“I fundamentally believe, and I believe this so, so strongly…Ten years into the future, if we do things right, we could have 90% of our healthcare done at home versus in a brick-and-mortar, physical infrastructure setting.”
-Susan Monarez, Former CDC Director at the 2025 HLTH Conference
When people learn what I do for a living, their first reactions are usually ones of intrigue laced with a little bit of whimsical delight. “House calls, huh? Cool! Super retro!” Or, if I catch the ear of an octogenarian, they’ll say something like, “I remember when Dr. Thompson used to come to our house when we were kids. I didn’t think doctors did that anymore!” What I love about these kinds of comments, is that they open the discussion up for me to wax poetic about how yes, house calls are a very “old-fashioned” way of practicing medicine. But in fact, we do it in a very modernized, technology-enabled way. The blueprint for what we are doing today may have been stamped decades ago during “the 1900’s” as my kids like to refer to it, but the successor plan is one marked by innovation, creative use of technology, and imagination.
Why is care at home something to aspire to? Why did Dr. Monarez feel so strongly about this topic that she felt the need to bring it up as a talking point on stage at one of the largest healthcare innovation conferences in the country? In my eyes, there are two drivers: Access and healthcare spending.
We all know that the headlines love to scream things like “US Healthcare is most expensive but least effective in the developed world” and to be honest, for many years of my career as a physician, messages like that used to trigger all of the defensiveness that I’ve built up over the years – my innate sense that I need to protect my profession from the demoralization most of us have been subjected to, particularly in recent years. But as I’ve worked on building out the platform of Pediatric Housecalls, I’ve come to understand that by pointing out the inadequacies of something does not mean you love it any less. In fact, to put it in parenting terms, ignoring subtle early signs that something is wrong isn’t an act of love, it’s an act of omission. It’s lazy parenting.
The reality is that the US healthcare system is expensive and inefficient. Add to that, that patient’s are growing increasingly dissatisfied. There are too many barriers to care, too few options for patients, and too much profit being made by publicly-traded healthcare insurance companies and health system conglomerates, on the backs of physicians and patients. The reason it has been allowed to continue for so long unchecked? Because physicians are viewed as public servants but we’re largely paid by private companies. And the appeal to be viewed as a public servant is alluring – it’s why most of us chose to go into medicine in the first place – to heal, to help, to serve. But we must do better. Instead of becoming defensive or feeling demoralized when patients express their frustrations with the system, let’s start separating ourselves from that old system. Let’s give them what they want: something…better. We cannot dig our heels in and continue down the same worn path that we “grew up in” during our training years. If we aren’t the leaders of innovation in healthcare, someone else will be. And the notion that we are going to entrust this innovation to tech-bros over medical doctors, is dizzying.
So where does that leave us? To use an analogy that we often told our kids as they were playing competitive sports growing up, “You have to play better than the refs ref.” Which is just a way of saying instead of complaining about the system not working for you, you have to be so good that the system doesn’t matter anymore. We as physicians, have to innovate better, show our value better, demonstrate improved outcomes better, be willing to create new practice methods better, be open to new (or re-purposed, in the case of house calls) ideas better. We have to be so good, so compelling, that the old systems can’t ignore us or constrain us. We have to create a new system. We must build our own house, create our own ideas, become our own industry leaders. In 2026, that is precisely my plan…to continue to make Dr. Monarez’s prediction a reality.
