of my mission, part of the "why" behind what I do, is to educate medical students and inspire them to choose a career in primary care specialties. Primary care doctors have the greatest impact on their communities, have the most tools at their disposal, and are most able to bend the cost curve in the health care ecosystem.

As a part of that mission, I spend a good amount of time interacting with medical students at Wayne State University School of Medicine (WSUSOM). This week, I took part in two different events at WSUSOM. The first was a mentoring session for first year students and the second was a mock interview session for the fourth year students. 

For the first year students, it's an opportunity to get to know each other, learn from each other, and to be a resource. For the fourth year students, it's an opportunity to help them polish their interviewing skills as they prepare for the next step in their careers - residency! 

This next generation of doctors will face significant changes and challenges in the health care system - from greater automation, to precision medicine, to even Artificial Intelligence. I hope that I can be a part of the foundation along with their formal education at WSUSOM that sets them on the right path to success in medicine. 

Thanks for reading, and have a beautiful day,

- Dr. Paul Thomas with Plum Health DPC

Volunteer Doctor at Tour de Troit 2017

One of my favorite events in Detroit is the Tour de Troit, a friendly 25 mile bike ride through Detroit and some of its beautiful neighborhoods. For the last 5 years, I've been participating as a volunteer medic, starting during my medical school training and continuing through residency, and now as a doctor. 

I love the ride because I get to see so many people who I know! There are so many people and businesses that support this ride and who make it a really special event. From the Great Lakes Coffee that's served with food from the Detroit Institute of Bagels, to the lunch after the ride from local restaurants, to all of the people from the community who come out and either volunteer or ride. It all adds up to a great time. 

Biking is also a super healthy way to see the city, and during the ride we have police barricades and police escorts, so it makes for a very safe environment for everyone who participates. A big thank you to the Detroit Police Department for keeping everyone safe again this year!

When I talk about health, I'm not only talking about physiological health, but also social health - I believe that events that bring together people from different communities and backgrounds can serve to strengthen our region and make us better. That's why I love Tour de Troit, because it is this space where people from across Metro Detroit come together. For future events in this same vein, check out Slow Roll or Open Streets Detroit

It's always a great ride, but it comes with a few injuries every year. This year the head count was about 7,000 riders and we had a handful of accidents and injuries to attend to throughout the day. There were about 20 of us medical volunteers, mostly medical students, and we delivered basic first aid for riders after minor injuries. For more major events, Emergency Medical Services were used. 

So, with fall and cooler weather fast approaching, make it a point to get out today, tomorrow, and the next day on a bike ride or a walk or a run - this is a great time to be active and healthy, and your body, mind, and spirit will thank you for the effort. 

Thanks for reading, and have a great day!

- Dr. Paul with Plum Health

Wayne State White Coat Ceremony Speech

The White Coat Ceremony, a New Tradition

The annual White Coat Ceremony is a relatively new tradition at medical schools across the country. In order to convey the virtues of the profession - compassion, altruism, duty, honor, respect, and responsibility - Dr. Arnold P. Gold created the event.

The first White Coat Ceremony was held at the Columbia University College of Physicians and Surgeons in New York in 1993. Dr. Gold believed that students should declare their commitment to the profession and the virtues therein at the beginning of their medical school journey, rather than at the end.

Now, 97% of medical schools have a White Coat Ceremony. The Ceremony gives a clear set of guidelines for these doctors-in-training to follow, and students are able to accept the obligations of the profession and commit to upholding the high standards that come with the title of "doctor". 

The Declaration of Commitment

I solemnly pledge myself to consecrate my life to the service of humanity;

I will give to my teachers the respect and gratitude which is their due;

I will develop my skills with conscience and dignity;

The health of my patients and myself will be my first considerations; 

I will respect those things that are confided in me;

I will maintain by all the means in my power the honour and the noble traditions of the medical profession;

My colleagues will be my comrades;

I will not permit considerations of religion, nationality, race, party politics, sexual orientation, or social standings to intervene between my duty, my peers, and my patients;

I will maintain the utmost respect for human life and I will not use my medical knowledge contrary to law;

I make these promises solemnly, freely and upon my honour. 

My Speech

First of all, it was a tremendous honor to be selected as the Keynote Speaker for the Wayne State University School of Medicine White Coat Ceremony for the Class of 2021. When I received the phone call to be the speaker, I was nearly speechless and unsure of my ability to live up to the expectations that come with this role. I needed 24 hours to think on the offer. 

After talking it over with my wife, I decided that this was something that I could do, and that I had a lot to say about the opportunity before these students and the medical profession in general.

When I was getting ready for medical school, I read several books. I was to be the first doctor in my family and I had a limited perspective on the medical field, i.e. I had no idea what I was getting myself into. 

One of the authors that stuck with me was Atul Gawande, a surgeon and writer out of Boston. He wrote about the appealing aspects of a career in Medicine: autonomy, complexity, and a direct relationship between effort and reward. 

However, something was missing. For me, that something is happiness. You see, doctors struggle with professional burnout, substance abuse, and suicide. We can speculate about why, but I think it's some combination of consistent perfection, frustrations with the monolithic systems within health care, and a heavy workload. I didn't want to get into the darker side of these concerns during the White Coat Ceremony, but they definitely influenced my speech. 

Because of these concerns and these problems in the medical profession, I believe that we need to focus on creating a culture of happiness in the medical field. How can we train doctors to be happy? How can we create hospital systems, clinics, and insurance policies that foster physician wellness and happiness? 

I don't know if there are great answers to these questions, but it's something that I have thought about deeply. For me, creating a happy practice involved creating a membership model for health care via Plum Health. That works for me, but during my speech, I encouraged these medical students to explore the profession fully and to find their own means of happiness within it. 

I wish the very best to the WSU SOM Class of 2021. I know that these students will be a part of a generation of doctors that revolutionizes the way we deliver high-quality, compassionate health care. Without further ado, my speech: 

Thanks for reading and for watching, and have a wonderful day,

- Paul Thomas, MD | Doctor with Plum Health in Detroit, Michigan

Wayne State University School of Medicine published an official write-up about the event on their webpage, here

Street Medicine Detroit

This month I had the opportunity to volunteer with Street Medicine Detroit, an organization dedicated to helping homeless people in Detroit with their medical care. This was an organization that I volunteered with and supported during its early days at Wayne State University School of Medicine.

The service is run by WSU medical student volunteers and they go out to different locations across Detroit and assist those who need medical care. This can be done on street corners, in soup kitchens, homeless shelters, and churches across the city.

This month, I met up with the volunteering students at Manna Community Meal to deliver health care services. This is in the basement of St. Peter's Episcopal Church in Detroit's Corktown neighborhood. It was a great way to give back, and if you want to support Street Medicine, they take donations at their website, here

 Talking with a group of medical students while volunteering with Street Medicine Detroit at St. Peter's Episcopal Church in the Corktown Neighborhood of Detroit, Michigan. 

Talking with a group of medical students while volunteering with Street Medicine Detroit at St. Peter's Episcopal Church in the Corktown Neighborhood of Detroit, Michigan. 

Plum Health Advocating for Direct Primary Care in Washington DC

This week we're in Washington DC, advocating for affordable, accessible healthcare services on Capitol Hill. We're meeting with the offices of Senator Stabenow, Senator Peters, Congresswoman Lawrence, and Congressman Conyers. This is one of those moments where I feel like the mission that I'm on is bigger than the community that I live in and bigger than my city and my state. Access to affordable health care is a National concern and our representatives and their office personnel have given us open ears. 

On Thursday morning, I boarded a plane to DC. That day, I met up with several of my Direct Primary Care colleagues at the DPC Summit 2017. We took a bus from our hotel in Crystal City to the Dirksen Building on Capitol Hill. We received instructions from our advisors about how to talk to our legislators: be authentic and tell your story. 

Here's the video I shot in the Detroit Metro Airport prior to taking off:

After our briefing, I was able to meet up with legislative assistants from the offices of Senator Stabenow, Senator Peters, Congressman Conyers, and Congresswoman Lawrence. Here's a video I shot inside the atrium of the Hart Senate Office Building:

The Hart Senate Office Building houses the offices of Senator Peters and Senator Stabenow. I was bouncing between this building and the Rayburn House Office Building, where Congresswoman Lawrence and Congressman Conyers have their offices. Here's a video I shot just outside of the Rayburn House Office Building:

Thanks for reading and watching, and have a great day,

- Dr. Paul Thomas with Plum Health DPC in Detroit, Michigan

Primary Care Clinic in Detroit

When I was a first year medical student, I worked with a group of my fellow medical students to build an outdoor medical clinic. We wanted to raise awareness about the lack of primary care services in Detroit, and we accomplished this by constructing an outdoor medical clinic.

Currently, there are roughly 50 - 100 primary care doctors in the City of Detroit. This equates to about 1 primary care doctor for every 6,000 - 12,000 residents, which is horribly underserved. In the future, I would like to see 1 primary care doctor in every single Detroit Neighborhood, from East English Village to Ford/Wyoming, from Old Redford to Lafayette Park. 

Having community primary care doctors creates a tremendous amount of value for the surrounding neighborhood - that doctor becomes a go-to person for folks who need health care and even emotional support. 

However, the current reality in Detroit is that folks either don't have access to a primary care doctor or are driving to the suburbs for their care. To illustrate that lack of primary care services, our group of medical students built an outdoor clinic as a part of the Heidelberg Project on Detroit's East Side or what you may call the McDougall Hunt Neighborhood. Of course, we had the approval of Tyree Guyton, who checked in on our work that day, and we also received some press from the Detroit Free Press and the Wooster Collective out of NYC. 

It was a simple clinic, with a reception desk, a door frame, a door, an exam table, and some chairs. On the door, we wrote all of the barriers to accessing health care services in Detroit and in the Nation. This was in 2009, when the debate over the Affordable Care Act was raging. 

I visit the location periodically, to see how it has changed over the years. The last time I visited the site was in September 2016 during the Tour de Troit, an annual bicycling event that takes riders around the city. Someone had added a skeleton and some body parts, and it looks like Tyree made his signature drawings of faces on our plexiglass wall. 

Plum Health may be in its infancy, but I know that we are already filling a need in the community in terms of primary care services. We recently surpassed 100 members and continue to grow, adding new members each week. We've taken care of newborns, toddlers, teens, and adults, and have addressed conditions ranging from sore throats to cancer.

As I continue to serve in the community, I hope to live up to the ideals that I put forth in this work of public art, to be the kind of community doctor that addresses the lack of access to health care in Detroit. I will also work to inspire the next generation of Family Physicians to take the leap into private practice in a community-based setting.

Thanks for reading, and have a wonderful day,

Dr. Paul Thomas with Plum Health DPC 

How to Quit Smoking in Detroit

The adult smoking rate in Michigan is 20.5%. So, of the Michiganders over the age of 18, roughly 1 in 5 are smokers and that translates to 1,557,000 smokers in the State of Michigan. Among the United States, Michigan has the 9th highest smoking rate among adults.

This is unfortunate because there are many adverse effects of smoking, from increasing the risk of heart attacks and strokes to increases in the rates of head and neck cancers and lung cancers. 

However, there are effective treatments that can help you quit smoking, and once you quit smoking many health benefits can be realized, from lowering your blood pressure to decreasing your risks of cancer. 

This week, I've had a few people ask for help in terms of smoking cessation, and I am happy to provide that type of help. In fact helping people to quit smoking has some of the best patient-oriented evidence in medicine. Full stop. 

Logistically, I would have you come in for an appointment. We would talk about where you are - pre-contemplation, contemplation, or ready to quit aka "quit mode". Then we'd review your medical history, current medications and any pertinent health-related issues. We would then formulate a treatment plan based on you as an individual.

In the person discussed in this video, we used Zyban or Wellbutrin or Bupropion (all different names for the same medication). This is effective in reducing the cravings that people feel for cigarettes. Then, we set a quit date. This is 1 week after starting the Zyban (bupropion).

After the quit date is reached, nicotine replacement therapy is used to tamp down hour-to-hour cravings. This can be in the form of a patch or gum or lozenges. Again, we personalize the method based on your preferences. 

Let me know if you'd like to start your journey to better health with Plum Health, you know that you can reach me through our contact page or by phone, 313.444.5630.

Sincerely,

Dr. Paul Thomas with Plum Health DPC

WeWork Creator Awards Detroit Application

Today, we submitted our application for the WeWork Creator Awards! I really enjoy submitting applications for contests like this, because it helps me to clarify our mission, vision and values. And it's an opportunity to learn and grow through outside feedback about our internal operations. 

In the application, they ask: "What problem is your idea, business, or organization solving?" For us at Plum Health, it's all about providing high-quality Family Medicine services in the community. It ain't sexy and it ain't super exciting, but it's so darn necessary! Having excelling primary care services in your neighborhood saves costs and improves health outcomes.

As they put it in this linked article, "One primary care doctor per 10,000 people in the U.S. can decrease hospital admissions by 5.5 percent, emergency room visits by 11 percent and surgeries by 7 percent."

This point is salient in Detroit, where there is an epic primary care shortage. Currently, there are only 50 - 100 primary care doctors in the City of Detroit for 680,000 people. That's 1 doctor for every 6,000 - 12,000 people. I recently wrote an article about this in the Detroit News.  

Historically, this has been a difficult issue to solve because practice location for doctors is often tied to reimbursement from the community. Primary care doctors have avoided Detroit because more than half of Detroiters are on Medicaid, which generates low reimbursements.

With Plum Health, we do not rely on government or third party payers of reimbursement. Instead, we bill patients directly: $10/month for children and $49 for young adults, which covers all doctor's visits, texts, phone calls, and emails.

Additionally, members also have access to wholesale medications, at-cost lab work, and at-cost imaging services. From January - May 2017, we have saved our members roughly $15,000 on their meds, labs, and imaging. We are here to provide a tremendous amount of value to our patients and our community.

Our ask for the WeWork Creator Awards: help us reach our goal of providing value for the community by supporting what we do at Plum Health DPC!

The WeWork application continued with the following question: "How do you, your business, or your organization interact with the community?" Put simply - we are imbedded within the community and provide ours services to community members.

At Plum Health DPC, we take care of folks of all ages, races, ethnicities, and orientations. We are practicing on the street level, open and accessible to the community. Our youngest member is 14 months old, our oldest is 63 years; some of our members earn less than $30,000 and cannot otherwise afford health care. These folks are often shut out of the traditional insurance system because they cannot afford the premiums.

In addition to serving our paying customers in the community, I regularly volunteers at Cass Community Social Services' Clinic in Cass Corridor and the Student Run Free Clinic at I-94 and Conner. Here, I'm able to deliver free care to the most vulnerable members of the community - typically the homeless and uninsured.

Finally, Plum Health is regularly at health fairs throughout Detroit, performing free health screenings for non-profit organizations and church groups.  

The last major questioned asked in the application was about how we would use the money if we won: "If you were awarded a grant, what new benchmarks would you be able to reach?" We are doing pretty well at Plum Health, adding new members each month and growing at a sustainable pace. However, if we won the Creator Award, we would be able to grow more quickly and therefore serve more people in Detroit and beyond.

Specifically, A grant of $18,000 - $36,000 would allow us to lease a larger office space and hire a second doctor. In a city with such limited primary care options, hiring a second doctor to work in the city would make a substantial difference in the lives of the people in our community.

We've taken care of folks who earn less than $30,000 and we've seen people who haven't been to a doctor in years, living in fear of generating large medical bills, and living with the consequences of their worsening high blood pressure and diabetes. Without the grant, the goal of leasing a larger office space and hiring a doctor would be at 6 - 12 months. With the grant, these goals would be achieved in 3 - 6 months.

Thanks so much for reading more about what we do at Plum Health DPC, and if you're a member of the WeWork community, thanks for taking the time to read our application and this blog post!

Sincerely,

- Dr. Paul with Plum Health DPC.