Dr. William Powers - HIV Specialist - Powers Family Medicine

As always I hate having to make posts like this, but I'm going to anyway because this needs to be said.

5 years ago when I created this practice, I said that it welcomed anyone.

There was a single qualifying statement on that "anyone". You must be part of the species homo sapiens to be seen at my practice. I only treat humans.

I'm going to add a second qualifier. "You must tolerate other patients at the practice"

Things are going to get more heated as we approach the election, and I am not going to tolerate any sort of disrespect towards any of my patients. Here is a non-exhaustive list of the kind of people that come to my clinic:

Mailmen
Water delivery guys
Drug Reps
LGBTQ humans
Humans that engage in B**M play
Humans that have polyamorous relationships.
Humans who abuse anabolic steroids and are looking to get clean.
Humans who abuse drugs and are looking to get clean.
Humans who abuse anabolic steroids, drugs, and aren't looking to get clean, but need help with some rash they've got on their foot.
People of size.
People of svelte.
Adult film actors and actresses
White, Irish, Catholic families from Birmingham with 9 children.
Gamers
Gaymers
Laura Yuschak
Conservative middle-aged men wearing red hats.
Liberal college students with nose piercings.
Communists
Marxists
Pedophiles who are good people who were just cursed to be like that and are looking for help so that they don't hurt anyone.
People with other paraphilias looking for help.
Convicted criminals, brought to the office quite literally in chains, to be seen for healthcare outside of the prison.
Elderly Jewish grandmas that bring me cookies.
Cat people
Dog people
Whatever ferret people are.
Religious people
Atheists
Trumpers
Bidenettes
Cheerleaders
Football players
Math bowl kids
Neurotypicals
Neurospicies
People with a lot of melanocytes.
People with a moderate amount of melanocytes.
People who wish they had more melanocytes than they do, and always go out on the dance floor and make a big deal about Sir Mix-A-Lot being played at every wedding.
People who are in the closet.
People who hate themselves.
Narcissistic people.
People who are having a mental health crisis and genuinely need help and not disdain.
People with cancer
People with god awful and unfortunate genetics.
Paralympic athletes.
Autistic, ADHD'd, 39 year old man children obsessed with their cats.
I could go on...

Oh I could name so many more, but I think that gets the point across.

If you cross the threshold of my clinic, it is expected of you that you will treat other guests of my clinic with respect, regardless of which one of those things they are or are not.

Once you are in an exam room, you can tell me quite literally anything and I will do nothing to judge you, I will work only to heal you. That is quite literally what you pay me to do. I can't really conceptualize doing anything other than that.

There is quite literally no private shame that you can say to me in an exam room in confidence that will result in me discharging you as a patient.

The few times I have ever had to discharge a patient, it was due to outright cruelty and disrespect for either my staff or other patients.

I hope this policy has been made clear. My practice will remain a place where all humans are welcome for care. Regardless of which group listed above they do or do not belong in.

This will be enforced with absolute prejudice. I will not tolerate any of my patients treating any of my other patients with disrespect. If you cannot abide by this, if you cannot sit side by side with someone who's ideology you dislike, and treat them like a fellow human being with respect, please do not come here.

Everyone is welcome here. When everyone is welcome that means people that you're not going to like are welcome too. You might not even like me. Many people don't. And that's okay, as long as you treat me with respect. I'll still do the very best I can for you as a doctor while you silently judge my life choices. I'll be none the wiser, but even if I was, I still wouldn't care, and would still just do my job.

Please do not make me enforce this policy again. It saddens me every time I have to do it.

Be excellent to each other.

-Dr. Powers

Dr Powers will be back from vacation tomorrow Thursday August 15th.

He's going to obviously have a pretty good amount of backlogged messages and such to dig through, so we appreciate your patience. We did the best we could to answer anything that could be answered by someone else, but some people's portal messages obviously have to be answered by Dr Powers.

He wants to thank everyone for allowing him the opportunity to take this little break, and to share this photo of a meteor that his girlfriend accidentally captured when they were watching the Aurora up North. What are the odds of that?

Just a heads up! For patients who are planning to see Dr. Paige Paladino for gynecologic surgery (Hyst or other)by the end of the year--you are encouraged to make your consult appointments now.

Dr. Paladino, better known by her knight name as Paladin Paigicus , "Slayer of Uteri" Is the gynecologist that my office uses that we trust to take care of our LGBTQ people as if they are actual real people.

The later into the year the consult gets the harder it is to get patients scheduled for hospital OR time, which she cannot control.

Every year we have a bunch of patients that are trying to get their hysterectomy done on their deductible for this year, and they want to get it done at the very end of the year, but they don't schedule fast enough, and then they end up missing out as there are no OR slots left. I'm warning people now in August before it gets too late in the year! Make sure you book your consult appointment ASAP!

She is with Somerset Gynecology & Obstetrics in Troy 248-816-9200.

I'm going to make a brief post here on Imane Khelif for the purposes of education as I am seeing a literal nightmare of memes and bu****it on my private Facebook feed from people that I never would have expected to see it from. I'm finding this particularly disheartening, as this poor woman does not deserve to be called any of the names she's being called, nor, to even be acknowledged by the world more than just as an athlete.

If you're seeing this post and you don't know who I am, I'm a physician who has more transgender patients than any other doctor anywhere on earth as far as I am aware. I've got about 3,000. I also treat disorders of s*xual development, inters*x syndromes, and I am working on publishing my theory of gender dysphoria and why it is associated with so many of the same health problems (Autism,ADHD,hashimoto's,hypermobility,pots,MCAS,etc) aka Meyer-Powers syndrome. Basically, as a doctor, I know a lot about human s*x hormones and s*xual development. This is my specialty and I have published on it multiple times. There's a ton of things that I don't know in medicine, but s*x hormones are something that I know like the back of my hand.

Take this information with a grain of salt, because I do not have this person's labs in front of me, nor their genetic testing, but based on the information I have acquired from reliable sources this is the situation as I understand it. I'm going to try and do an ELI5 with this, so forgive me if you are very educated on the topic and this is an oversimplification.

Imane has something called androgen insensitivity syndrome. This is when the androgen receptor in your body is non-functional. Or sometimes, barely functional. We call this CAIS or PAIS (P being for partial and the C for complete)

The androgen receptor is a protein to which androgens, such as testosterone bind, And when they do, boy stuff happens. Genes, enzymes, proteins, hormones, things are expressed that do boy stuff when you have testosterone binding to its receptor.

When a person who is XX has this, nobody really notices. The woman is effectively hyper female, and lacks pretty much any form of masculinization and has limited p***c hair.

When it happens to somebody who is XY, the SRY gene differentiation pathway, which is basically the gene on the Y chromosome that makes boy stuff happen, fails. It fails because no matter how much androgen you expose the fetus to, it will not masculinize. It just won't.

It's important to remember that every man and woman on this planet when they were a fetus looked like a girl and had a va**na until a certain point in development when these genes kick on. The default configuration for human beings is female. If you have SRY, then the male things should happen.

In this case, your XY fetus develops fully, but SRY can't do its job. The baby is born, and the moment that they come out of the birth canal, the doctor says it's a girl! They will be born with a va**na. They look like a normal female neonate.

As they age and go into puberty, they will develop breasts.

They will have a normal va**na, except, when it would be time to get their first period, it never happens. The reason, is that there is no cervix at the back of the va**na, and there is no uterus behind it. Effectively, those structures do not develop. The person will have a completely normal female external appearance, but not have a uterus or the ability to menstruate.

To be clear, if that is enough in your mind for this person to be considered male, I would point out the existence of Mayer-Rokitansky-Küster-Hauser syndrome, which is an XX human being who has pretty much the same body. Sometimes they don't have a va**nal opening at all, and they don't have a uterus.

Ovaries and testicles are analogous structures, and if you do not go down the male development pathway, those go**ds stay up inside the body in the position of ovaries.

Now, the issue here is that this person is still XY, and the body, is attempting to do what it's supposed to do and produce testosterone to masculinize that human. Which it does. A lot of it.

Because of something known as feedback loop inhibition, there is no real limit the amount of testosterone produced by this person beyond the absolute maximum that their go**ds can crank out at any time. Quite often, they will have an absolutely astronomical testosterone value. The reason being is that the body is attempting to make more and more to bind to the receptor and do its job, and it just isn't getting the signal that says it's working. So it just keeps making more and more testosterone. Think of it like someone shouting at someone with hearing loss. They just keep getting louder and louder until the person finally responds. But in this case, the androgen receptor is deaf. It will not respond. It does not hear the signal from testosterone.

This is something I sometimes see in young transgender women before transition when I run their baseline labs. They will have an absolutely astronomical testosterone value despite not looking very masculine at all. In those cases, the patient has partial androgen insensitivity syndrome, as they do have a p***s, but they are very under masculinized. They have an androgen receptor, it just doesn't work normally. It's a little wonky. And so binding testosterone is like trying to put the square peg in a round hole. Unless you're really hammering it pretty hard, you're not going to get much masculinizing output. And even then, your success will be minimal.

Regardless, in the case of this person, because the body cranks out so much testosterone attempting to do what it would naturally do, they will fail testosterone limit testing for a female. (Which happened to Imane)

They're going to have an absolutely enormous testosterone value because of this feedback loop. However, that testosterone isn't doing anything. It's not causing masculinization, it's not making her stronger. It's not giving a competitive advantage (assuming that she has CAIS).

So basically, you have a person who is born, looks like a girl, acts like a girl, has girl parts, and when she reaches puberty, doesn't get me**es. She doesn't have a uterus because that structure never develops, but she effectively has what's known as an ovotestis in the position of normal ovaries, aka testicles that never descended.

If you run gender testing for competition to test her chromosomes to decide whether or not she's male or female, she will test male. If you check her testosterone value, it will be way way above the female range. And she will fail.

But, despite these facts, she is phenotypically female, and does not have a competitive advantage.

Some argument could be made that in a case of partial androgen insensitivity syndrome, there could be some competitive advantage as effectively, she would be a hypermasculine woman (I believe this is the case for Caster Semenya). They still have a va**na, but have more testosterone signal than the average cisgender female would have. The only way to know that would be to have a sequence of the androgen receptor and see how functional it is. If it's CAIS, a complete knockout of the receptor, they do not have an advantage. If anything they might be at a slight disadvantage because "normal" XX females do have testosterone. Hyperandrogenism is extremely common in elite female athletes.

Regardless, this is not a transgender issue. It has nothing to do with transgender people. This is an inters*x issue. This is always going to be a problem, because depending on what test you use, the person will have different results.

If this was the 1950s, we'd take a look, and yep, that's a va**na. Girl.

Then, if we get chromosomal data, XY, boy.

If we get hormone data, wow, that's a huge testosterone, boy.

Obviously, with discordant results, it's difficult to determine with the right thing is to do here. These issues never came up 50 years ago because we didn't have the level of testing we have now. But now we're seeing all this variability in human s*x differentiation and we're getting these situations.

Now if you're asking me whether or not this is fair? I'm not going to be the guy who makes an opinion on that. The best I could say is that if a person has XY CAIS, A complete androgen receptor knockout, they are at zero competitive advantage over other females, possibly even a disadvantage.

If they have PAIS, they might have some competitive advantage as they have more androgenic signal than a woman would have. It would depend on how much sensitivity remained of the androgen receptor.

Regardless, after seeing days of bigotry, memes, and armchair geneticists prognosticating on what the right thing is to do here, I had to say something.

I again ask you to take this with a grain of salt as this is not my personal patient, I have not seen any of her lab testing personally, nor do I know for sure that this is the correct diagnosis. It's simply what I've been able to gather from what has been posted online. Regardless, it does seem to fit correctly with what I've read, and hopefully you find it useful.

I hope that this will help educate you, and that you can share this post with those who also need the education. I hope that those people, once they're presented with the correct information, will be receptive to it rather than hostile. I've had to deploy Timothy 2:12 a few times so far this weekend for people telling me what their Bible says takes precedence over what my Medical Degree says.

I have tried to make this as informative but yet politically neutral as possible. As I have seen both far left and far-right commentary on this, and both are wildly incorrect.

That being said, I will leave you with one little bit of humor, and that it is hilarious to me that conservative people would finally be in agreement that there really are men with va**nas. I'm glad they finally have come around to understand that. =)

-Dr. Powers

Last night, I found out that one of my patients committed su***de.

I've been a doctor for 11 years now, and in that time, as far as I'm aware, I've only lost two patients to su***de. I understand the suicidality risks of transgender people, and despite treating about 3000 over the past decade, I've only had two su***des.

However, two su***des is two su***des too many.

The first was a young girl, barely 18, and I was completely caught off guard by it as we had been discussing taking medications to slow aging and to extend lifespan quite literally hours before she did it. I still to this day don't know what I missed. I'm still haunted by it and think about her often, wondering how I failed her.

This second patient, was someone who was chronically ill, recently became my patient, I figured out what was wrong with them (they had a rare diagnosis), got her on treatment, and the last time I saw her, she was literally miraculously better, feeling healthier than she had in years. There was an enormous improvement in pretty much all of her symptoms, and she was actually upbeat and hopeful about the future.

But then.....this happened. I have no idea why.

I cannot put into words how difficult this is for me mentally, as I feel like I failed, I missed something. In both cases, these were not patients that expressed suicidality in the slightest. I was completely blindsided by it. I have to this day no idea what I could have done differently or what I missed to indicate this could happen.

I just want to make this post here, to say, from a completely selfish standpoint that what I feel in my chest right now is absolutely awful, and I never ever want to have to feel this way again.

If you're my patient, and you're struggling, if you're contemplating ending it, please, talk to me.

I am not going to sit on my high horse and judge you. I've openly admitted that after going through tragedy after tragedy and loss and grief from 2017 to 2021, I nearly broke a number of times and I'm honestly lucky that I'm still here.

Part of the main reason I am, is because some of my transgender patients reached out to me at what was quite literally the most critical moment, though they had no idea at the time. It was like they had some prescient ability to know I needed help at that moment. If they had not done so, I would not be typing this right now.

I will do literally anything to prevent having to feel this again. If you need help, if you think you're at your limit, I ask that you please give me a chance to do my job and help you get out of that dark place, as I 100% understand how that despair feels, and that when you're in it, its suffocating and feels inescapable.

It is however not inescapable, and now many years after being in that darkness, I look back on those times with bewilderment trying to understand how I ever got that close to the abyss, incredibly grateful to still be alive and to get to experience reality and live a life.

In short, I will do literally anything in my power to prevent there ever being a 3rd su***de of a PFM patient, and I ask, if you think that's the path you want to take, you give me at least one opportunity to try and help you. Even for strictly selfish reasons, I never ever want to have to feel this a third time, so please, allow me the opportunity to do what I can do to help.

If you're reading this, and you're not suicidal, and life is going pretty damn well for you right now, today's a great day to reach out to people you care about who might not realize you do, or who may really need that helping hand. Just do a little check in, and give your family/friends/loved ones the space to be honest about how they're feeling.

The patient who reached out to me that day in 2018, they had no idea how critical that message was at that moment, but without it, there would be no Powers Family Medicine.

I appreciate if you've read this far, and ask that if you're doing well, you offer your support to those who need it. If you're in need, please, I am here for you, I will do literally anything to prevent this happening a third time. Please, reach out to me today okay?

- Dr Powers

The results of the patient assistance fundraiser are in!

This year, the event with all donations raised $3523.01!

As promised, Dr Powers will personally match everything raised by the community, which means $7046.02 has been added to the coffers for the fund. That's a lot of hormones! (And other critical essentials!)

We hope everyone enjoyed coming out, we realized afterwards that we only got a few pictures this year! I'm missing pictures of the organ toss and the covid slayer dart throwing game, and really anything not pictured here, so if you have some photos from the event, please do share them in the comments!

(Please share and spread the word!)

This Saturday, July 27th from 12-4pm in the PFM parking lot (23700 Orchard Lake Road, Farmington Hills) we're having our annual LGBTQ patient assistance fund fundraiser, and this year is going to be bigger and better than ever before!

Take a look at all these fabulous auctions/raffles/prizes, even Fenrir is impressed! We've got gift baskets galore, tabletop gaming sets, even a limited edition splatoon nintendo switch console!

Fenrir will of course be there for anyone who wants to meet the Guinness World Record tallest cat in the world!

Dunk Dr. Powers into the dunk tank, eat some food, win some raffles, play some carnival games and have a great time!

All proceeds from the fundraiser or community donations will be tallied and then personally 1:1 matched by Dr. Powers to double our funds raised for the year.

These funds are used throughout the following year to help patients in desperate situations. They have been used to prevent homelessness, pay for medication or equipment, or for other patient emergencies to help protect the most vulnerable members of our community when they need help the most.

We really think this is going to be our best fundraiser ever, so do your best to come by between 12-4pm on Saturday. We so appreciate the kind donations and support from the community and local businesses that help make this possible, and we can't wait to show you all the surprises prepared for this year!

See you Saturday!

Next week, Kate Meyer is visiting and will be with me all week as we continue to work together on Meyer-Powers syndrome, our unified theory of everything for the interconnectedness of queerness, gender dysphoria, ADHD, autism, hypermobility, thyroid dysfunction, mast cell/allergy issues, IBS, etc etc (everyone knows all the related things, If you want to see the full list just check out /r/DrWillPowers on reddit. It's a pinned post.)

She is looking for people to interview and speak to who have the syndrome, and who have experienced it, and additionally have treated it. And how those things have worked out.

Being as a large fraction of my patient population has the syndrome, well, there's quite a lot of you out there who might want to talk to her!

If you're willing to be interviewed by her or meet up with her next week, please contact her at:

[email protected]

We really appreciate the contributions of the community. This syndrome has existed for as long as time, and been ignored, dismissed, and even mocked by the medical institution as some sort of psychogenic illness. The amount of people on TikTok complaining of this constellation of symptoms, yet being utterly ignored by their doctors is immensely frustrating to us. We really believe in this and we think we can help these people! We appreciate your support.

Thank you so much in advance if you're willing to help us with our research!

-Dr. Powers

I swear, the mysterious artist AG must have some sort of prescient ability to understand when I'm feeling stressed out.

We started today with a power failure, throwing everything into disarray this morning, and of course, high levels of stress. But then, this arrives!

I quite literally think that this is my favorite one so far.

The title of this is "The Real Reason For The Phone Problems"

As always the attention to detail in these is incredible. On the wall is a transgender pride flag with an IKEA "Blahaj". Fenrir is chewing The phone cable while wearing a Bitcoin collar, and Polaris and Hyperion are playing with the Steampunk Victorian style rotary phone and knocking it down while the offices rainbow LED heart glows in the background.

This person just gets me.

There is probably more hidden stuff in here that I haven't even found yet.

Getting these is an absolute joy, and I think think this one is my favorite one ever.

Thanks as always AG. You are deeply appreciated. This one will be framed and put up on the wall with all the others and their world record certificates! Whoever you are, you're a good human. Thank you. 🩷🤍🩵

Please come support our event (Saturday July 27th 12-4pm at Powers Family Medicine), or share this anywhere it needs to be seen. All proceeds go to help our patients with medical care or other discretionary emergencies. As always, Powers Family Medicine will match 50:50 with all funds raised from or donated to the event!

Fenrir, The Guinness World Record cat ( https://t.ly/OoDvz ) will be in attendance and all 40lbs of him will be taking selfies with you in exchange for any donation to the fund!

Doctor Powers will be in the dunk tank. Come get revenge for his forcing you to be healthy! Win prizes and bid on awesome donated items!

Help us get the word out and SHARE! Thank you! =)

Just a reminder, our fundraiser is coming up on July 27th from 12 pm to 4 pm. If anyone is interested in donating to the cause please email Laura at [email protected]. Last year we had a multitude of items ranging from massages, Botox, comic books, toys, spa baskets, a tool kit and companies offering discounts on house services. Even if you can’t be there you can contact to donate and we will be live streaming the event while everyone gets a chance to dunk Dr. Powers! Looking forward to seeing everyone there!

Dr Powers and Laura (office manager) will each be on vacation starting Wed the 19th of June and will be completely unreachable until the morning of June 27th (thurs). Internet service is not guaranteed where they will be, so it is entirely likely they will not be reachable at all.

They have coordinated to take their once a year vacation simultaneously (though to different places!) to cause less chaos for the office. Sommer and Dayna will be covering for Dr. Powers and answering messages/refills/etc.

If there is anything critical you need done by one of the two of them we need to receive it by 5pm tomorrow (tues june 18th) or it will have to wait a week until they return!

Save the date!

Our annual patient fundraiser event is coming up July 27th! We will be having an even bigger event this year with more games of chance, skill, food, prizes and so on!

Anyone wanting to donate items for the raffle/auction or volunteer their time, please email [email protected]

Thanks as always for your support of our most vulnerable patients!

(Yes, Dr. Powers will once again be doing his time in the Dunk Tank!)

Three different patients today I had to educate about cat allergies.

It's a common misconception that people are allergic to cat dander.

The primary allergen protein for cats, is found in the saliva. It is known as Fel D1

https://en.m.wikipedia.org/wiki/Fel_d_1

While a tiny amount is released from the sebaceous glands, most of the load of this protein comes from the cat grooming itself.

As you can imagine, months and months of the cat licking itself, licking its coat, deposits ever greater levels of Fel d1 onto the hairs of the cat. Subsequently, this is what triggers the allergy in people. Cats build up massive amounts of this protein on their coats.

If you're allergic to cats, but you live with one, bathe it.

If you regularly bathe a cat, you will consistently strip off this allergen, and reduce the overall allergen load to which you are exposed.

The cat may not be thrilled about this, but trust me, it'll help your allergies a ton!

A lot of people don't realize this, and it's a very easy way to improve the situation.

(Not pictured here, how to bathe a cat. You're on your own with that.)

-Dr. Powers

Fel d 1 - Wikipedia Fel d 1 is a secretoglobin protein complex that, in cats, is encoded by the CH1 (chain 1/Fel d 1-A) and CH2 (chain 2/Fel d 1-B) genes.[2][3]

Once again there has been a good old catastrophic internet failure of ATT for all of Farmington Hills.

As a result all my afternoon patients had to be rescheduled. Restoration is estimated at midnight tonight but we'll see how that goes. Just wanted to warn anyone who has an appointment for tomorrow.

We use a cloud-based EMR service and so it only works if we have an internet connection. I cannot write notes, send scripts, or do anything without internet access. Welcome to the future.

This is all I can get out of them at the moment, hopefully they update soon:

Hi, it's AT&T. There's an internet outage in your area. We expect to fix it by Tue 04/23 12:00 AM EDT. Go to https://my.att.com/t/MtbiXKyCWOUC63 for status and support. Espanol? Envie SP

Smart Home Manager

1. Is there interest in us adding fillers or collagen stimulators such as Juvederm, Restylane, Sculptra, etc to our Botox services?

2. A lot of people keep asking what the plan is for next year.

This is all I can tell you right now.

Starting 2025, the only Medicaid we will accept is Meridian. That's it. We are announcing it multiple times throughout the year so that everyone can know that they need to switch to this one if they would like to stay with the practice if they have Medicaid.

Then, in regards to me, it is yet undetermined whether or not next year I will be doing concierge medicine or not.

Basically the situation is this. Things have improved financially with the practice, but still are not where they need to be. We are still having difficulties with patients paying their bills and so on.

If I am not able to pay myself the sort of salary that I would make working for any other hospital system anywhere else, I am going to have to change the way that we structure the practice. Quite simply, we spend so much time and effort caring for the Medicaid population and other disadvantaged populations that we flat out cannot sustain to do this endlessly financially.

The only way that we could do this would be to split the practice into two separate practices effectively, those with regular insurance that would like to see their current provider that isn't me, they can do so.

Those that would like to see me would basically have an annual membership service. They pay a flat fee for the year, and anything they need done, it's just covered. Cosmetic / Laser services would be offered at an extreme discount to these patients as well.

This option is probably particularly appealing to those who do not have insurance, as it is vastly cheaper than insurance.

For example, I pay $400 a month for my own personal catastrophic insurance that has a $9,000 deductible. This is ridiculous.

I pay $5,000 a year to have the pleasure of paying $9,000 more dollars per year before this insurance does anything for me. I have it because of the remote possibility of something catastrophic happening to me that I obviously can't handle for myself.

So basically I would pay $14,000 a year for medical services for any other doctor that I see for any reason for the entire year.

But for example if I signed up with a doctor who did a $1,500 a year membership fee, I would effectively pay my concierge doctor only that, and then nothing else throughout the entire year. We would have a private deal where effectively, I keep him on retainer like a lawyer, and I don't pay anything beyond the membership fee no matter what happens for any of his services. If I see him twice a year, or, if I see him every two weeks for OMT, I pay $1500 a year. The fee is the fee regardless of the services rendered (with the exception of some things with a consumable cost like lasers or pellets, which would be offered at an extreme discount.)

We have not yet decided if we are definitely going to do this or not. I'm going to basically make that decision around September.

I am doing my best to not have to do this as it is not something that I want to do, but I also would like to be paid more than effectively minimum wage to be a physician. And I've been doing this for years out of charity, but I can't really do it anymore. If it is possible to continue to sustain the practice and its current business model, we will do that. But if come September, it is not financially viable still, we are still owed an enormous amount of bad debt, and the situation is not improving. We simply have no other choice. In order to be able to support our extensive Medicaid population, this is what we will have to do.

Effectively, the better off patients in the practice will More or less subsidized the ability for us to see Medicaid patients at a loss.

I would imagine that this would be well received by this community simply because this is effectively a form of socialism. Those that have more can basically pay more such that those that have less can pay less.

Regardless this is not yet written in stone, we are still making an evaluation every month financially to decide where we're headed, and make a decision ultimately by September about what we're going to do for 2025.

Regardless, if you have Medicaid, you must have Meridian Medicaid after New Year's Day in 2025. If you currently have some other Medicaid that we are accepting, you will need to switch when it comes to enrollment. If you do not do this, you will be unable to see us anymore without having to pay cash prices. We are giving you a years notice about this change, so that everyone can change to Meridian if they do not want to have to pay cash.

This is set in stone. It will not be changing. Starting 2025, Meridian will be the only Medicaid we accept. I cannot stress that enough. If you are not signed up for it now, prepare to change.

One more time:

We will only accept Meridian Medicaid after Jan 1st 2025. If you have any other form of Medicaid you will have to switch this fall during enrollment.

Thanks for your understanding. We are trying to keep our doors open, pay our staff well, take good care of our patients, and make sure that I don't have to live like a resident anymore. It admittedly really sucks to have spent 13 years training and have a nearly a decade as an attending under my belt and know I could make more doing full time as a manager up the street at McDonald's. I've done all the charity I can do for 5 years. I'm exhausted. I'm sorry. Things have to change.

-Dr. Powers