There were a few sources of inspiration for my practice.
The local food movement in Vermont
Previously, I worked for a big-system hospital, and mandates, regulations, and demands increased every year. How patients were treated was looking more and more like a factory process. At the same time in Burlington, Vermont, I was watching the food culture go the other way. Organic and local food was exploding. It was grown more thoughtfully and there were far more options than the old factory-food system. Great ideas often move from one area to other. I think medical care can learn something from the local food movement.
The craft brewery movement
The craft brewery movement is instructive on an entrepreneurship level. In the 1970's President Carter de-regulated parts of the beer industry and allowed home brewing. Almost overnight, individuals began to experiment. Those individuals often grew into small breweries and then mid-sized breweries, chipping away at the dominance of the goliaths while giving people choices. Today we have amazing beer like Rock Art Ridge Runner.
The cell and smart phone industry
40 years ago, Motorola employee Marty Cooper made the first cell phone call, and President Lyndon Johnson became the first, most famous user of car phones. Much like the early days 20 years ago of concierge medicine, cell phones were expensive and used by a small group of early adopters. But cell phones, now called smartphones, followed the classic innovation diffusion curve, and as they did, prices dropped and quality exploded.
The same thing is happening today in concierge internal medicine.
My husband Dan Cunningham has started and built businesses his whole life. Listening to him, I realized some of the innovations other industries made years ago have been ignored by health care. For example:
- Appropriate technology. In economic development, there is an ideology known as "appropriate technology," which means that the cheapest tool that still gets the job done is the best one. Appropriate technologies are small-scale, labor-intensive, efficient, and locally-controlled, according to non-profits and academics, and do nothing more than meet people's needs.
- Market disruption. Small companies, small non-profits, and motivated individuals almost always are the ones that create the type of disruptive innovation that shakes up an industry, introduces new ideas, and improves people's lives. Without the ability for small players to enter an industry, it bogs down into a morass of inefficiency, higher prices due to consolidation, and customer neglect. This is what has happened to health care today.
- Models like concierge medicine can unite different parts of the political spectrum because they are the grassroots emergence of an anti-rentier agenda, where smaller practices start to offer people an alternative to the monopolistic, management-heavy, siloed industry that is health care today.
My husband had the experience as an entrepreneur and I had a burning desire to improve health care for the middle class. As patients of mine told me they were paying well over $10,000 dollars per year in insurance premiums, it was clear it was time to act.