Primary Care Without the Conveyor Belt: Why One Doctor Is Walking Away from 4,000 Patients with Dr Frank Okuson

Send us Fan MailPrimary care is supposed to prevent illness, not just react to it, yet the way healthcare is paid for often pushes doctors into an impossible pace. I’m joined by Dr Frank Okuson Jr, a board-certified internal medicine physician and medical director in Texas, to talk candidly about what it’s like managing thousands of patients with complex chronic disease while trying to do the right thing with diabetes, hypertension, obesity and metabolic health. When the day is built around volume, the “root cause” conversation becomes the first thing to disappear. Frank explains why he’s transitioning away from the standard insurance-driven workflow towards a smaller, prevention-focused practice model of roughly 300 patients. We dig into what that extra time unlocks: closer follow-up, better coordination with specialists, real conversations about sleep, stress, diet and exercise, and support that improves medication adherence. He also shares why advanced screening can matter, including deeper cardiovascular risk markers such as apolipoprotein B and lipoprotein(a), plus tests for inflammation and insulin resistance, especially when standard lipid panels look normal but risk is still high. We also get into the parts people avoid saying out loud: the cost fears that shape patient decisions, the hours lost to paperwork and prior authorisations, and the emotional reality of not being able to bring every long-term patient into a smaller model. If you care about preventive healthcare, physician burnout, patient-centred care, and what a more sustainable future for primary care could look like, this conversation will give you both the frustration and the blueprint. Subscribe for more honest clinician conversations, share this with someone who’s frustrated by rushed care, and leave a review with the one change you want most in primary care.👤 Guest BiographyDr Frank Okosun Jr. is a board-certified internal medicine physician and Medical Director at Brazos Primary Care in Texas. With over 20 years of experience in medicine, he specialises in managing complex chronic conditions including diabetes, hypertension, and cardiovascular disease.Driven by a passion for delivering deeper, more meaningful patient care, Dr Okosun is transitioning his practice from a traditional high-volume model to a prevention-focused approach, centred on root-cause medicine, advanced diagnostics, and personalised care.He is also a Clinical Assistant Professor of Internal Medicine, contributing to the education and development of future physicians.🔗 Guest Contact & LinksWebsite: https://frankokosunmd.com/LinkedIn: https://www.linkedin.com/in/frankokosunmd/Subscribe on SubstackVoices in Health and Wellness is published on Substack, as part of The Diagnostician. Every episode lands there with written notes and reflections you won't find in the podcast feed. Free to subscribe.👉 https://thediagnostician.substack.com/s/voices-in-health-and-wellnessAbout the podcastVoices in Health and Wellness features conversations at the intersection of medicine, lifestyle, and human potential, with clinicians, scientists, and thinkers shaping the future of care.About Dr Andrew GreenlandUK-based medical doctor and founder of Greenland Medical, specialising in Integrative and Functional Medicine. Trained in both conventional and root-cause approaches, Andrew helps people optimise health, performance, and longevity, with a focus on cognitive resilience and healthy ageing.