Direct Primary Care Doctor
Dr. Garrick Baskerville is a board-certified Family Medicine physician and the Founder of METSI Care. He received a B.S. degree in Biology from the Pennsylvania State University. He then received his medical degree from the Pennsylvania State Hershey College of Medicine and completed his residency at Christiana Care Health System in Wilmington, DE. He has practiced in Primary Care, Urgent Care, Sports Medicine, and Occupational Health (Worker’s Compensation) for almost 15 years now. Dr. Garrick is a national speaker and has spoken at the SXSW Conference 2019, was a panelist for the American Academy of Family Practice DPC Summit in 2020 and 2021, and many other times at schools, churches, organizations, and community events.
Dr. Garrick is passionate about providing HIGH QUALITY care that addresses all aspects of what makes us human beings, including MIND, BODY, and SPIRIT. He believes that care should be AFFORDABLE for EVERYONE and that QUALITY CARE takes time. That said, he believes a patient should have time to address their issues and not feel rushed during a visit. At METSI Care, the visits are 30 - 60 minutes if needed. When he practiced in traditional, insurance, based models of care, he was scolded by administrators when he wanted to spend more than 15 minutes with his patients. That didn't sit right with Dr. Garrick and he told himself back in 2012 that he would eventually start his own practice where he could provide the care he believes in which EVERYONE should have ACCESS. With that, he founded METSI CARE.
Dr. Garrick is also a photographer where he enjoys capturing human expressions of joy and excitement. Dr. Garrick started photography using his dad's professional Minolta camera after losing his father to Multiple Myeloma in 1997. He used the camera as a way of healing and connecting with his father which he still does today. Dr. Garrick decided to attend medical school because he wanted to be the doctor for other people the way he would have been for is father if he could.
In his free time, he also enjoys creating and cooking healthy recipes as a freestyle cook, and attending live music events, comedy shows, art shows, and performance art/theatre events. He was an extra in Season 3 of House of Cards. He was fabled with learning the bass guitar and hopes to get good enough one day so he can start performing.
Dr. Garrick opened METSI Care in November of 2019.
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Welcome to the podcast,
Thanks so much for having me.
You have been opened since 2019 and in the past, you've mentioned that your dad and the healthcare that he received when he was diagnosed with bone cancer really impacted your career choice and your journey into medicine.
So I wanted to start with asking what was that experience like with your dad and how. Actually end up in you choosing medicine as a career.
Yeah, thanks so much for asking that question. so first off, I've had interested in science and all that, and being a nerd, a science nerd, since I was a child I remember drifting off in my brain and thinking when my teacher, my third grade teacher, Mr.
Rothman was talking about rocks. I remember saying to myself in my head, oh my God, Really awesome and exciting to learn about science. And I said, I'm going to be a doctor one day. So that was the first time that I ever thought about becoming a doctor. And then after my father was diagnosed with cancer and I was his, one of his caretakers when I was 13, 14 years old.
And then I saw him, To his demise and his death. When I had just turned 16, I realized that, I was unable to help him. Of course I, I wasn't able to help him in the way that I re you know, that had a lasting effect on his life. And so I said, To myself this is going to be my career path.
There was nothing that was going to stop me from doing medicine. Previously I was, I had to come up with these other alternative careers that was going to be a little bit more of an easier path. I had thought about becoming a businessman if you will And I've. I had also thought about becoming an actor and playwright when I was in high school, but this it was solidified after my dad passed away that I was going to become a physician.
I am so sorry for your dad's passing and I cannot even imagine, losing your dad at 16. I lost mine in my twenties and just being a 16 year old and handling that is definitely something that not all kids can go through and then thrive afterwards.
So it is such a Testament to your dads impact on you as well that you have been able to use his experience to help fuel your passion for medicine. Because you bring up how you thought about being a business person, doing, acting and also thinking about being a doctor was in the mix.
And so by creating your own clinic, how have you been able to still do, to still be a creative and to still do things outside of medicine?
So the beauty of direct primary care is it frees up the physician to basically cater their own schedule to their lifestyle. And the patients that select that doctor is usually going to be okay with it and understand that the physician has a life outside of work but also wants to be there for their patients.
So with my direct primary care, Office hours while I'm available. But I also make sure in my evenings that I have the time to do the, my creative outlet outlets including, going to concerts and small music shows. With my other music, loving friends and hearing the local community musicians perform.
And some of them are my friends. Some of those performers are my. And then I love singing along or air drumming or air bass playing. Cause I, I do have an interest in learning the bass, I have a bass guitar so that's, it's fun to be able to attend music events. And that's one of the biggest things that I do as far as my creative outlet is to attend music and talk about music with.
Amazing. so when I want to go back to before you were a DPC doctor, before you opened up your practice, you had graduated from medical school at Hershey, and then you completed your residency at Christiana care and that life to now, what was your outlook on your career?
Like at the time, because I'm guessing you didn't have as much time back then to do these things that you just discussed.
Yeah that's true. As someone who loves to, what the wide scope of family medicine and do a whole lot, I. Aspirations to be a great family doctor and see patients, grow from birth to death and be a big impact in that.
And the unfortunate thing that happened after I graduated residency was the metrics of hospital organizations putting limits on actually connecting one-on-one to your patient. And. Having the ability to enjoy the moment of being with another human being. So I always, I felt the pressure of the organization that I worked for at the time that I was unable to connect and to get to know my patients on a human level.
And it was more about how quickly could I get the patients in and out. So frankly, I would meet the metrics. So I was not let go.
so many people listening to this podcast can absolutely relate to that. When you get so involved in how many are views, how many FTEs, how many, numbers of my worth as a physician?
It's not about care. It's not about quality of carrots. I mean, Yes. Like you can argue that, oh, by meeting that A1C of 7.1, you're actually doing patient. It's no, because 7.1 is a cookie cutter number and that doesn't fit everybody. So frustrating. And you've said this before, you said that in 2012, it just didn't sit right with you and you were scolded by your administrators in terms of.
Whenever you would take more than 15 minutes, you would be penalized for that. And that is definitely something that people don't believe that actually happens when they're not in medicine. And it definitely does affect people who are paid by RVU. It's an ugly truth about meadow.
It's horrible. And for those that are listening, that don't know what a RVU is, it's actually it means the relative value unit, and it's basically putting a value of a monetary value of what the physician is doing for you. And there's an incentive to basically have as many RBU's in the year as possible for the doctor to meet the metrics so they can actually maintain their employment with the organization.
That's paying them. Because that's linked to a salary. So if the doctor is not meeting their RVU requirement the administration can let the doctor go. They can fire them. And it's usually the really good doctors that are actually bringing in less RVU because they are actually spending time with the patients and they're not rushing them through.
Those are the ones considered by the organization as being ineffective. And they use these kind of business administration words to basically say they're inefficient or not effective or whatever, but it's, they're inefficient and bringing in money. But actually the care that they're providing is actually amazing care because the most important thing that a physician has with a patient is actually time.
And the time is needed to accurately diagnose a patient and to care for. And the way that they are meant to be cared for. And unfortunately with the way insurance based care is it's they take that time away. And I can share with you the first day of medical school. Or it was actually the day of our white coat ceremony.
I remember at Hershey medical school. The Dean has the Dean Davis amazing physician whom I learned a lot from, but he said students and parents, I want to tell you this one thing, but the most important thing. That you have and that will help you get to the right diagnosis with your patients is sitting down, listening to them, let them tell you the story.
And any additional time you have, you do a physical exam to confirm what you're thinking, but you already know what's going on because you listened to that. And then any lab testing is meant to support that diagnosis, but not to search for the diagnosis. You. Pretty much it I've already an understanding, an idea based on your history and your physical.
And this is something that has been unfortunately lost in medicine. Dr. Who shared that with um, the Hershey Penn state Hershey medical school students you know, and I'm sure he did this every year. You know, This is something that we, along with other physicians value is actually the time with our patients, listening to them, examining them and using labs as to support the diagnosis, but not to search for one because we should already have a good idea of what's going on.
And a lot of patients don't understand this. They think we need lab tests and imaging. to figure out everything. And unfortunately, the system of insurance-based healthcare and administration, they have an incentive for doctors to do a lot of lab testing and imaging testing, which may be unnecessary because it's bringing in.
Financial gain for that organization. And direct primary care doctors. We understand there's a problem with that. And that's why we've a lot of us have opened our own patient, clinics. So we can provide the care for our patients without doing a whole bunch of unnecessary lab tests, imaging tests, and referrals.
Definitely. It's so interesting because, partially because of the pandemic, but also because the system continues to be atrocious for our patients, is that it's not only physicians who are realizing. Time matters. And like you said, in your intro that it's a relationship based care that we all, want to provide and family medicine, internal medicine, pediatrics for primary care, as well as specialty care, but too frequently, you know, I hear the, no one's ever spent this much time with me.
And it's that is a tr I hate hearing that I really kills me when I hear that, because I'm like, Okay. I am so sorry that that has happened to you in the past. That should never be the case with anybody, but it's, I hear that so often. I want to ask there, when you had her Dr. Davis, when you had experienced these administrative slaps on the wrist, or, you know, the fear of being fired I want to ask, at what point did you see.
Thinking about, if I could do it differently, this is how I would do it. And how did that transition into Mitzi care?
The thought of it first came in 20 12, 2 years out of my residency graduation, but two years of practicing and having my first job working for a large hospital system.
So my first job out of residency was working for a federal cough at health center or FQHC. That was an amazing experience. We didn't have the same metrics, working basically for the government. And so they wanted us to provide good care for basically uh, uh, low income. Population who was either Medicaid level below Medicaid or just above Medicaid.
So we, we took care of people that had Medicaid or were uninsured or under-insured, and we provided really great care at that organization and I'm happy to have worked for them. And then I moved. On to working for a large hospital system in 2012. And then that's when I first learned about these metrics that we didn't have at the federal qualified health center.
And I knew that there was something wrong because these metrics were taken away from actually quality care, because it was taken away my ability to sit down and listen to my patients and connect with them. And then that is really the way to to have a good relationship doctor, patient relationship, which involves.
And the trust is broken to an extent when the patient feels unheard or unlistened to, or the doctor is standing up and standing by the door because they're trying to get out of the room because they don't want to get in trouble from the organization who keeps time on the physical. Um, And this is something that, many listeners may not know all the physicians know this, but the doctors through the electronic health system, every interaction you have with a doctor is recorded in a time basis by the organization that's paying adopter.
This is for. Insurance-based practices. And if the doctor spends more time than as allowed by that organization, their job is in jeopardy. And so in this is, I'm getting to in 2014, the organization I was working for. They had a meeting with me and my office in 2014. And they said to me, Hey doctor Garrick, your patients love you.
You have really high press Ganey scores, but your average time with the patients is 22 minutes. And they said the average time that the other physicians have in this network on average is 16. For that interaction and they said, we're going to have you decrease your time by six minutes. And they also said to me, that to help incentivize you to drop your time with your patients.
So you can be on par with the rest of the doctors and our network. They said, we're going to have you do a performance improvement plan to get down to. Time. So going from 22 minutes to 16 minutes and that involved, cutting out mental health treatments with my patients and I can share with you mental health is actually one of the number one things that I do currently.
And I did back then for my patients. I have a huge interest in and treating diseases such as depression anxiety. Bipolar disorder. And I've even treated schizophrenia effectively. And in my practice and the organization, I work for a hospital based organization in the suburban Philadelphia said to me, you have to stop doing.
All mental health treatments. And for those who may not know, but the number one place for actually patients in this country to get care from for mental health is from their primary care. Provider, whether it's a doctor or a nurse practitioner, physician assistant, but it's through primary care.
And that, that includes internal medicine, family medicine and pediatrics. And so they were telling me that I was unable to do the thing that I loved so much in medicine. And I thought. All of my patients that I was taking care of, that they were effectively being treated. And my patients in the community that I worked for, it was a blue collar community.
And they said doc, we're not going to get care for mental health at any other place other than seeing you. And so with this conversation I had with the administrators, from the organization, I worked for. I I was deeply saddened that I was no longer going to be able to care for them in the way that I had them.