The Physical Cost of Staying in Insurance-Based Healthcare

If you're a healthcare provider searching for something like "how to leave insurance-based practice" or "is burnout normal in healthcare," you've probably already felt it in your body before you had the words for it.

The fatigue that sleep doesn't fix. The dread that starts before you pull into the parking lot. The slow accumulation of moments where you realize you are practicing medicine in a way that is costing you something you can't quite name.

Healthcare providers are trained to push through. The culture of clinical training rewards endurance, and insurance-based systems are built on volume.

Most providers absorb this as the cost of the career they chose.

What rarely gets named is what that absorption does to the body over time.

Chad Stencel, a family nurse practitioner with over a decade of clinical experience across multiple specialties and large health organizations, described it this way: he would pull into the parking lot of his organization and instantly get a headache. Before he walked in. Before he saw a single patient.

That is not a mindset problem. That is a body keeping an accurate record.

Chad's experience isn't unusual. It's just unusually honest.

During his time in large health organizations, Chad held significant roles, including divisional quality leadership, and developed real expertise in areas such as pharmacogenomics and complex chronic care. By every external measure, he was succeeding.

Inside, he and his business partner were both deteriorating. They had persistent headaches. They didn't want to go to work. They stopped looking forward to continuing education. Chad developed kidney stones because the surgical environment he was working in didn't allow him to take a break.

"We were both getting sick," he said. "We knew we couldn't keep doing this."

The turning point wasn't a dramatic resignation. It was a quiet recognition that the environment itself, not their effort, not their skill, not their commitment, was the problem.

Chad and his business partner spent six months to a year researching what it would take to open their own cash-based primary care practice. They consulted attorneys, accountants, and their licensing board. They asked questions that most providers were never taught to ask inside large organizations because those organizations handled everything on the backend.

Then they opened.

Eight months into running a cash-based practice, Chad describes his health as the best it has ever been, mentally and physically. No headaches. He looks forward to going to work. He recently spent an hour and a half with a single patient. That patient stood up and hugged him before leaving.

His wife and family have told him he's a different person.

That transformation isn't incidental.

It's structural.

When the appointment model changes, when a provider is no longer required to see 25 patients in a day, when documentation doesn't consume hours after hours, when an insurance company isn't deciding what tests can be ordered, the body responds accordingly.

The answer to "what do you do?" is not your job title. It's the outcome of your work, stated in plain language, for the person standing in front of you.

There is a belief embedded in insurance-based training that burnout is a personal failing. That if you managed your time better, set clearer boundaries, or developed more resilience, you would be fine.

Here's what's actually true:

Chad didn't develop kidney stones because he lacked boundaries. He developed them because the system he was working in did not allow him to take a basic human break. That is not a personal problem with a personal solution.

This is something that gets lost in the conversation about cash-based practice: the model isn't only better for patients. It's better for the providers delivering the care.

When Chad spends ninety minutes with a patient, that patient gets solved — not triaged and scheduled for three more appointments. And Chad ends that interaction with something left in the tank, not depleted by the gap between what he was trained to do and what the system allowed him to do.

Sustainable care requires sustainable practitioners.

A cash-based structure doesn't guarantee ease. Chad is transparent about the challenges, marketing is hard, building a patient base from scratch takes time, and there are days that make you question the decision. He and his business partner have both had moments when they wanted to return to a W-2 position.

But they keep returning to the same comparison: kidney stones, parking lot headaches, and a family that barely recognized them, versus a practice where they control the pace, the approach, and the quality of every interaction.

"We will never go back," he said. "If my business fails, I will do something different. I cannot go back to a place where the only concern is insurance and money."

The fear going in is almost always about money and legitimacy.

What practitioners typically discover on the other side:

The revenue math, when providers actually run it, is often a revelation. Seeing 8 to 12 clients per week at a rate that reflects the depth of care being delivered frequently produces more annual income than 25 to 30 patients per day at an insurance-reimbursed rate, with a fraction of the volume, documentation, and depletion.

Chad goes deeper in his episode of the Starting a Business Simplified podcast — including how he and his business partner researched and built their practice from scratch, how they approach pricing conversations with patients, and what pharmacogenomics testing is and why he believes every provider should be offering it.

You can watch the full episode here:

Chad Stencel, Family Nurse Practitioner, is the founder of True North Medical Care in Minnesota, offering cash-based primary care, pharmacogenomics testing, and ultrasound-guided procedures. He was a guest on the Starting a Business Simplified podcast hosted by Suzy Wraines.

If you're a practitioner starting to ask the questions Chad asked, this conversation is worth your time.

If you want a starting framework as you think through your next move, the Cash-Based Practice Starter Guide is a free download at cash-based-practice.beehiiv.com that covers the scope of practice, business setup, pricing, and a regulatory-readiness checklist, written to help you see clearly without spiraling into fear.

Knowing what you do and being able to say it clearly are two different skills. The first comes from your training. The second comes from practice, and it gets easier every time.

You don't need a perfect answer. You need one that's honest and specific enough for the right person to recognize themselves in it.

Suzy Wraines

P.S. If you already have a cash-based practice and want to be found by patients searching for your specialty or location, take a look at the Centered Care Directory.