Family Medicine

The History of Wayne State University School of Medicine

This week, I was invited to give a presentation on the history of Wayne State University School of Medicine during its Sesquicentennial Celebration. Yes! The WSU SOM is 150 years old, and it has a rich history of diversity, inclusion, and innovation that should be celebrated. Interestingly, the history of the Medical School is the history of the University, as the University grew out of the Medical School. While I can't cover the entire history in a single blog post, I will give some highlights from the early years of the college below. When the full presentation is released later this year, I will post it to the blog as well. 

Theodore A. McGraw, MD, founder of the Detroit Medical College, which would later become Wayne State University School of Medicine.

Theodore A. McGraw, MD, founder of the Detroit Medical College, which would later become Wayne State University School of Medicine.

The Detroit Medical College was founded in 1868 by five returning Civil War Veterans. One can only imagine the horrors that they saw on the battlefield and you can also imagine the inadequacy that they felt in treating wounded soldiers. In the 1860's, aseptic surgical techniques were only beginning to be used and anesthesia was not fully understood. 

Can you imagine what it might have felt like to be a battlefield clinician, and not having the proper tools or training? Dr. Theodore McGraw, founder of the Detroit Medical College is quoted as saying: "I had discovered in my two years of army activity that I was deficient in that exact knowledge of anatomy that was essential to good surgery.  The advent of antiseptic and aseptic surgery, besides, had opened a new field for operative work, that of the abdomen, which demanded a study of anatomical relations which had never been taught in the schools."

Dr. Theodore McGraw was focused on both teaching and learning, and that desire is summed up in this quote "We entered into the matter with unbounded enthusiasm – enthusiasm for teaching and developing ourselves."

To this end, the charter of the Detroit Medical College elucidated how this would be achieved. In the charter (pictured below), it is written that "Pains will be taken to instruct each Student in PRACTICAL DIAGNOSIS. For this purpose the advanced Students will be called upon in turn to examine patients. After pronouncing a Diagnosis, questions will be asked in relation to differential symptoms... ...Little benefit can result to the Student from seeing cases diagnosticated and treated by the Professor of Practical Surgery and Medicine, unless he is first allowed to exert his own powers, and test his own knowledge, by personal examination of the patients."

The Detroit College of Medicine charter from 1868, signed by founding physician Thodore A. McGraw, MD. The charter puts forth the founding principles of the institution. 

The Detroit College of Medicine charter from 1868, signed by founding physician Thodore A. McGraw, MD. The charter puts forth the founding principles of the institution. 

This ethos of having students practice medicine, to serve the community, and to learn by doing, echoes throughout the history of the School of Medicine. This is the very foundation of the University and the key to its enduring greatness. It is also the reason that I chose to attend WSU SOM - I wanted to immerse myself in the diversity of the city and the breadth of clinical opportunities available in Detroit, from serving homeless and uninsured patients in community clinics to learning from some of the leading minds and researchers in the country at the University clinics. 

At its inception, the Detroit Medical College set up a relationship with Harper Hospital and St. Mary's Hospital, which allowed students to learn from and serve the people of Detroit. The focus is, and has always been, learning by doing. The early photos below illustrate these tenets. 

 

 

The above photo series include the following images: first is the Detroit Medical College, which housed the medical school after 1868, the second image shows students during anatomy lab sometime around 1900, which is not very different than anatomy lab at the School of Medicine today. The third image is St. Mary's Hospital, one of the two clinical training sites after 1868. The fourth image is the operating theater at St. Mary's Hospital in 1898. The Operator is Dr. Henry O. Walker. At his left, hands behind his back, is Dr. Theodore McGraw, the founder of the Detroit Medical College who emphasized teaching by doing. The final image is Harper Hospital, the primary clinical training site for students at the Detroit Medical College. 

It was an honor to be able to relay the history of Wayne State University School of Medicine to my physician colleagues this weekend, and it is a great reminder of what makes doctors from Wayne State unique and so  skilled - the focus on hands-on clinical training and the diversity of the people we have the privilege of serving. 

Thanks for reading,

- Dr. Paul Thomas, Physician with Plum Health DPC

 

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!

Plum Health on Daily Detroit

This week, we were featured on the Daily Detroit Podcast. It was great meeting up with Sven Gustafson and Jeremiah Staes, the journalists behind the publication, and hosting them in our office in Southwest Detroit. 

You can listen to the full episode here:

Here's what Sven Gustafson wrote about our practice, in the context of the interview:

Dealing with health insurance is few people’s idea of a good time — if you can afford it at all, that is.

Now, a doctor operating out of an office in a former Detroit Police Department precinct headquarters? That’s flipping the script on the traditional model of health care.

On this episode of the Daily Detroit Happy Hour podcast, we schedule an appointment with Dr. Paul Thomas of Plum Health in Southwest Detroit. He’s practicing a model known as direct primary care in which patients pay a membership rate, starting at $10 a month for children and climbing to $89 a month for seniors, directly to the doctor. In exchange, patients get more personalized care, better access and lower-cost medications, imaging and laboratory services.

Dr. Thomas, who graduated from the Wayne State University School of Medicine, estimates he can cover 80 to 90 percent of most people’s health care needs. So he acknowledges it’s not a complete solution to our country’s problem-plagued health care system.

We talk to Dr. Thomas about how direct primary care works, how it differs from traditional insurance-directed health care and how it affects both patients and his life as a working physician. He also tells us about the various ways he’s using digital technology to facilitate his job and market his business.

Find us and subscribe on Apple Podcasts or wherever fine podcasts are downloaded. Previous episodes are here.

Daily Detroit's tagline is "what to know and where to go in Detroit" - it's worth knowing more about Detroit, if you're a resident, a Metro Detroiter, or from another part of the world. Sven and Jeremiah cover interesting stories and give great insights, so their podcast is worth a listen/subscription. 

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

- Dr. Paul Thomas with Plum Health DPC

Family Doctor Accepting New Patients in Detroit Michigan

During the busy days and weeks of the year, sometimes we forget to make one thing clear - we are a family medicine service in Detroit, Michigan and we are accepting new patients in our family medicine clinic. 

Family Doctor Accepting New Patients in Detroit Michigan

My name is Dr. Paul Thomas and Plum Health DPC is a family medicine clinic in Southwest Detroit and we are accepting new patients. As a family medicine doctor, I take care of patients of all ages and stages. This means that I can take care of children or pediatric patients as well as adults.

What We Treat

We treat a broad range of conditions, from the acute care concerns like sore throats to coughs and colds as well as influenza. We also treat high blood pressure, diabetes, and other chronic conditions. Additionally, we perform procedures like Pap tests, skin lesion removal and biopsies, as well as rapid strep test, rapid influenza testing, and rapid mono testing.

Why We Are Different

We are different because we're available, affordable, and accessible. Our service is just a click away, so don't hesitate to send us a note here or through any of our other social media channels.

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

– Dr. Paul Thomas, M.D.

Paul Thomas MD TEDxDetroit Video

THE DAY HAS FINALLY ARRIVED! Our talk at TEDxDetroit has been posted on YouTube! Check it out here: 

In case you missed the original blog post after the TEDxDetroit event, check out my thoughts on speaking during the event, here

Thanks for reading and have a wonderful day!

- Dr. Paul Thomas with Plum Health DPC

Paul Thomas MD on Small Talk with Mark S. Lee

This weekend I was featured on Small Talk with Mark S. Lee. The radio broadcast airs on CBS Radio in Detroit! I was last on Small Talk in March 2017, and since that time, Plum Health DPC has grown in size and I've been asked to participate in some speaking and community events. 

In this episode of Small Talk with Mark S Lee, we talk about the TEDxDetroit event that was held on November 9th 2017. We highlight a few of the key points that I spoke about during that event. Foremost, I believe that health care should be affordable and accessible for everyone. Second, we talk about how doctors can be overloaded by their patients' concerns, and those concerns can slip through their fingers, like grains of sand. 

We also give an overview of Direct Primary Care and how you can find a Direct Primary Care doctor near you by using the DPC Mapper online

Mark asks what's wrong with our current system? And I respond by saying that the prices in the health care ecosystem are inflated, which makes health care unaffordable for many people. 

To illustrate, I make an analogy about Health Insurance vs. Auto Insurance. If we used our Auto Insurance policies to pay for tire rotations, oil changes or gasoline, those prices would be significantly inflated. However, that's exactly what we do with our Health Insurance policies. 

It's always enjoyable being on Small Talk with Mark S. Lee, and this time was a unique experience as the Honorable Former Mayor Dave Bing was interviewed just prior to my time slot! Not only is Dave Bing a former mayor, but he's also in the NBA Hall of Fame. He continues to be an example of great leadership as he continues his work with the Bing Youth Institute, so it was an honor to be a part of the show with him.

Thanks for reading and thanks for watching!

Sincerely,

Dr. Paul Thomas with Plum Health DPC

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

Why It's Important to Have a Family Medicine Doctor in Detroit

Today I had the pleasure of speaking with Keith White of the Cancer Awareness Resource Network. We talked over the phone about his organization, the work we're doing with Plum Health, and the potential that we have to serve folks with cancer in Detroit and beyond. 

Keith has had an amazing and inspiring journey. To read about him, check out what he wrote on his "about us"page. One thing Keith realized, though, is that even if folks have great health insurance, they may still have really high co-pays for doctor's visits and medications. He reached out to see what Plum Health could offer those with cancer and those in remission in his network. 

Simply put, we can offer the best primary care experience in Detroit. What that means is that you have a Family Medicine Doctor or a Primary Care Doctor who is truly your advocate. I take my role seriously, and I will advocate for your health and wellbeing, your family and your finances while you confront cancer. How do we do this? 

First, I focus on you and take a wholistic approach to your care. I have more time to spend with you, to get to know you and understand where you're coming from, what you're dealing with, and where you want to go with your life and your health. As your family doc, I will make sure that you're taking the right medications, that you are getting the right screening tests, and keeping up with treatment.

Second, I take care of folks in the context of their families and their communities. If there are emotional or familial stressors, we can talk about those and look for solutions together.

Third, I watch out for the financial wellbeing of my patients. This means that I make my prices clear and understandable, I don't charge co-pays for visits, and I give my members medications at wholesale prices. 

Cancer and its treatment are hard enough, so when facing these difficulties, you want a primary care doctor who knows you well and who can advocate on your behalf. 

Thanks for reading, and have a wonderful day,

Dr. Paul Thomas with Plum Health

The current look of our Plum Health Direct Primary Care office in Detroit, Michigan

The current look of our Plum Health Direct Primary Care office in Detroit, Michigan

Starting a Direct Primary Care Practice in Detroit: What Inspired Me

I initially discovered direct primary care while on a road trip in November 2012. I was driving back to Detroit from a residency position interview at the University of Minnesota. I believe it was a libertarian-minded podcast featuring an interview with Dr. Josh Umbehr, discussing his startup in Wichita, Kansas, called Atlas MD. 

It was refreshing to hear a Family Medicine doctor speaking so passionately about saving people money, delivering better care, and practicing in a unique way. The message resonated with me, but at that time I was pursuing a faculty position at a residency program because I enjoyed teaching so much. Suffice it to say that I filed this “Direct Primary Care” concept in the back of my mind.

Between my second and third years of residency, I went to the Michigan Academy of Family Physicians (MAFP) annual meeting in Traverse City. It was July 2015. There I met Dr. Clint Flanagan of Nextera Healthcare in Denver, Colorado. He spoke unequivocally about the value of being a primary care doctor and the tremendous value that we provide for our patients. His passion for the profession also came through in a way that I hadn’t experienced before.

These two leaders in the field served as a contrast to the typically burnt out and grumbling physician that I had met thus far in training. Even the best doctors grumbled about paperwork, prior authorizations, late patients, packed schedules, and all of the other difficult parts of being a primary care doctor.

At that point, I knew that I would pursue an alternative practice model. It only made sense – less-than-fulfilled physicians practicing in a less-than-ideal system surrounded me and I knew that life could be better on the other side. Additionally, I always had this inner drive to deliver medicine in a more equitable and just system. Direct primary care seemed to align with my values as an individual and as a doctor, but I needed to dive deeper.

So, as an elective rotation, I drove out to Wichita and Denver, and spent a week learning from both Drs. Umbehr and Flanagan. I kicked the tires, took copious notes, and tried to bring the best of their practices to my community in Detroit, Wayne County, and Southeast Michigan.

Now it's September 2017 - almost 5 years after I had initially heard of "Direct Primary Care". Now, I'm living DPC every day, taking care of people of all ages and stages in my clinic in Southwest Detroit. I'm even caring for people while on vacation - I helped about 10 of my patients while I was traveling abroad over the last week. 

I am able to do this - to be the doctor that I was meant to be - because I am a Direct Primary Care doctor. This post is about inspiration, and what inspired me, and what continues to inspire me.

I am inspired by the fact that I can help people with real health care needs either in my office or over the phone, or via video chat or email. I am inspired by the fact that I am able to serve people who haven't seen a doctor in years, because we've lowered the cost barriers and therefore have made our service more accessible. I'm inspired by the fact that we can do so much good in such a small space.

I'm also inspired by the potential for Plum Health to grow, and to serve more people in our immediate community and across the region. I'm inspired by the happy patients that I get to work with everyday.

I've had great mentors along the way, specifically from the pioneers in the Direct Primary Care world, and I'm grateful for their help in getting me to a successful and sustainable DPC practice. 

Thanks for reading this reflection, and have a wonderful day,

-Dr. Paul with Plum Health DPC

Dr. Paul Thomas of Plum Health DPC, in the Plum Health office!

Dr. Paul Thomas of Plum Health DPC, in the Plum Health office!

Plum Health featured in Good Life Detroit

This week, Plum Health DPC was featured on the blog Good Life Detroit. Jennifer is the creative spirit behind Good Life Detroit, and she did a fantastic job writing about our clinic and Direct Primary Care in general.

I really appreciated her perspective as a mother - she notes in the article that she has 5 children! - and that she paid $125 for a 20 minute doctor's visit for one of her children. Contrast that with our clinic, her child could have been seen for a full year for $120, with as many visits as needed included in that price. 

This is how we make our primary care services valuable for the community that we serve. If you were not aware, Detroit is a large, low-income population. We recognize this as a fact, and have adjusted our pricing to be accommodating for the community that we serve. 

Another great point that she brought up in the article is the frustration that people can experience when trying to reach their doctor! Sometimes reaching the doctor can be like pulling teeth. She puts it more eloquently, here: 

"Another great benefit of Plum Health Direct Primary Care is patients have the opportunity to speak directly to Dr. Paul without the hassle of long wait times and call screenings. Instead of having to go through a series of steps just to talk to their doctor, patients can call, text, or email Dr. Paul directly. In some cases, some doctors require you to leave a message with the office staff for a callback.

"Most of the time the office staff member screen’s the doctor’s calls and you have to tell the staff member exactly what it is you need or what your question is. Then you wait for the doctor to call you back, which can be anywhere from the same day or one to two days later, all depending on the doctor’s schedule.

"Members of Plum Health have Dr. Paul’s cell phone number and email address. They can reach him anytime they need to ask a question in regards to their health."

There are several other great points that she makes throughout the article. I was really impressed at her depth and thoroughness. I also appreciate her helping to get the word out about affordable, accessible health care in #Detroit. We're trying to serve as many folks who need this type of care, and articles like these help us to reach communities outside of our circle of influence. 

Thanks for reading and have a wonderful day,

Dr. Paul Thomas with Plum Health Direct Primary Care 

Plum Health Direct Primary Care is in Detroit, Michigan. We practice old-fashioned family medicine, but we use technology to make ourselves more accessible to our patients when they need us! I love this graphic that Jennifer at Good Life Detroit created for us! 

Plum Health Direct Primary Care is in Detroit, Michigan. We practice old-fashioned family medicine, but we use technology to make ourselves more accessible to our patients when they need us! I love this graphic that Jennifer at Good Life Detroit created for us! 

I also really liked this graphic that Good Life Detroit made about our pricing tiers at Plum Health DPC - really easy to read and understand! 

I also really liked this graphic that Good Life Detroit made about our pricing tiers at Plum Health DPC - really easy to read and understand! 

Direct Primary Care on NBC News

This week, Direct Primary Care was featured on NBC Nightly News with Lester Holt. If you are unfamiliar with this new model for healthcare delivery, Direct Primary Care is a membership model for healthcare that charges a relatively low fee for primary care services. The NBC News team starts out the piece by discussing the amount of time that the doctor is able to spend with the family, "maybe 30 - 45 minutes". At Plum Health, our visit time is about 1 hour for initial visits and 30 minutes for follow ups, so on par with what was stated in the video. 

The video then goes on to discuss the benefits of Direct Primary Care with unlimited visits and the ability to text message the doctor for a flat, monthly fee. For most direct primary care doctors, patients are able to visit the doctor and have digital interactions with the doctor whenever necessary. At Plum Health, our patients can call, text, and email anytime and see us in the office anytime they need us. 

The article then discusses the cost of the monthly membership, which is typically between $25 and $85 per month. In our case at Plum Health DPC, our prices are between $10/month for children up to $89/month for adults over 65 years of age. Young adults under 40 years old pay $49/month and adults over 40 years old pay $69/month. Direct Primary Care practices across the country typically fall in the $10 - $100/month range. Any monthly charges over and above $100 gets into the realm of Concierge Medicine. We wrote a previous blog post about the difference between Direct Primary Care and Concierge Medicine, here. 

The NBC Nightly News piece goes on to discuss what's included in or what is covered by a typical Direct Primary Care practice. Typically, DPC practices cover unlimited primary care visits. At Plum Health DPC, our patients have unlimited visits with Dr. Paul, unlimited texting, emails and phone calls or unlimited digital communication. In addition, we charge at-cost pricing for routine lab tests and we charge wholesale prices for medications. Some doctors choose to include some basic blood work in the cost of the membership.

Because we don't charge an enrollment fee, we chose not to include basic blood work in our service. Instead, we perform at-cost labs at Plum Health. Complete blood cell counts are $4, Comprehensive metabolic panels are $6, Thyroid Stimulating Hormone tests are $6, Lipid panels are $6.55, and we have a modest draw fee of $2.

How Much Direct Primary Care Costs Plum Health DPC.png

Families save money by choosing Direct Primary Care. The NBC News article discusses how the family featured in the video saves $500 each month by using a Direct Primary Care service and pairing that with a low premium, high-deductible plan.

This pairing of services is the ideal way to save money on your health care expenses. The issue that some people run in to is finding that Catastrophic coverage plan. Many of those plans have gone away after the Affordable Care Act was signed into law by President Obama. This is one of the many road blocks to wider implementation of Direct Primary Care plans. The other impediments include the inability to use Health Savings Account funds for DPC plans. 

The next part of the article gets into the philosophy of Direct Primary Care. It talks about how Dr. Cunningham left a traditional family medicine practice. Now that he operates a Direct Primary Care practice, he sees fewer patients and makes less money. But, the income loss is worth it to him, so long as the insurance companies no longer dictate how he's supposed to take care of patients.

This part of the video touched a nerve with me. So often, we as doctors do not take care of our patients in the most optimal or ideal way because of the barriers put in front of us by insurance companies. By not accepting insurance company dollars, we are free to take care of patients in the way that they deserve to be taken care of. Dr. Cunningham says "It feels great to be practicing medicine the way it's supposed to be", and I agree!

Operating Plum Health DPC has allowed me to develop deep, trusting relationships with my patients that I never got to experience as a resident or in a traditional practice. The element that is so important to developing this relationship is time. When I am able to spend an hour with each patient during each visit, I am able to give them my full attention and deliver the kind of care that they deserve. 

Dr. Cunningham, a Direct Primary Care doctor in Massachusetts, talks about how he is able to practice medicine the way he's supposed to be. 

Dr. Cunningham, a Direct Primary Care doctor in Massachusetts, talks about how he is able to practice medicine the way he's supposed to be. 

On the other hand, the article highlights the critical elements of Direct Primary Care: "Critics say there's already a shortage of primary care doctors". They don't really expound upon this thought or bring this thought to its logical conclusion, which is that if we already have a shortage of primary care doctors, then it is inexcusable for those primary care doctors to see less patients. 

I take umbrage with this remark. There is a dearth of excellent primary care doctors because the practice of primary care medicine is one of the most challenging fields in medicine and it is often the lowest paid field in medicine. Medical students often choose higher-paying specialties in medicine that come with greater job satisfaction and less role strain.

I see the practice of Direct Primary Care as solving some of the issues with the current system. DPC medicine helps to eliminate the role strain that young doctors feel. When I have an hour to take care of a patient, I can really address them as a whole person. In the traditional or fee-for-service model, a primary care doctor has 10 - 15 minutes to address the whole patient, and this is nearly impossible. I've been there, seeing patients at this rate, and the best you can do is address 1 or 2 concerns before you have to move on to the next patient. 

Direct Primary Care also can offer doctors a chance to earn a greater income if they have a panel of roughly 500 patients or members in their DPC practices. Some doctors choose to see less patients in their DPC practices, and therefore would make less money, but there is an opportunity to increase primary care doctors' salaries. 

By eliminating the role strain that primary care doctors experience and by paying them a better salary, we can attract more medical students to primary care medicine fields like family medicine, general internal medicine, and general pediatrics. I take umbrage with the thrust that doctors should not see less patients because the system is broken.

It would be worse to see the system perpetuated with exhausted, frustrated, burnt-out primary care doctors seeing 2,500 patients each year. It would be better to have more medical students attracted to primary care fields, seeing 500 patients each year, limiting their role strain and increasing their incomes. 

Another critique is that Direct Primary Care does not cover specialists visits or hospitalizations. I find this to be a moot point because the main thrust of Direct Primary Care is to deliver primary care services directly to our patients. We make no mention of Direct Specialty Care or Direct Hospital Care, and we make no attempt to promote these services in our offerings.

Too often, American consumers conflate "health care" with "health insurance", but these are distinct and separate services. You need to have health insurance, either a low-premium, high-deductible plan or a catastrophic coverage plan. This health insurance does exactly what the name implies: it insures you and your health against major, unexpected events. 

Direct Primary Care, then, delivers the affordable, every-day primary care services that are needed by  you and your family. You need to have primary care coverage, but you shouldn't have to pay an insurance company to pay your primary care doctor for what amounts to low-cost primary care services. 

It makes sense to pay an insurance company to pay hospitals and surgeons for higher cost care, but it doesn't make sense to pay insurance companies to pay your primary care doctor for relatively lower cost primary care services. 

As a side note, Plum Health DPC does offer specialists consultations for difficult clinical questions through our relationship with Rubicon MD. This allows us to ask about diagnostic testing, special labs to order, or to help us solve a difficult problem. But, as in the video, we do not offer specialists visits as a part of our service. 

The closing thought from the NBC Nightly News video is that despite the drawbacks, it is worth it for some individuals and families to pay for Direct Primary Care services. As a Direct Primary Care doctor, the benefits are clear: you have a doctor on call for you any time you need it and access to time and cost-saving auxiliary services. The NBC reporter says that "Direct Primary Care is the answer, to save money and have a doctor who's always 'in'". 

Thanks for reading and have a wonderful day,

- Dr. Paul with Plum Health DPC

Plum Health Featured in Crain's Detroit

This week, Plum Health DPC was featured in Crain's Detroit Business. The opportunity came up after meeting with Mark S. Lee on his program, Small Talk with Mark S. Lee. During the on-air interview, we only had 15 minutes to talk about Plum Health and Direct Primary Care. It simply was not enough time to get down into the nuances of what Direct Primary Care is, the mission of Plum Health, and the future of health care and health care policy in this country.

This follow up interview in Crain's Detroit allowed for a deeper dive into these nuances, and so I must thank Mark S. Lee and the Crain's Detroit editorial team for working with me and publishing this important piece. You can read the full article here.

I truly believe that Direct Primary Care will play a greater role in our health care ecosystem as people/health care consumers wake up to the actual cost of their medical care. By making health care prices transparent at Plum Health DPC, we allow people to use free market principles to purchase the health care that they need. 

Thanks so much for reading, thanks again to Mark and Crain's Detroit, and thank you the readers, followers, patients, and supporters that make Plum Health DPC possible!

- Dr. Paul with Plum Health

What Should I Read During My Pregnancy?

This week, I met with a young woman who is beginning her journey with pregnancy, child bearing, and starting a family. This is an exciting time and I'm happy to help young families as they make this transition. She asked me a question that I haven't been asked before, "what should I read during my pregnancy?"

As an avid reader, I wanted to recommend something. But, the truth is this: I haven't read any pregnancy books! I've been pushing this off until my own family becomes pregnant. I still wanted to answer the question, so I took it to my social media community and they showed up with some great responses.

First, they recommended books! This seemed like an obvious first response, and they had good reasons for each one that was recommended.

However, some of the respondents in the group said don't read anything! "Too many opinions, too much to think about. Just go with the flow and trust your instincts." In fact, this sentiment was written by a family medicine doctor and colleague of mine, and it was echoed by another family medicine doctor.

This "read nothing" approach is an interesting take on the subject, but I second guess their thrust here because they have a significant amount of medical knowledge and practical experience in taking care of pregnant women and their infants. Most lay people and non-doctors lack this knowledge and experience, and that's why non-doctors gravitate towards reading books about pregnancy, child-bearing, and child-rearing: the unknown can be frightening! And some of that fright can be alleviated by reading and learning from the experiences of others. 

Finally, people mentioned subscribing to daily/weekly emails or downloading certain apps. This was best described by a friend on social media: "I read a few different books (i.e. What to Expect), but I found that subscribing to receive emails was most useful (what to expect, the bump). They gave quick summaries of important issues. Also, pregnancy apps have tons of good info and daily updates on what's going on in your pregnancy at that time." Another person recommended the BabyCenter app and the BabyCenter website.

My recommendation? As I said, I haven't read any of these books, used any of these apps, or carried a child to full term myself, so take this cum grano salis: pick 2 - 3 resources and enjoy the experience of pregnancy!

Thanks for reading and thanks to the community of moms, parents, and grandparents that responded!

- Paul Thomas, MD

Plum Health on Detroit is Different

This week, Plum Health DPC was featured on Detroit is Different with Khary Wae Frazier. Khary is the founder of Detroit is Different, which discusses the rich cultural tapestry of Detroit and features the people and businesses that make up this great city. You can check out our episode on his website, here

You may know Khary from his work with the Motor City Match - he makes videos for the Motor City Match, featuring entrepreneurs that have won the competitive business challenge. Here's the video that he made for Plum Health DPC.

Here's how Khary describes the work that he does: 

Detroit is Different is about culture, and business makes up a lot of that for our city. The products, services, and the style/ process in which they’re delivered are uniquely Detroit. The gate of the Detroit River has welcomed world travelers for centuries. Today the port remains America’s busiest border for importing and exporting goods. I’ve always felt the best asset we’ve offered the world are Detroiters.

Here's the video before we went live on his Podcast! 

Thanks so much for reading and watching,

- Paul Thomas, MD 

Opinion Published in the Detroit News

This week I wrote an opinion piece and it was published by the Detroit News! I'm very excited about getting the word out about the benefits of Primary Care and the work that needs to be done to address the health disparities in our city and in our region. Here's the link. A sincere thank you to Ingrid Jacques for giving me the opportunity to write this.

There are always constraints, with time and with resources, and the article was edited to fit the allotted space in the Sunday paper. So, here is the essay that I wrote in its entirety prior to editing by the News:  

If you live in the City of Detroit, you may find yourself driving to the suburbs for your primary care services.

According to top officials in the Detroit Health Department, there are roughly 50 – 100 primary care doctors in Detroit. For a city of 683,000 people, that’s about 1 doctor for every 6,000 – 12,000 residents, which is horribly underserved.

Interestingly, Wayne County as a whole has 1 primary care doctor for every 1,515 residents. But, the supply of doctors is not equitably distributed across communities within Wayne County. Areas like Grosse Pointe and Dearborn have a relative saturation, while cities like Inkster and Detroit remain underserved.

By contrast, Washtenaw County has 1 primary care doctor for every 598 residents and Oakland County has 1 primary care doc for every 655 residents. These are more equitable and desirable ratios.

We need more primary care doctors in our communities. Research has shown that as the number of primary care doctors increases, health outcomes improve and costs decrease.

Data released by the American Academy of Family Physicians reveals that an increase in one primary care doctor per 10,000 people reduces hospital admissions by 5.5%, ER visits by 10.9% and surgeries by 7.2%.

In an era of greater awareness of healthcare expenditures, that’s a lot of bang for your buck.

Unfortunately, the medical system does not incentivize primary care medicine. Specialists like Orthopedists, Cardiologists and Dermatologists are reimbursed at much higher rates than primary care specialists like Family Medicine doctors, General Internal Medicine doctors and Pediatricians.

And the graduating medical student is acutely aware of these discrepancies in pay.  The median level of med school debt for the class of 2015 was $183,000 and the total cost may surpass $400,000 if paid over the long term with interest.

As the average student considers an average salary of $443,000 as an Orthopedist or $204,000 as a Pediatrician, choosing primary care medicine becomes economically strenuous.

And for those doctors who choose primary care specialties, primary care offices are often set up in more affluent neighborhoods where the reimbursement levels are higher. These location selection decisions are often out of the hands of individual doctors and dictated by corporate, profit-driven health systems.

This suburbanization of primary care medical services has had a terrible effect for Detroit’s residents. WalletHub recently ranked the City of Detroit as the least healthy major city in the United States, ranking 150 out of 150.

After the WalletHub list was published, the former Health Department Director was quoted in a Detroit News article: “Detroit health chief Dr. Abdul El-Sayed wasn’t surprised with the results, which he blamed partly on the lack of doctor’s offices in neighborhoods, healthy food stores, transportation and safe places to exercise.”

But, there is hope. The longstanding work of free and low cost clinics like CHASS, the Student Run Free Clinic, HUDA, and Joy-Southfield Clinics should be acknowledged. It is also encouraging that the Michigan State University of Osteopathic Medicine Popoff Clinic on Mack Avenue on the East Side is complimenting these stalwarts. Additionally, a Direct Primary Care service, Plum Health DPC, in Southwest Detroit/Corktown is providing another option for Detroit residents.

Finally, as Downtown, Midtown and New Center become more sustainable, primary care services should begin to take hold with potential spill over benefits for adjacent neighborhoods.

Paul Thomas, MD

Family Medicine Doctor with Plum Health DPC

Thank you for reading, and have a wonderful day,

- Paul Thomas, MD

A newspaper clipping from this Sunday's Detroit News about health care and health disparities in the city of Detroit and the potential solutions to address them. 

A newspaper clipping from this Sunday's Detroit News about health care and health disparities in the city of Detroit and the potential solutions to address them. 

Medical Equity Conference

Yesterday, I attended the Inaugural Health Equity Research Conference at Wayne State University. It was held in the student center and brought together several stakeholders in Detroit. The day began with several excellent presentations from undergraduate students and medical residents, ranging from Sickle Cell Anemia to Hearing Aids and Alopecia related to Chemotherapy.

After, a panel was held that brought together some thought leaders in the public health sphere, including:

  • Dr. James Blessman, who spoke about the Citizenship Report card and the importance of eating more healthy foods, as in the Nutritarian Diet. 
  • Dr. Michele Cote, of the Karmanos Cancer institute who spoke about Lung Cancer screening 
  • Dr. Wassim Tarraf who discussed being a statistic himself, as an immigrant and adopting some of the unhealthy practices of living in America, like an unhealthy diet. 
  • Dr. Dawn Misra - of the Wayne State University Department of Family Medicine and Public Health who has an interest in perinatal health disparities. 
  • Julie Comstock-Gleason, who spoke about the importance of community health and community health workers as experts who know the community well. Currently, she's working on a project about heart health by building community health awareness groups and asking individuals to write themselves letters about what it means to be heart healthy. 
  • Dr. Phillip Levy is an emergency medicine physician at Henry Ford hospital and he discussed transformative moments in his career while taking care of patients in the emergency department at Lincoln Hospital. One of his quotes that stuck with me is when he referenced Roemer's law, or the idea that in an insured population, a hospital bed built is a filled bed. This means that whenever we as a community decide to build a hospital bed, it will not sit empty. This lead to further commentary about treating people who are ill rather than taking care of people so they remain healthy. 
  • Dr. Abdul El-Sayed, formerly of the City of Detroit Health Department, now making a run for Governor of Michigan had the audience repeat the definition of Public Health. Public Health is what we as a society do together to create healthy conditions. He also discussed how resources that keep people healthy are not evenly distributed. He noted that 40% of Detroiters don't have reliable access to transportation, creating an environment where people are not able to access basic services or meet their basic needs. 
  • Dr. Kim Jaffee of the School of Social work at Wayne State University discussed a pregnancy and nutrition surveillance system. Her team looks at the macro factors that affect pregnant women. She also is interested in low birthweight babies and the disparities in infant mortality rates between different communities. She is now examining the health disparities in the transgender community. One statement that she made that stuck with me is that Transgender patients who have to teach their doctor about who they are and what it means to be transgender are 3x's less likely to access care when they need it. 

Health Equity is a big reason why we do what we do at Plum Health. We lower the barriers to excellent primary care services by making healthcare more affordable. We lower the costs of medications and lab testing by delivering these services at cost, saving our patients thousands of dollars each year. If more primary care doctors are able to practice in this Direct Primary Care model, we could truly make healthcare more affordable and accessible for all people. 

Thanks for reading and have a wonderful day,

- Paul Thomas, MD

Vaccine Finder

Recently, I wrote a blog post about getting your flu shot! #GetYourFluShot And when I was reading articles on the CDC website, I came across Vaccine Finder. Vaccine Finder is a nifty online resource that allows you to enter your zip code to find the nearest clinic or pharmacy that dispenses vaccines.

It lists the basics like the address, phone, hours of operation and website. In addition, as the clinic or pharmacy owner, you can enter in the price of the vaccines that you dispense. As a Direct Primary Care clinic with transparent pricing, we did just that! You can see that our Influenza Vaccine costs $10.53, our Hepatitis A vaccine costs $68.42, and our TDaP vaccine costs $47.47. 

Another cool feature is that you can use the website to hail an Uber to get you to the vaccine dispensing location! 

FYI, we're in Corktown/Southwest Detroit, and if you enter in our zip code (48216), we will be the #1 result! 

Thanks for reading, and have a wonderful day, and #GetYourFluShot,

- Paul Thomas, MD

Volunteering at Cass Clinic

Volunteering in the community is an important part of what I do as a doctor. I enjoy helping medical students learn the basics of primary care and serving the community in this way.

This week, I'm at Cass Clinic for their Saturday Morning clinic. It's in Detroit's Midtown Neighborhood and they serve people without insurance, who are homeless, living in drug rehab centers or otherwise vulnerable.

I am grateful that the Wayne State University Medical Students continue to care for the community in this way as they run this clinic without much outside help. If you want to donate medication, bathroom supplies, or hats, gloves, and socks, there's a donation link on their webpage - www.cassclinic.com.

Additionally, I volunteer at the Student Run Free Clinic on the East Side of Detroit at 5555 Connor Ave, just south of I-94. I volunteer at the SRFC once a month and at Cass Clinic about once a month as well. 

I have been volunteering at the Cass Clinic since about age 17. I grew up attending a Methodist church and I was looking for unique volunteer opportunities. I came across the Cass Clinic as it is a part of the Cass Community Social Services, which is a Methodist organization. When I started volunteering, I worked with Medical Students at WSU SOM as they took care of patients in this setting. Watching these young medical students was an inspiration, and from that point on knew which medical I wanted to attend - Wayne State! 

In Detroit, just like in many communities, the needs are great. I know that a few half days a month will not save the world, but these small actions do make a big difference in the lives of the patients that we serve. 

Thanks so much for reading and watching!

- Paul Thomas, MD

February Update

Hey everybody! It's February 2nd and time for an update about our services and a little bit of an overview about what we do. January was our first full month of operation in a brick-and-mortar space and we were able to have 20 new members join the practice! We are currently located at 1759 West 21st Street, Detroit, MI.

What makes them want to join? First it's our dedication to great service. When you make an appointment, you typically get 1 hour of uninterrupted time with me, Dr. Paul Thomas. We talk about your medical history, review any records that you bring, perform a physical exam, draw any blood samples if necessary and give any medications if necessary.

The great thing about our Direct Primary Care model is that we get these labs at-cost and the medications at whole-sale prices. Our lipid panel is about $7 and our Comprehensive Metabolic Panel is about $4. Our current price for Azithromycin or a "Z-pak" is $1.15. We sell Lisinopril for about $0.40/month. Yes, you read that correctly! Forty cents for a one month supply of Lisinopril. 

I give Flu shots for $10.53, Hepatitis A vaccine for $68.42, Tetanus Diphtheria and Acellular Pertussis (TDaP) vaccine for $47.47. Our price for Metformin is $0.40/month if you take 1 pill each day and $0.80/month if you take 2 pills each day. I recently dispensed Augmentin for a skin infection for $4.82. 

If you're interested in this type of care: more time with your doctor, clear and consistent pricing, the ability to have easier communication with your doctor via text and email, you should sign up for our services.

You can either call 313.444.5630 to set up an appointment or enroll on our website, here.

Thank you for watching and reading, and have a great day!

- Paul Thomas, MD

An Interview with Dr. James Blessman

Today, I attended the monthly Wayne County Medical Society meeting. There were several topics discussed and my mentor Dr. James Blessman brought up an upcoming lecture. Dr. Joel Fuhrman will be at the Detroit School of Arts on February 2nd, 2017 at 6 pm (doors at 5 pm). There's more information at this link. Full video of the interview is below!

During the meeting at the Wayne County Medical Society of Southeast Michigan, several topics were discussed. Currently, the Detroit Public School system stresses abstinence first in their curriculum. This does not mean that the DPS teaches abstinence only, so a group of Medical Students from Wayne State University School of Medicine came to the meeting to clarify the curriculum and obtain the Medical Society's support. 

Additionally, the Medical Society discussed burnout and health habits among physicians, the recent increase in Hepatitis A cases in Wayne County, and the recent publication of a Human Trafficking Awareness video. As for the Hepatitis A, you can receive a shot for $10 via the Wayne County Health Department in Wayne, Michigan. At Plum Health, we wholesale the Hepatitis Vaccine for about $70 and in the insurance world, coverage varies depending on which private insurance company you use.

Dr. Blessman also brought up Joel Fuhrman, MD and his upcoming lecture at the Detroit School of Arts on 123 Selden Street in Midtown. The event will be held on February 2nd at 6 pm. Dr. Fuhrman is a leading thinker in the area of medical nutrition, with several best-selling books on the subject. He has been noted to say that the foods that you should eat include the "GBOMBS", or Greens, Beans, Onions, Mushrooms, Berries, and Seeds. The main point is that you want to have more micronutrients in the foods that you consume. 

Thanks for reading, and watch the video below!

- Paul Thomas, MD