The last thing I said to my One Medical physician on a recent call to discuss my Covid illness was this: “I know you’ll be quitting within months, and you won’t be able to tell me where you are going. I’m going to hunt you down and find you. You are the only reason left for me to belong to One Medical.”

Sure enough, I received a mass email from my physician on Monday informing me he’s leaving One Medical February 15. “I’m sorry that I’ll no longer be able to serve as your primary care provider — it’s been a pleasure caring for you!” he said.

My physician has never shared one personal detail with me. I don’t even know where he’s from. He never gave even the slightest hint that he was unhappy working at One Medical. All I know his medical degrees are from prestigious schools and that he trained at top-tier hospitals.

Then how was I so sure he’d be gone within months?

Here’s how: The best physicians don’t appear to want to work at One Medical.

This is my third commentary about One Medical, a money losing, fast growing McMedicine chain offering primary care “provider” services in about a dozen cities. The first commentary, published on November 20, 2019, gushed about the excellence of the physicians who treated me and the superior quality of care I received. I featured three physicians and I urge you to look at the commentary just to view their photos. Here’s a link.

I’d estimate that the three physicians I showcased had more than a half century of experience between them. All three docs are long gone from One Medical.

Here’s a link to my second commentary, published less than three years later, headlined “Amazon’s Toxic One Medical Acquisition.” Whereas I was once One Medical’s biggest cheerleader, I’d soured on the company with a vengeance. In my experience since my second One Medical posting last July, the company has declined further.

Amazon was supposed to complete its $3.9 billion takeover of One Medical last month, but the deal is possibly being held up because it was disclosed that the FTC had requested “additional information and documentary materials.” Don’t hold your breath the FTC will move to block the deal, despite President Biden’s edict last July calling on regulatory agencies to get tougher on healthcare mergers.

After Biden issued his edict, the FTC allowed Grand Rapids-based Spectrum Health to acquire  troubled Beaumont Health in suburban Detroit, despite a public warning from Spectrum’s former CFO that the deal had “the potential for massive financial loss.” I can recite more than a dozen other reasons why that deal should never have been allowed.

Lina Khan/FTC photo

The FTC is a troubled agency that’s suffered a brain drain under the leadership of Lina Khan, a 33-year-old Ivy League academic who’s reputed arrogance and inexperience reportedly was responsible for veteran FTC staffers jumping ship. That said, Khan previously was a vociferous Amazon critic, so much so the company asked that she recuse herself from any antitrust probes of the e-commerce giant because of prior bias. Even if Khan moves to derail the One Medical deal, I’m doubtful the FTC still has the legal firepower to take on Amazon’s lawyers in court.

San Francisco-based One Medical was founded in 2007 by a tech entrepreneur who — surprise, surprise — was looking to disrupt primary care. The company inked a deal early on to provide primary care services to Google employees, giving it instant cachet with tech geeks who loved they could book their appointments online and other technology flourishes One Medical offered.

One Medical went into aggressive growth mode in 2017 when Amir Dan Rubin took over as CEO. Rubin is the Tom Brady of upscale healthcare management. Prior to joining One Medical, he was president and CEO of Stanford Health. I used Stanford Health when Rubin ran the place, and I’ve likened the experience to what I’d expect from Ritz Carlton if that company ran a hospital. Earlier, Rubin was COO of UCLA Health, another A-list hospital system.

Although I was underwhelmed with the initial physician I saw at One Medical’s Beverly Hills office, when I called to cancel my $199 annual membership the company promptly issued a refund but asked that I give them a second chance free of charge. I agreed, and I was blown away with my One Medical experience in my initial years.

My primary care physician was an affable Midwesterner with considerable experience, including working at a respected medical device company. As the physician also had considerable management responsibilities, it was sometimes difficult to get an appointment with him, but there were other well credentialed doctors on staff, and I was comfortable seeing them.

Another great One Medical benefit was that if you had a medical question or needed a prescription refill, a physician assistant promptly responded, usually within minutes.

I’m blessed not having to see physicians often, so I’m not certain of the timeline of the turnover. I just know that one day when I needed medical care, my primary One Medical doctor was gone, and so were all the other physicians I had trusted and relied on. In their place were overwhelmingly physician assistants and nurse practitioners. The credentials of the few physicians I saw listed in the Los Angeles region didn’t inspire trust or confidence. One of them not only attended a medical school I was unfamiliar with it and it was located in a country I never heard of. The few listed physicians had limited experience and all the listed “providers” were without exception attractive, a few looking like models.  Made me wonder if good looks were a One Medical hiring prerequisite.

PAs and NPs will tell you they are just as good as MDs and DOs, and some claim to be even better. If you want to believe that someone with about 3,000 hours of clinical training is just as well trained as someone who underwent 15,000 hours or more of clinical training, then you’ll love where medicine is headed. If you’re old school like me and believe there is no substitute for training and experience, then consider this a wakeup call that Alexa won’t give you.

Of this I’m certain: any lay person who reads “Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare,” will share my reluctance to see a NP or PA unsupervised by a licensed and experienced physician. The limited training some NPs and PAs can undergo to get licensed is frightening. My review of the book can be found here.

Niran Al-Agba, the book’s co-author, is a fearless pediatrician whose been vocal in her criticisms about St. Michael’s Medical Center (SMMC), the hospital serving her suburban Seattle community that made national news last fall when a nurse was forced to call 911 because the hospital ER didn’t have sufficient staff. Al-Agba figured prominently in this feature I wrote about the incident.

One Medical is losing money, and possibly has always been drowning in red ink. Amazon agreed to pay a huge premium to acquire One Medical, and the e-commerce retailer will need to quickly staunch the losses and make the chain profitable. Amazon’s focus will be to cut costs, and it won’t accomplish this recruiting experienced physicians who graduated from Stanford, Johns Hopkins, University of Michigan, and other prestigious medical schools.

The truth is there isn’t a sufficient supply of even mediocre physicians available to meet the growth aspirations of Amazon and other retailers who want to enter the primary care space.

Amir Dan Rubin

Walgreens is opening hundreds of doctor-staffed clinics through its $6 billion investment in the primary care company VillageMD, while CVS is hoping to add some real doctors at its MinuteClinics that are currently staffed by nurse practitioners. If Amir Dan Rubin couldn’t maintain the high physician quality standards for which he initially strived, there’s no chance that Walgreens, CVS, or Amazon can do it. Obviously, primary care isn’t a business that’s easily scalable.

One Medical’s response times to medical questions has declined significantly as the company has expanded. I expect Amazon will offshore the function, if One Medical hasn’t already.

Rubin is supposedly staying on after Amazon completes its acquisition, but I expect that within a year or so of the deal closing, he’ll get a sudden hankering to spend more time with his family. Rubin’s estimated net worth is at least $138 million, much of it from selling nearly $100 million of One Medical’s parent company stock. Rubin staying around to work in Amazon’s healthcare business strikes me as akin to Los Angeles Rams coach Sean McVay moving to Regina to become coach of the Saskatchewan Roughriders.

There are some who argue that technology will allow NPs and PAs to up their game, relying on algorithms instructing them what to do when patients present their conditions. I’ve had my fill of technology promises, particularly in healthcare, where the latest and greatest tech often doesn’t work. As an example, when I was at UCLA Health Monday for a follow up on my prostate procedure last year, it took the technician four attempts to get a blood pressure reading. When I became alarmed after the second failed attempt, the technician told me it was a new piece of equipment that repeatedly wasn’t working properly.

UCLA’s radiology department is an example of responsible use of physician assistants. Before I saw the interventional radiologist who performed my prostate procedure, a physician assistant spoke with me to review a questionnaire I filled out. The PA’s job was to identify possible areas of concern and brief my physician before he met with me. But it was my physician who reviewed my results with me and made certain I understood them.

Politicians on both sides of the aisle pay lip service to addressing health care costs and the declining standards of patient care, but it’s all for show. A report earlier this year from Physicians Advocacy Institute and the consulting firm Avalere found corporate entities increased their ownership of doctor practices from 2019-2021. The only politician I’ve found expressing concern about Amazon’s One Medical acquisition is Sen. Josh Hawley. It’s a safe bet that we won’t be reading about Hawley’s concerns on the op-ed pages of the New York Times.

Seeking Alpha

My expectation is that as primary healthcare is consolidated into a half dozen or so corporate hands, we will see practices like what the major airlines did when they eliminated competition. In due course, patients will have to pay extra to see a physician, rather than a NP or PA “provider.” Then charges will be introduced to see more experienced providers. Rest assured, patients will be billed a “technology charge” for the devices NPs and PAs will increasingly rely on.

Even the wealthy will be impacted. When concierge care was first introduced, only the best credentialed physicians could get away charging premium fees to access them. My primary care physician at Stanford Health was a rock star; he left to go into concierge care and if I’m not mistaken headed up Stanford’s medicine-for-the-rich operations for a time. But I’m increasingly hearing of physicians of no distinction charging concierge fees for their services. They can get away it because the alternative increasingly are places like One Medical or going to an Urgent Care center, some of which are owned by private equity firms and also employ NPs and PAs.

Private equity firms running Urgent Care centers staffed by NPs and PAs. What could possibly go wrong?

Speaking of Urgent Care, I recently raised a ruckus at a Cedars-Sinai outpost when I insisted on seeing a physician, after being told I’d be assigned “to the next available provider.”

As for One Medical, my physician in his email recommended four individuals. One was a PA, one graduated from a medical school I never heard of, one was too much of a virtue signaler for my liking, and one, despite seemingly good credentials, struck me as a tad too New Agey. Notably, I’d estimate the combined years of experience of all the recommended providers was less than any of the One Medical physicians I hailed in my first commentary.

One Medical also is a virtue signaler. It appears that all the company’s providers, at least in Los Angeles, are expected to list their preferred pronouns. I long for the days when seeing physicians for medical care was the rule, not the exception, and we referred to them as “Dr.”

I vowed when I last spoke to my departing One Medical physician that I’d track him down. I will make good on that promise. Hopefully, there are no legal reasons preventing him from treating me when I do.

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