Value in a Visit

🎧 Episode 57 – "Value in a Visit: A Doctor Becomes the Patient"

Hey, it’s Dr. Fred Bagares. In this episode, I share my recent experience as a patient in a traditional insurance-based clinic—something I rarely do since switching to direct care practice.

I went to see an ophthalmologist for some concerning floaters, and the visit made me reflect deeply on what value truly means in a medical encounter. As someone who's worked hard to build a personal, relationship-driven practice, it was eye-opening (pun intended) to sit on the other side and witness a very efficient—but impersonal—system at work.

If you’re a physician, patient, or just someone curious about what truly matters in healthcare today, this episode will give you a lot to think about.

🕰️ Episode Highlights & Timestamps:

• [00:00] – Why I saw an ophthalmologist (and what triggered the visit)
• [01:00] – First impressions: busy waiting room, multiple waiting areas
• [02:00] – A step-by-step walkthrough of the visit logistics
• [03:00] – The actual medical encounter: 7 minutes with the doctor
• [05:00] – Breaking down what I paid for vs. what I experienced
• [06:00] – The disconnect between medical quality and emotional experience
• [08:00] – What patients value in healthcare vs. other service industries
• [09:30] – Why the human side of care still matters—barbers, vets, and doctors alike
• [10:30] – "Price is what you pay. Value is what you get."
• [12:00] – How direct care models offer a more meaningful patient interaction
• [13:00] – Rehab isn’t transactional—it's relational and nuanced
• [14:00] – Why insurance-based systems often fail both patients and clinicians
• [15:00] – A challenge to both patients and physicians: What are you going to do about it?

This was a personal one. It reminded me why I started MSK Direct in the first place—to offer something better than a system that often prioritizes process over people. If you’re fed up with 7-minute visits and checked boxes, this episode is for you.

👉 Don’t forget to like, subscribe, and share if this episode sparked something for you. Let’s keep the conversation going about what healthcare could and should be.

Would you like a matching Instagram caption or quote graphic to promote this episode?

Transcript

0:00

What is rehab or rehabilitation? My name is Fred, be Garris, 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. I. 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. I've been practicing direct care for approximately a year, and fortunately I am very healthy. I rarely go to the doctor. but I've been having some floaters recently and I saw my local optometrist and they got a little bit worse recently, so they referred me to go see an ophthalmologist who is actually out of network. So I thought it'd be A cool talk today to describe my experience. so I went to the local ophthalmologist. it was fairly easy to get an appointment. and As soon as I checked in, There were a lot of people, the waiting room was full to the point where there was actually people out in the wait, the hallway. I. Okay. And once I checked in, sat down and it took about 40 minutes for me to be called back, which again is fairly typical. That might actually be early. I've had some patients say it takes about 60 minutes to get called back, but eventually I was called back in. This was kind of interesting. They actually took me back to a separate waiting room area. and so I waited there for maybe another 10 minutes and then one of the staff grabbed me to start taking some measurements, of my eyes and. Eventually they dilated my eyes. Once they did that, they brought me back out to the waiting area, to give it a chance to work. so I'm now back in the original waiting area and maybe about 10 minutes later, they brought me back into the treatment room. Where I was met with, one of the scribes, the scribe was taking some general demographic information and then the physician eventually came into the room and automatically, said, greeted me, but started looking at the images, of my retina and, while they were. Looking at the images they were narrating to describe the findings. And then they turned their attention towards me and started asking me some specific question about the floaters. Essentially it was about two to three questions. I just really wanted to know, some basic stuff. and then they walked out. It was maybe about a. seven minute visit, after the ophthalmologist walked out, the scribe continued to, work and eventually brought me out to the checking ar they brought me out to the checkout area. I got my receipt, and then I wa and then I drove home. overall I wanted to talk about my takeaways from the visit because I've been practicing direct care for about a year, and as a business owner, I try to create a certain type of experience for my patients and. I think it's actually a really good exercise for physicians to think about, the business aspect. Because aside from paying for the lights and the utilities, you obviously do have to think about your customer, which is the patient in this particular case. So these were some of my takeaways. overall the scheduling process was fairly easy. the check-in process was, typical. but I paid upfront as opposed to paying, like a$50 copay, because they're out of network. I paid them upfront. I believe it was like 300 and maybe$310 or so. It was an efficient visit. I think that's the, that's one of the main takeaways. It was very efficient. aside from the waiting time, but that's expected when you're, when you have a high volume clinic. but aside from that, once I got going, it was fairly efficient. the physician seemed to be fairly thorough. got in and then got out. I had all my questions answered. Checkout was smooth. Now that being said, I didn't really come away with a great feeling, from the visit and I was trying to tease apart why that was. I think some of it has to do with my obvious perspective. at, if I was a patient in the insurance based system, I would say that was actually a pretty good visit. But someone who is in the direct care space and as a physician, you have to look at things from your consumer standpoint and. Essentially I paid$310 for an insurance based experience. and that's what a copay will get you. And when you are participate with insurances, they really just pay for the visit if you met your deductible, so on and so forth. But. the clinic itself was really organized as an insurance based experience because that was the higher volume I can only assume, right? So my main takeaways from the visit was I'll call it efficient. I think, end to end, it was a fairly efficient visit. Aside from the waiting time prior to being called back, which is pretty typical, I think 30 to 60 minutes in an insurance-based practice Is the standard. but once I got back there, I was moving along from person to person, I believe I received, good medical, attention. they did seem to be very thorough in terms of, looking, At the images and the actual examination, but I left there feeling like I wasn't the focus of the actual visit, and meaning that it almost felt like there was just so much more effort placed on getting. patients from place to place, which again, is important, to be respectful of patient's time. But even in the time that I was there with the ophthalmologist, with the scribe, they really didn't pay much attention to me. It was almost like if the images were in the room and I was at home virtually, I would probably feel like I got the same amount maybe. It might actually even feel like I got a better experience because at least with a virtual visit, like you're forced to actually have to look and talk to the person. but during this visit, you know, a large portion of the effort of the staff and the physician was really looking elsewhere. of course they're, paying attention to the work. That had to be done, but, it didn't really feel great. I think at the end of the day, from a patient standpoint, but it does make me question, what is it that a patient or a consumer wants out of? A medical visit versus another type of visit. So if I hired a power washer, if I hired a plumber, I think I would appreciate and value different things. being on time, being responsive, I don't think I would be as concerned about eye contact and, being friendly and the back and forth. if they were just silent and just did the work, I think I would be okay with that. but I don't know if that's necessarily the kind of experience I wanted out of, dealing with another physician. Or being treated by a physician. I personally don't think that is the experience that I was hoping for or that I think I would like to pay for. I did get their expertise. They did a lot of testing. They did, the imaging piece of things. But at the end, it didn't really feel like I was being paid attention to, so it just, it felt very impersonal, very transactional. And so that left me with the question, is this an essential piece of the healthcare experience? Like should patients feel It is personal. I think it's sad to say, but is that important to everybody? It might not be important to everybody. so I hesitate on calling it the standard of care, but, we are humans. I, again, thinking of other expectations, taking my dog to the veterinarian, I do observe. How the vet interacts with my dog, but a lot of the interaction is really still with the human. even when you bring in a pet, the interaction between the humans I think is what, as a consumer I value. If I had a veterinarian that was great, but I didn't really feel like they were connecting with me, the owner, I think that goes a certain way. another profession is. being a barber, or even a hairstylist, there's obviously the skill piece of things. There's the experience piece of things, but then the human aspect is huge. you're sitting in someone's chair for presumably, 20 to 60 minutes. the banter, the friendliness does go a long way. I've definitely had my share of. like b plus, haircuts over the years, but the person I was getting the cut from kept me coming back, and it I don't wanna say it offset, the work, but it definitely made me want to see them and give them my business. So it almost comes down to that old Warren Buffett's saying of, price is what you pay, value is what you get. And, I paid a premium, I, I went to an insurance-based clinic and I paid a premium, and I don't expect to pay a premium, go to an insurance space clinic and get a premium experience that, that's not what I'm saying. I, if anything, I think that the, everybody should receive, the same level of good care. And again, the point of today's episode isn't necessarily to point out, whether I received good care versus bad care is really just the experience of. Re-experiencing the healthcare exchange as a patient, but as someone who has opened up their eyes to another model of healthcare, which is direct healthcare. in terms of the value, again, I don't wanna say I paid a premium, but I just don't think that. It felt different, that the value just wasn't really there. and again, not for everybody. it's, I think the boxes were checked, but just the personal interaction I think for me is a big part of the value. and one of the main reasons I opened up my own practice wasn't necessarily just to break away, but was to deliver, the level of care and the type of care that I felt comfortable with. it's one of the reasons why I left, the insurance based model, was that I couldn't practice the way that I saw fit. It just was not sustainable in that particular model. but. I guess it's really a personal preference, until you actually experience a different type of healthcare model. I guess most people are, don't really know what they don't know. maybe your current experience is what you prefer, maybe it's not, but. again, it's one of the main reasons I opened up this practice was to show the public show patients that there is a different level of care I. And that's available, that's being provided to the community, especially when it comes to musculoskeletal medicine because, I saw an ophthalmologist and obviously their system is just the eye, but if you've ever had an injury to the neck, the back, the shoulder, the elbow, sometimes you're seeing 2, 3, 4 different specialists before, they actually have all the diagnostic imaging complete. And then at the end of that, they still don't exactly know what's going on. Again, I think that this is an important conversation to have specific, especially when it comes to rehabilitation, because rehabilitation should not be a transactional experience. this is not a situation where a mole is being removed. there when it comes to rehabilitation. There is a lot of counseling involved. It's not, the problems aren't always, I don't want, I don't wanna say simple, but they're not always, the outcomes aren't always defined and things aren't always predictable. nothing is in medicine, but I think rehabilitation, pain conditions is probably one of the top of the lists of, Why people go to the doctor, why people go to the emergency room, dollar spent, things like that. And I truly believe that if the person caring for the patient, develops a relationship with'em. That the overall outcome is going to be better, and I believe a large reason why it's better is because of the human interaction that's going on. I think the last thing I, as I said, I think it's vital at this point. The more I talk to patients they're not really happy with the way that healthcare is going right now, and while we'd like to blame it on insurance and, venture capital and so on and so forth, on some level it's, we have to look at ourselves. If you're a physician out there not happy with your situation, you're burning out on some level, what are you gonna do about it? Yeah, same thing. If you're a patient and you're looking at, the current level of insurance based care you're receiving and you're looking at alternative care, but that alternative care doesn't accept insurance, it comes at a higher cost. What are you gonna do? the system is not going to get better. There is no incentive for the insurance companies, the. Pharmacy benefit managers, the pharmaceutical companies, the hospitals, there is no incentive for them to change. They are all profiting. So again, just a different, just wanted to share this episode with you guys. or at least my personal experience, and I. Overall, I got what I needed. I feel like I, I can follow up with them in the future if necessary. And, I think my medical needs were met. It just, I think it just was really the personal interaction piece that was missing for me. And, not to say that they didn't try very hard, but it just seemed, again, like most of the effort was more on the process than the actual person. So if that matters to you, then definitely start looking around for other clinicians in your area that believe in a different level of care. at the end of the day, I just want my community to know that there is a different way of doing things. Thanks again for listening. See you next week. 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.