It's called a boutique practice. My day job is as an ER nurse (while I finish my CS degree), and it's totally the way I'd go for my medical care if there was someone around that did this.

Some doctors with a boutique practice take a retainer fee plus bill insurance. Sounds like this guy is going the cash only route. I'm sure he'll end up making more money that way, regardless.

The average GP in NYC probably makes about 120,000 - 150,000. But they have to carry a 5,000-10,000 patient load while each patient gets 15 minute appointments. Some docs routinely see over 20 patients a day. This guy is charging a $500 retainer for two visits a year. That means that if he has 300 patients, he's making what a regular GP makes at an HMO. If each patient has two visits a year, that means that he can have 2 appointments a day and make the same amount as an HMO doc. That's his break even point. Anything over that, and it's gravy. I'm willing to bet that he has a 500 patient load. So, he's bringing in $250,000 net plus extra visits and appointments. So, by going cash only, he's probably making twice what an insurance doc would make.

This guy also does house calls only. So, he doesn't have the overhead that he'd normally have with an office--staff, office rent, equipment, etc... He doesn't have to hire billing specialists. He outsources all of his X-Ray and lab work, so no overhead there. And, he has an unofficial network of non-jerk specialists that he can refer people to that he likes working with.

I'm surprised that this hasn't caught on more than it has.

If you're his patient, look at his appointment schedule. He's giving people a half-hour to one hour time slots. And, he does a lot of his consultations over the wire, via IM, video chat and cell phone. He probably doesn't have to see his patients most of the time, and it's a lot easier for his patients to get in touch with him. His patients are happier and he has a much better quality of life.

Brilliant.

You're right. It completely creates a multi-tiered health care system. Those who can pay more get better care, and those who can't get worse care. But that system already exists. It's just off the record and off the books. You'll see more and more of this as the health care system worsens.

People who are wealthy have better insurance and congregate in wealthy neighborhoods. So, doctors and hospitals in that area are better funded and provide a higher quality of care. The brightest doctors compete for jobs in these areas, because they know that they will have more insured patients and get paid more over the course of their career. If you want the best doctors in a city, go to a clinic/specialist in the richest neighborhood.

Low income areas have a high concentration of low/no health insurance patients. So, the health care system in those areas tends to be underfunded and the doctors often get paid less. So, you'll see less competition for doctor jobs in those areas as well.

Everybody has access to Emergency Rooms regardless of the ability to pay, that's mandated by law. But, in low income areas, the Emergency Room generally looses money for the hospital, so it's underfunded and understaffed. In the wealthy areas, patients have insurance and can pay so the ER makes money for the hospital and is staffed accordingly.

Here in California if you have no or low insurance, good luck seeing a specialist unless it's a life or limb threatening Emergency. It's next to impossible to see an orthopedist or a dermatologist in LA unless you have great insurance or pay up front with plastic.

If you don't have health insurance, you get referred to the county health system which is generally terribly overburdened. ER's at County hospitals can routinely have a 12-24 hour waiting time. That is, if you break a leg, and go to a county ER in California, chances are, you'll sit in the waiting room for half a day before getting anything for pain.

What this guy is doing is simply calling a spade a spade, but at least he is advertising his rates, and he helps his uninsured customers know where to go for low cost services like X-Rays and Specialist referrals, and he tells them how much it's going to cost his patients.

Based on my personal experience, I have to say you are completely wrong :)

"Then the effects of being measured by performance would propagate all the way back to high school, flushing out all the arbitrary stuff people are measured by now. That is the future of web startups." What an impressive conclusion - I hope it happens.

Not all threads here seek answers. Some seek data.

Counterexamples don't refute a pattern, but they often elaborate on it. After all, the original pattern is often derived from a series of examples itself. For people that are looking to draw their own conclusions (which is most of us, right? I'd hate to think that my or anyone else's contributions here are taken as gospel truth), this is invaluable. "Quit your day job" hides a lot of complexity. "I had this crazy idea for a suborbital flight startup while I was getting drunk with my chimney-sweeper, and we quit our day jobs, took on $100K of debt, then failed miserably when nobody would buy our flying broomstick" is a lot more useful, because then you can judge whether your situation is like the unfortunate chimney-sweep and decide accordingly.

Debunked: http://itre.cis.upenn.edu/~myl/languagelog/archives/004965.h...

One thing he failed to mention, whatever you do, make sure you are in the money "making part of the bussiness".

E.g. If you are tech person, work on a pure technology company, where the product you are making is the money maker. You will be treated much better, as the company will try to maximize your productiviy.

If you are a tech guy, working, let's say in a finance company, where technology is considered as an "expense", then you will never be treat as well, b/c you are less worth to the company, and they will always try to minimise your expense.

So... they are offering to accelerate your startup by means of giving you discounts on their software. In that case, Linux-based startups must be traveling at the speed of light...

No. You can turn us down though. (Two groups did, both very early on. I don't know what became of them.)

So the only ones who make money are those who actually provide value. What a concept.

I laughed hard as soon as I read that "benefit".

Obviously YC hires some verbosity thugs to come beat you senseless with dictionaries until you apologize in less than 120 words for wasting their time.

I'm sure it's just a way to keep the task of reading all those applications under control, and not a hard and fast rule. Of course, the standard response about defining your idea succinctly stands!

Within the next month, I hope.

I wish acquisition was this easy. I worked at a very large bank in Emerging Technology and I pushed our group to buy 3 startups. We passed on all of them because of bureaucracy and lack of vision. Heck, the same bank passed on paypal (and tried to create their own), and now they have to compete head to head with a company that could be in house.

The unexpected Ted Stevens reference at the end really made me grin. I find Stevens so hilarious and horrifying at the same time.

I was surprised to find it in a PG essay, but on reflection it seems really appropriate in context. Though it did distract me enough that I had to read the last section twice.

What Paul ignores is the fact that most people out of college are faced with seemingly insurmountable debt as a result of having to pay for an education - esp. in America (and to a lesser extent in Canada). This is one problem that will prevent startups from happening at such a rapid pace as he anticipates. In fact, most graduates want to find stable jobs to pay off their debt -- startups are not really on most graduates' radar. On a somewhat related note, Businessweek had a survey of the top ten desirable places to work for new graduates -- three were govt. agencies, one accounting firm, google, etc.

Moore's Law, open source, more abstract languages, the web for promotion. (I believe this list is in the Wikipedia entry for YC.)

I seriously doubt it. Doctors have always had gentleman's agreements to refer patients to each other, and then refer the patient back once the specialist is done.

The only kind of payola that I've ever seen after 14 years in health care are drug companies purchasing cruises/lovely dinners, etc... for doctors.