Healthcare, Worth & Choosing Something Different
There is so much that happens behind the scenes in healthcare.
Being a healthcare provider is an incredibly emotional job. Yes, because we are invited into the intimate stories of our patients, their health, their struggles, and sometimes their very lives. But also because healthcare is where so many of the complexities of our society come together. Poverty, racism, sexism, ableism, capitalism, environmental injustice, ancestral trauma, and the systems of power and oppression that shape our lives all intersect in the bodies and experiences of the people we care for.
Our health and wellbeing are deeply shaped by the systems we live within. As providers, we don't just see the cuts and bruises. We also see the underside of the boots that caused the harm.
Some days, this awareness feels incredibly heavy.
Other days, I have the privilege of walking alongside someone as they find their way back from the ledge, and we are both reminded of how resilient, beautiful, creative, and inherently worthy of love and belonging each human being is.
I think it's this part of my work that keeps me hopeful. Even in the face of so much suffering, I get to witness the extraordinary ways people continue to heal, grow, and care for one another.
But there's another part of working in healthcare that I don't talk about as often. And it's the part I've been struggling with most lately.
The systems we're working within aren't just failing the people who need care. They're also making it increasingly difficult for those of us providing that care to do our jobs in ways that feel humane, thoughtful, and sustainable.
Again and again, people come into my office sharing experiences of healthcare appointments where they felt rushed, dismissed, or unheard. Sometimes they've spent years trying to understand what's happening in their bodies, only to be given five or ten minutes to tell their story before being handed another prescription or referral.
I don't believe most doctors enter this profession wanting to practice that way. I think many of us begin with a genuine desire to help people, only to find ourselves working within systems that place enormous demands on our time while leaving less and less room for the relationships that make this work meaningful.
When I opened AndyND, I wanted to do something different. I wanted to offer longer appointments, to have time to listen, to get to know people and their families, and to create a space where care felt like a relationship rather than a transaction.
And I wanted that care to be accessible.
I knew insurance would be challenging, but I believed that with enough persistence, creativity, and a willingness to work hard, I could somehow make it work. Nearly ten months into running my own practice, I'm realizing just how much I've been asking of myself to keep that promise.
I haven't received payment from OHP since opening. My billers and I have spent countless hours on the phone, week after week, trying to resolve administrative problems that seem like they could be addressed through one conversation with someone who has the authority to help. Instead, we're transferred between departments and representatives, sometimes AI agents, who give us different instructions each time. Just when we think we've found a solution, the next person tells us we're headed in the wrong direction.
Meanwhile, I'm continuing to see patients, pay my staff, cover the costs of running a practice, and try to make sense of how a system that is supposed to support healthcare can make providing it so incredibly difficult.
And I know my experience is only one small part of a much bigger problem! I see how much people are paying for insurance every month, only to face enormous deductibles, unexpected bills, and denials for care they thought was covered. I had one patient tell me recently that they pay over $850 for their single-household premium per month and still have a $5000 deductible! $850/month = $10,200/year! $One month's payment is more than I make for an entire years worth of payments from some insurance companies!
I'm on OHP myself (yes, that is how little my income is), and even with my medical education and understanding of the healthcare system, I struggle to access care. I think often about how exhausting and discouraging this must be for people who don't have the time, knowledge, or resources to navigate it all.
I imagine (and hope) a lot of you understand the rage I feel about all of this inequity.
For me, that rage is fueled by seeing firsthand just how deeply people need care. By witnessing incredible providers give every ounce of themselves, burning out in the process, just to ensure their patients receive whatever crumbs are left after these greedy systems have taken their fill. I see how much money, time, and energy are consumed by complying with the inane demands of corporations that never had people's best interests at heart in the first place.
And perhaps the most frustrating part has been recognizing how much of my own energy I've continued to pour into trying to make this system work. I've told myself that if I just worked a little harder, made a few more phone calls, figured out the next billing problem, or gave it another month, things would eventually fall into place.
But lately, I've been questioning what it's costing me to keep believing that.
Recently, I attended a workshop exploring sex, money, and power at the Temple of Belonging. It was an incredibly beautiful, challenging, and deeply uncomfortable experience.
If you've ever wanted to have all your shadows brought to the surface and get whacked over the head with a giant stick of self-realization, I highly recommend going to Temple.
I had three migraines while I was there. Three! And somehow, despite how physically and emotionally difficult parts of the experience were, I left feeling more connected to spirit, community, and myself than I have in years.
It was during this workshop on sex, money, and power, when we were invited to reflect on what was holding us back, that I found myself confronting something I've been avoiding.
I've been in an abusive relationship before. I was head over heels in love and could justify just about anything. I made excuses until the cows came home, convinced myself things would get better, and couldn't see what now seems so painfully obvious.
sitting in that workshop, I realized I was doing something awfully familiar with our healthcare system.
Except this time, I know exactly what I'm dealing with! I know how harmful it is. I know how much it's taking from me, and how little it's giving back. And yet, here I am, still trying to make it work. Still believing that maybe if I work a little harder, make another phone call, give it a little more time, something will change.
So why the hell would I stay? It certainly isn't love keeping me here.
I think I've been so afraid of what leaving might mean for my patients, and so committed to making healthcare accessible, that I haven't been willing to acknowledge what staying has been costing me.
I know from experience that recognizing an abusive relationship doesn't make leaving simple, and I don't confuse being harmed with being responsible for that harm. But this workshop helped me recognize something about my own choices, and the ways I've been avoiding taking responsibility for my wellbeing.
I've been so focused on fighting for the kind of healthcare I believe everyone deserves that I've forgotten I'm one of those people, too.
I think part of me has believed that leaving insurance would mean abandoning the people I care about. That choosing to value my own work and wellbeing would somehow mean turning away from my commitment to accessible healthcare.
And that is where so much of my grief lives.
I know that as AndyND moves away from insurance, there will be people who won't be able to continue receiving care here. People I've come to know and care deeply about, whose health, families, and stories matter tremendously to me.
I'm especially grieving the possibility of leaving OHP. Being able to care for people who rely on Medicaid has been an important part of my vision from the very beginning. I've spent nearly ten months fighting to make it work, even without receiving payment, because I believe so strongly that everyone deserves access to thoughtful, compassionate healthcare. I still believe that!
But I'm beginning to recognize that I cannot personally carry the financial and emotional burden of making healthcare accessible within a system that makes doing so increasingly unsustainable. And I cannot keep asking the people who work alongside me to carry that burden either.
I've been thinking a lot about what it means to value myself and my work. Not just in theory, but in the actual choices I make about how I spend my time, what I agree to, and what I'm willing to continue sacrificing.
I think I've spent much of my life believing that caring deeply about something meant being willing to give everything I had to it. But I'm learning that there has to be room for me in that care, too.
Something else that stayed with me from Temple of Belonging was the experience of being surrounded by women who were genuinely supporting and celebrating one another. Women sharing their gifts, making space for each other's needs, and offering care without the expectation that anyone had to earn their place through how much they gave.
I felt something there that I've been longing for, perhaps without fully realizing it...A different way of being in community. One where we recognize that our wellbeing is connected, where we share responsibility, and where supporting one another doesn't have to come at the expense of ourselves.
I've been thinking about this as a way of leaning into the matriarchy, and what it might look like to build businesses, healthcare practices, and communities around those values. Not just imagining a different world, but beginning to create one in the places where we actually live and work.
I believe these small, grassroots efforts matter. That when we create spaces where people feel valued, where resources and responsibilities are shared, and where care is something we both give and receive, those experiences begin to ripple outward.
This is part of the dream taking shape with The Tending House (more to come!).
I imagine a shared home where AndyND can grow alongside other healthcare providers, small businesses, and community offerings that support women, children, and families. A place where we can share resources, celebrate one another's gifts, and create something that feels nourishing for the people receiving care and for those providing it.
I'm still figuring out what this will look like. There are financial realities, logistical challenges, and plenty of questions I don't yet have answers to.
But I feel hopeful. So deeply hopeful.
And I think that's what I want to share most as AndyND begins making some difficult changes over the coming year.
These decisions aren't coming from a loss of faith in healthcare or a desire to stop caring for people who need support. They're coming from a growing understanding that if I want to continue offering the kind of care I believe in, I need to find a way to do so that is sustainable for everyone involved.
I know that not everyone will be able to make this transition with me, and that is something I will continue to grieve. I also know that having the option to step away from insurance is a privilege that not every patient or provider has.
I don't have an easy answer for that contradiction.
But I do know that I want to keep finding ways to make care accessible, to remain transparent about the choices I'm making, and to invite others into the work of imagining and creating something different.
I believe we can support one another in ways that our current systems so often fail to. I believe we can create spaces where people are cared for without asking others to sacrifice themselves in the process. And I believe that when we begin doing this in our own small communities, we create possibilities for change far beyond them.
This is the hope I'm carrying into the next chapter of AndyND.
With love and gratitude,
Dr. Andy
Comments