Direct Care: My Vision for Patients

Hey everyone, it’s Dr. Fred Bagares. In this episode, I take you behind the scenes of my recent trip to the 2025 Free Market Medical Association Conference in Oklahoma City. This wasn’t just any conference — it helped reignite a spark I’d been missing for a while. I reflect on how my path shifted from traditional medical associations to embracing the direct care model, and how stepping away from the status quo has brought both pushback and empowerment.

If you're a clinician frustrated with red tape, or a patient tired of navigating insurance barriers, this episode is for you. I share why I believe the future of healthcare lies in returning to a direct relationship between the patient and provider — and what it felt like to be in a room full of people who actually get it.

🔑 Episode Highlights & Timestamps:

• [00:32] – Why I stopped attending traditional specialty conferences
• [01:55] – Burnout, red tape, and the moment I needed change
• [02:47] – Enter the direct care model: a shift in purpose
• [04:07] – Attending the PM&R conference but feeling uninspired
• [05:02] – First impressions of the Free Market Medical Association Conference
• [05:52] – Who was in the room and what made it different
• [06:33] – Everyone agrees: the system is broken
• [07:00] – Learning about the players behind insurance-driven care
• [08:03] – Feeling seen, understood, and validated
• [09:07] – The skepticism (and quiet curiosity) from my peers
• [10:00] – My telemedicine startup before COVID — and how no one believed in it
• [10:40] – The more people doubt me, the more I know I’m onto something
• [11:04] – Where are the national conversations about healthcare delivery?
• [11:56] – A room full of innovators and disruptors
• [12:12] – Meeting future physicians: students who want to think differently
• [13:00] – Expanding Talking Rehab to cover more on direct care
• [13:04] – What direct care really means to me

This one is straight from the heart. If you're thinking about doing things differently — whether you're a doc, a student, or just someone who wants better care — I hope this gives you a little motivation. Thanks for listening and letting me share this journey with you.

📲 Follow me for more:

• Instagram: @drfredbagares
• YouTube: Dr. Fred Bagares
• Linktree: linktr.ee/drfredbagares

#DirectCare #HealthcareReform #TalkingRehab #FreeMarketMedicine #PMR #Physiatry #MedicalInnovation #PatientFirst

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Transcript

0:00

What is rehab or rehabilitation? My name is Fred Begaris, a board-certified sports and spine medicine physician in Virginia Beach, Virginia. After 10 years of practice, I still find musculoskeletal medicine both fascinating and challenging. This podcast is about the lingering thoughts and questions I've had after residency and fellowship. My hope is to spark discussion, challenge dogma, and share my experiences in musculoskeletal medicine. Welcome to the Talking Rehab Podcast. I just got back from the 2025 Free Medical Market Association Conference in Oklahoma City. It was my very first time going to this type of conference, and I wanted to give you a little bit of a backstory as to how I ended up there. I've been very active in my academy for my specialty, which is physical medicine and rehabilitation, for several years. A lot of times, for many years, I went to the conference for a multitude of reasons, education, networking, but more importantly, a nice little breakaway from the day-to-day grind of work. I started volunteering my time, doing work, and I was super passionate about it, particularly when it came to medical student and resident education and advocacy. And I went there consistently for several years, starting as a fourth-year medical student, all the way up until maybe my second or third year of clinical practice. And then once I switched over to a different business model where I opened up my own company and my employer was no longer paying for my membership, I started to question what value I was getting from going to these type of conferences. Not to say anything bad, but in terms of from a personal standpoint, I was now at a different career point in my clinical career, where education was great, practicing was doing pretty good. It became a little bit mundane, so I started looking for other conferences to go to. And over the course of about seven or eight years, my career changed tremendously as I went from job to job. And this was the time when I started to develop my own business plan and started looking at a direct care model where I take the insurance company out of the equation so that I can provide better care for my patients. And that was a whole journey in and of itself. And I decided I'll probably do a episode on that separately. But the long story short was my passion for clinical medicine has always been there, but it's been starting to wear down due to the day-to-day burnout from clinical practice and battling insurance companies, battling administration and red tape. So I decided to go back recently because it was almost a decade since the last time I was there, not necessarily for the clinical aspect of things, but I was, I wanted to look for inspiration, essentially. Could an association, any association support my current passion, which is direct care access for patients through direct specialty care or direct primary care? But more importantly, looking also for ideas about free market medical care. So I went to the conference from, which I did an episode a couple months ago on it. It was great, but at the same time, I kind of left it missing something because the focus of the conference was really mainly about the clinical aspect of things. There was some business aspects of it, but I didn't really come away feeling inspired or with any new ideas. And from a clinical standpoint, I also wasn't really learning anything new, which was something that I had always enjoyed. But I stay up to date with the current research and I'm always looking for innovation and I didn't see anything new that I hadn't read before. And I definitely didn't see any new innovations or a space for innovation to be created. So it seemed like a very typical format that just didn't really interest me. It was, I loved seeing my old colleagues and friends and things like that, meeting new medical students. Because that's always been a passion of mine and that part was great. But I recently went to this three-day conference in Oklahoma City, the Free Medical Market Association. Overall, it was a great experience. The hotel was great. The accommodations were great. But just the general vibe of the conference was just amazing. I think it had to do with the composition of, or the people that attended this particular conference. Usually the conferences I've attended have always been mainly clinicians. But in this particular case, it was a variety of people that attended. There were certainly clinicians, physicians, physician assistants, nurse practitioners. But there were also other vendors, people who were insurance brokers, third-party administrators. There was a lot of employers. And the whole premise was, or the whole feeling of everyone there was that the system is broken. And that is the healthcare system and its intersection with clinical care and the insurance business. And essentially, it is broken, it's corrupt, and everyone there acknowledged that as the problem. And we all worked towards solutions. So just looking at the agenda of all the different lectures, they were all looking for solutions for the future. Because the unfortunate truth that everybody realizes is that insurance-based model of healthcare is not working. It's very expensive. Patients aren't very happy with the level of care that they're receiving. I learned at this conference that a lot of employers are looking for alternatives to an insurance-based model because the premiums are just simply going higher and higher. Unfortunately, I also learned about the corruption, essentially, that's going on multiple levels of healthcare delivery and insurance. So that was, I think, important for me to know. I didn't want to get too much into the weeds there, but I got just enough to essentially learn who the players are in the game. And now I have some direction on what to look out for, how to provide care. If anything, I came away with essentially feeling empowered. When I go to some of these other conferences or talk with local colleagues, they simply don't get what I'm doing. They look at me as someone that's outside of the box. I'm just trying to make money, so on and so forth. But I never, for me, medicine was never really about money. And the reason why I created my direct care clinic was basically to reestablish my connection with patients. That's what has been my North Star, is providing excellent care directly to the patient. Anything and anyone that is between me and my patient is a distraction. It's just as simple as that. I don't need to call it corruption. I don't need to point fingers. I just simply look at the equation as me plus direct patient access equals quality. That's just what I believe. So this is exactly why I opened up my practice. But going to other conferences and talking with colleagues, I just didn't really get that same energy. If anything, the truth is that a lot of people are very, essentially, they weren't necessarily supportive of my views and what I was trying to do. They politely just said, oh, that's nice. But I know I read people pretty well. I can tell that they're just like watching from the sidelines, slowly waiting to see if I fail. But interestingly, I also know that they are looking to see if I'm going to succeed because the unfortunate truth is that a lot of the people who are criticizing me taking this direct care model are also looking for an exit strategy. So I'm not oblivious to the fact that some of the hate that I receive is because they recognize the problem and that I'm doing something about it. And it's hard to it's hard to look at someone doing something about a problem that you have. And I simply I get it, I guess I get I'm not there to convince them that they shouldn't feel this way. But if anything, I look at the hate or the the lack of support as motivation, because it seemed I've always had really very innovative ideas. And whenever I brought them to people that I trusted, they always kind of they always shot it down. They always shot they always shot it down. And a great example is the fact that I opened up a telemedicine practice prior to covid. And it completely got shut down by everybody I talked with. I guess the patients were always really very supportive. But when I would talk to colleagues, they just basically looked at me like I was crazy. Interestingly, covid tanked my business, but it was proof of concept. And that's for a different episode. But I have always had ideas that weren't always well supported. But at the same time, I've started to learn that when people don't support my ideas or the more adamant they tell me that it's not going to work. Essentially, I know I'm knocking on the right door. So it was really nice talking with other disruptors, other people who think outside of the box, other people that at least acknowledge the actual problem. I think a lot of physicians and people in the health care space, we just keep our head in the sand and hope things get better. But the unfortunate truth is that it's not at these national meetings that I go for PM&R. Again, the focus is mainly clinical aspect and other things. But at what point it does the business of health care delivery? Not even business administration, but at what point is that is that part of the agenda where we take a look at how we are delivering care? As a system and question whether or not it's actually working, it might be one or two lectures per year, but it is definitely not the emphasis. And I know that there are people out there that have been advocating everything that I've been saying right now for years. I know I'm not the first person, but it was really very nice to attend a conference where people supported one another. We exchanged ideas. There was just a general excitement. It was also great to see medical students. I met several medical students at the conference ranging from first year to fourth year, and I love talking to them. It took me back to my earlier days when I did all my medical and resident education and advocacy work. I will start to add a little bit more content about direct care as I move forward on this platform because I'm starting to realize that I have a pretty wide reach. Some of the people that have been contacting me aren't just physicians or physical therapists. I've had people that are non-medical reach out to me or give me feedback. So it's the internet. I have no idea who's listening, but I'm only glad that you guys are listening. I'm looking forward to delivering more content, not just about rehabilitation, but direct care. Direct care where it doesn't necessarily have to be a cash-based model, but it does have direct care in my mind is just any system where the relationship is between the patient and the physician first and nobody else. Thanks again for listening, guys. I hope you have a great day. Thank you for listening to the Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement-filled day. Take care.