As of today 11/8/2023 the amount of money owed to PFM by our patients is nearly $200,000. We still don't send people to collections as we're not trying to kick a community when they are already down and struggling.

We've really tried hard to be the place where people can get top of the line care at an affordable level, including our approximately 1000 Medicaid patients, but this is not sustainable.

I am currently the lowest paid person in the practice, as its physician. Our awesome front desk receptionist Dylan makes more than I do and has for all of 2023. As the owner, I should be the first to bleed when times are tough. A few years ago I was taking our staff on paid vacations, and at this point, I'm stressed about the future of the practice.

I am trying very very hard to not have to switch to a concierge model of practice as I do not like the bourgeoisie as I spent most of my life as a proletariat, but my hand is basically being forced by theft of services and us simply trying to be empathetic. It has not helped that reimbursement continues to be cut by insurance companies, who are making it ever harder to collect what we're owed.

At our patient fundraiser, we raised $10,000 for the patient fund, of which we contributed $5000. We reserve this fund for our most desperate of patients, and it can't even come close to dealing with our bad debt.

If we cannot turn this around by next year, this will be an implemented change in how PFM works. Effectively, members of the community who can afford a monthly membership fee will be able to have concierge level care (without any insurance too) and these additional funds will help support the Medicaid patients that we see currently at a loss who will be seen by mid levels only. Its the only way I can see to make things continue to work. I think anyone who's had my care understands how it's different from what you can get elsewhere, and those who have their cancers caught early and rare diagnoses made will speak on my behalf.

I'm sorry. I've done my best for a very long time to do what I could to not have to do this. I'm going to give it a little bit longer, but if people do not change the way that they interact with us, we're going to have to change how we interact with them.

- Dr. Powers