It has been an honor to practice primary care in the community in which I grew up and where I now live with my wife and our 5 year old twins. When I made the decision to become a Family Practice Doctor, I had a vision of what I thought my practice would be like…it would be in a community similar to where I grew up; I would have personal relationships with all of my patients; I would be accessible to my patients when they need me; I would be able to spend as much time as I want with my patients; and the list goes on and on.
Over the course of the past couple of years, due to many factors, it became very clear to me that my vision for how I wanted to practice medicine was not coming to fruition; at least not in the dysfunction of the current healthcare system. I started to read about a movement in the world of primary care medicine called Direct Primary Care (DPC). DPC was quickly gaining notoriety and attention, not only in the medical community, but in the business world as well. Slowly but surely news outlets such as MSNBC, FOX NEWS, and CNN started to interview doctors who opened DPC practices across the country. The Wall Street Journal, The New York Times, Forbes, and other major news outlets started publishing articles about the DPC movement and the attention that it is getting in the medical community. The more I read and the more research I did, it became obvious to me that the vision that I had for how I wanted to practice medicine- as well as the vision that I had for how my patients deserve to have me practice medicine- could be achieved by opening my own DPC practice. I truly believe that Direct Primary Care is a large part of the solution to the healthcare crisis in this country.
After two years of doing research, attending DPC conferences, having numerous conversations with doctors who are already operating successful DPC practices, and lengthy discussions with people in the business world, I am proud to introduce you to Gold Direct Care. I am the first doctor in the state of Massachusetts to open such a practice, and I know it is the right thing to do for me, but most importantly for my patients.
Please peruse GoldDirectCare.com to learn more about Direct Primary Care. I look forward to growing my practice with you, my patients, by my side. And I thank you for allowing me the privilege of being your doctor.
Hello, I am Dr. Carmela Mancini and I have recently joined Gold Direct Care. I am so excited to be a part of the Direct Primary Care movement! Like many physicians in today’s healthcare environment, I realized that my idea of being a doctor was not possible in the current system. I wasn’t able to spend the necessary, quality time with patients; decisions were often based on what insurance dictated and not what I thought was medically appropriate; there was disintegration of the doctor-patient relationship. This is when I discovered Direct Primary Care and I have not looked back.
I am board certified in Internal Medicine and have spent the last several years as a hospitalist. Prior to medical school I received a Masters degree in Public Health and spent 5 years as a public health advocate and epidemiologist. I subsequently went to medical school at Nova Southeastern University and eared a degree in Osteopathic Medicine. I completed my residency in Internal Medicine at Baystate Medical Center in Springfield, MA.
I am very excited to be accepting new patients. Please contact the office at 781-842-3961 or email me at email@example.com to schedule a free consultation.
For those of you interested in learning more about Direct Primary Care please attend one of our information sessions at the Salem Waterfront Hotel (225 Derby Street Salem, MA 01970) on November 9 (1-3 or 7-9) or November 17 (1-3 or 7-9). Go to http://findnsave.wickedlocal.com/Local-Ads/a-634135/Gold-Direct-Care for complete details or call 781-780-2461 to RSVP.
Ever since I watched my grandfather and grandmother suffer from devastating diseases like diabetes and dementia, I have always been passionate about how we treat people at the end of their lives. With all of the technology, specialized medicine, and wonderful hospitals we have in this country we often never know when it’s time to stop using them. As physicians, we are so afraid of losing patients (i.e. failing), and death and dying in general, that we often lose sight of “life and living”. Sometimes the best medicine is to not only let people go, but more importantly to let them go on their own terms.
Yesterday, I lost of one my longtime patients and supporters- Mr. Wilbur Basset at the age of 89. (I am using his name and picture with permission from his family.) Wilbur and I met when I first moved to practice in Marblehead 8 years ago. What struck me about him was both how healthy he was for an older man, and even better how incredibly sarcastic and funny he was. I always enjoyed that he was for lack of better terms “a curmudgeon”. He never complained unless something was truly bothering him. It took 8 years, and me removing myself from the factory mill of modern day healthcare in order to move to the Direct Care model, for me to actually meet his family and spend time with them. I am so glad that they stuck with me and gave me the chance to show them what medicine can be like.
Unfortunately, over the past few months Wilburs illness and condition worsened. I saw him in the office with his daughter a few weeks ago and I could tell that he was declining. Given how stubborn he was, he always fought through stuff, but this time he just looked different. As I helped him in the car he said “I am so ‘blanking’ done with this.” I just knew he was ready. So after his daughter and I had a great chat about consulting with Hospice, he sadly ended up in the hospital before we could get the consultation scheduled. When I visited him there I could see how miserable he was. After a week or so, which of course included a few unnecessary consults, he rapidly worsened and was transferred to the Kaplan House where he peacefully passed away with family by his side after a day. Fortunately I got to say my goodbye to him yesterday.
As a system, we have to do better for patients like Wilbur and their families. We must do better. For me, I will always remember him the way he was a few weeks ago, and I will always be thankful to have had the opportunity to care for him and his family through his journey. I may not be a specialized surgeon or a cancer specialist, but I am so thankful that Wilbur and his family went Direct Care with me and granted me the most gratifying job in the world. I was his doctor.
Rest in peace Mr Bassett. You have earned it and did it on your terms.
I want to dedicate this entry to my now 6 year old twins- Cameron and Isabella. It is amazing to me that time is going by so quickly and that you two are already 6 years old! It seems like just yesterday we were learning how to give you your first baths, and now you are in Kindergarten learning how to write and count. You are now talking back instead of just screaming….although often there is still some screaming. Your are playing soccer, learning how to skate, tumbling, building legos, and all of these other amazing things that are so enjoyable to watch. Yet, most importantly, you are constantly inspiring me to be a better person.
You are a significant part of the reason why I left a well-paying job as an employed physician to put us in debt and start this practice. I know its often hard when I am working many hours trying to take care of patients or working to grow this business, but I want you to know that you are why. I love when when you both ask questions like “how was your patient?, are they ok?, did you get any new patients today?” It shows me that we have taught you to care! In the crazy world we live in we are often bombarded with ugliness and what people are doing wrong. I want you to have a dad who shows you what is right. I want you to see that doing the right thing is not always easy and that people may act like you’re crazy, but to keep doing it. Do not give in to naysayers and fight for what you know and believe to be right. If you do these things you will never fail. You may have to “regroup” and find other solutions sometimes, but you will never fail.
As one of my boyhood idols Wayne Gretzky once said: “You miss 100% of the shots you never take.”
So always take the shot- or at least pass it to someone who has a better scoring chance. And thank you for driving me to be the type of doctor, father, and person that I want to be. As much as I love medicine, I will always love you guys more. I hope you always know that. So Happy Birthday and enjoy the gifts that you will play with for 5 minutes and then never touch again 🙂
Today, October 1st 2015, is a very critical day for the “disease management” system that we mistake for a healthcare system in the United States. Today is when the new coding system called ICD-10 goes live for a majority of American physicians and Nurse Practitioners. This is nothing more than another layer of bureaucratic red-tape that does nothing to enhance the quality or cost of your care, but rather furthers the disease process. All it does is waste more of your physicians and office staffs time- time that should be spent working towards your care. Instead it just feeds an already broken machine that is aimlessly running on fumes while blowing exhaust into the faces of the people whom matter most- the doctors and the patients.
Luckily for us and other brave practices and patients across the nation, we have nothing to do with this nonsense. We have decided to escape the mess and fix medicine from the ground up. Our focus is solely on working together towards a system that actually makes sense and works for our patients. This is what gratifies us most- being able to provide care the way we trained to do. So help us raise awareness about the Direct Primary Care model today- National Direct Primary Care Day! Check out the following link, share it, talk about it, and maybe even buy a t-shirt:
Because DPC is known for it’s price transparency, this is a list of our most common labs and their prices. If you don’t see a test on here which you would like to know the price of, don’t hesitate to send Meghann an email at Meghann@golddirectcare.com.
I am writing this as a sincere thank you to the Research Team and Incite Health at the Center for Primary Care at Harvard Medical School for taking the time to visit us this summer to see and hear what Direct Primary Care is all about (Here is link to story: Harvard Medical School Team Visits Gold Direct Care). If an institution of Harvard Medical Schools caliber can get behind this model of care, the potential for growth and implementation is boundless. Hopefully, we showed their team that the simplistic model of Direct Primary Care in combination with an appropriate high deductible/Health Savings Account insurance plan accomplishes everything that the Quadruple Aim is about:
Lower costs….even for insurers
Better health outcomes
All of which lead to the most important goal….HAPPIER PATIENTS!
Hopefully our relationship with their group- as well as other medical schools- will continue to grow as we continue our efforts to get more patients, doctors, employers, insurers, and legislators to buy into an old but new model of care that actually makes sense for all. The top down approach is not working so why not ground up?
So I couldn’t not share this story about myself, MassHealth, and our completely dysfunctional healthcare system. After I left my old job to start my own Direct Care practice I needed to take on the more formidable task of finding my own health insurance that made sense for me and my family- we have two 5 year old twins. So I did what a lot of people did and went on the “Exchange” aka the “Connector” and entered all of our personal data including dates of birth, addresses, and of course estimated income. Now as I have always been an employed physician this was all new to me, but I felt that I would at least have some understanding and knowledge on how to shop for health insurance. Yet, after getting about 2/3 of the way through I put up my hands in surrender as I could not make heads or tails of anything. I can not even imagine what a lay person feels having to shop for something so convoluted and poorly organized. So I did the logical thing and called a local friend who sells other types of insurance and he connected me with a knowledgable professional that understands the health insurance market. He got me and my family what we needed at the best price possible. Then I just forgot about it….
Until yesterday September 14 2015, when I got home and checked the mail. In there was a letter from MassHealth and The Childrens Medical Security Plan that my son Cameron- not his twin sister, not my wife, not me, just Cam- had been approved for a MassHealth plan effective DECEMBER 11 2014!!! Actually a separate letter states that “MassHealth is changing my premium payment because of a change in your family’s circumstances.” Huh???? What status change? I didn’t even know I was approved and paying a premium to them in the first place! Also enclosed was his card (as you can see in the picture above) for both medical and dental plans at a cost of $64 per month with really cheap copays- well for me that is. You may also notice that in the body of the letter there are not one, but three different numbers for me to call if I have various questions. Well I actually only have one question with two parts….1a. why in Gods name am I even getting this?! and 1b. how am I or any member of my family even close to qualifying for government subsidies??! Somehow just one of my family members qualifies for subsidized medical and dental care from our state and federal government but the rest of us do not? Clearly this is huge mistake based on some information that I input into the Connector back in January of 2015 right?
So what should I do? Should I try to game the system and dump my more expensive, current insurance for my son and take this cheaper offering for him at the cost of the taxpayers of Massachusetts? Should I just wait and see all the administrative waste that will be used to figure this out and catch on to me and eventually correct the problem in another year or two? The answer to all of these questions for me is a resounding NO. Instead I will write a blog article about it that a few people will likely read and just chalk it up to another Dr. Gold rant on healthcare in the US. My deep hope, however, is that at some point more people will read this and actually think!
What are other people doing with these healthcare mistakes and oversights that our government is making with your hard-earned dollars and taxes you pay? How much money is wasted if this mistake happens to 3,000 people that actually pretend they deserve the subsidy and use it? Is this what you want your money spent on? Waste? Is this really how you want your care to be delivered? Would you tolerate it if you paid an 800 dollar a month or higher premium for your families health insurance and found out that a friend paid 64 dollars a month due to a clerical error? Now do not get me wrong, I am for all people of all walks having good access to high quality, affordable healthcare, and there are ways that the government could help do this the right way. I will not get into all the gory details here, but one possible solution is working with Direct Care doctors like me and Iora Health to spend your tax dollars on something of worth- actual healthcare instead of bureaucratic, administrative waste. Now, I think I’ll go shred my sons new MassHealth card and save the state some money. I would rather stay true to the Oath I took and hope that it is spent on care for people whom actually need the assistance instead. Doubtful, but a doctor can hope right?
So this is a quick and short post, but I just wanted to write something today and dedicate it to all of the people and families who lost loved ones on 9/11. The first responders that day- the police, firefighters, EMTs, doctors, nurses- and really everyone that helped others out that day, showed the good side of people in this country. They showed the side that cares for others and that risks their own wellbeing to help others in the face of tragedy. Too often all we see in the media is the bad side of people, but there is a really good side that sadly often gets overshadowed.
So my hope is that we find ways to “Never Forget” every day- not just 9/11. Remember what you felt like that day and try to nourish the kindness and good you witnessed on a DAILY basis -not just when tragedy strikes. That is what I hope we are doing with this type of medicine- bringing back the humanity. We need more in medicine and we need more in our daily lives. Thanks for reading and never forget.
We often read about the Primary Care shortage across the country continuing to grow, especially in states like Massachusetts that have a higher proportion of specialists. Some will argue that its exaggerated but numbers do not lie. Call a local doctors office and find out how long it takes to be seen as a new patient- provided they are even accepting new patients. Well here comes Direct Primary Care with smaller patient panels of 600-1000 patients versus the 2500-3000 of typical insurance based panel sizes, and along with it comes the critics. “You are worsening access,” we are told. Well the reason access to good primary care is poor is because the system is driving medical students- all with plenty of debt- into higher paying specialties. The system is forcing good docs to leave medicine early- whether it’s to retire early, move into administrative positions, or even go work for insurers! I argue that Direct Care can fix this by providing a professionally gratifying, financially rewarding experience so that more students like the ones I teach from Tufts will actually want to go into the field.
Take my current 3rd year Tufts medical student Ian Murphy who states: “I felt that a career in Primary Care would be rewarding but financially unsustainable and mentally draining. After being here for the past 3 weeks, I am now encouraged to look at and explore Primary Care more closely before making a career choice.”
And finally read this email from Salem resident Jennifer Kugel that I received a few months back (with her permission of course). She will be spending a day with me this week.
I am a perspective medical school student looking to gain insight and experience into the world of medicine. I have an undergraduate degree in Sports Movement Science from Salem State University, and am planning to take the MCAT’s next April and apply by June.
I heard about Dr. Gold’s Direct Care initiative while listening to NPR a few weeks back. I was thrilled to hear that someone locally (I live in Salem) is trying to change the way healthcare is being run. When I got home I looked up his website and read through all of the pages and anecdotal stories. I was quite taken aback to find a doctor who was still interested in doing house-calls and practicing preventative medicine rather then dealing with problems as they come.
As with many people who want to become a doctor, I have envisioned it since I was a toddler. As I have gotten older and taken alternate paths to get my degree, I have continually asked myself why I want to BE a doctor. The answer is still simple; I want to help people. With healthcare operating the way it does, patients are not getting the attention they need, and problems are not caught soon enough. Too many decisions are based off of what people can or cannot afford, and not what is best for their life and lifestyle. To see that an established doctor wants to go out of his way to make the system work better for everyone involved is quite inspiring.
I would greatly appreciate an opportunity to shadow Dr. Gold and gain experience from someone with a vision of a better healthcare system. I am hoping that by the time I finish my medical school experience, that I may be able to take the vision and apply it to my own patient care.
Thank you for the consideration, and I look forward to hopefully meeting Dr. Gold in person soon.
So after battling with the state of Massachusetts since February, we finally got the okay to supply State Vaccines. The vaccines which we can supply are:
DTaP (Helps children develop immunity to three deadly diseases caused by bacteria: diphtheria, tetanus, and whooping cough aka pertussis.)
Hep A (Used for prevention of liver disease caused by the hepatitis A virus.)
Hep B (Used for prevention of liver disease caused by the hepatitis B virus.)
HIB (Used for prevention of invasive disease caused by Haemophilus influenzae type b bacteria.)
IPV (Used to combat poliomyelitis aka Polio.)
PCV13 (Used to protect infants and toddlers from pneumococcal disease.)
RV (Oral Dosage- Used to prevent Rotavirus which is a contagious virus that can cause gastroenteritis.)
These vaccines can be supplied to anyone under the age of 19. However, we will not be supplying HPV or Menactra(Meningococcal Meningitis Vaccine). We do have places we can send our patients to receive these vaccines at a cash price, or by using their insurance.
We will be implementing a $20 inoculation fee to help pay for the needles and syringes. This is just a one time fee per visit, NOT per vaccination.
If you have any questions, or would like to set up an appointment, please call our office at 781-842-3961.
If you would like to know more about the vaccines, or what schedule your child should be on, you can visit the CDC website here.