From a successful indie author, I want to say: thank you. Thank you. Thank you.
I'm also an 'overnight success' 20 years in the making. I just published my 20th novel. The last 14 were within the past 3 1/2 years. I could not have done this successfully within the traditional publishing system, where I banged my head against the gate for almost two decades, told I needed a platform before I could get a publisher to look at my books. But I needed to be published in order to get a platform. So I did the work myself and now I have enough wonderful fans to earn enough to support a family of four on one paycheck. I'm not special -- I'm a midlister at best in my genre -- but every book outsells the last one and the only way I see right now is up.
So I get cognitive dissonance every time I read an article about how people aren't reading, aren't buying books, etc., and that authors are making nothing and publishers are dying off. The media and trad publishers choose to put on blinders and stick with the 'hollow system' of bureaucracy while us indies are killing it -- and it's a joy because we get to interact with our fans the way it sounds like J.J. Abrams et al want to. I wouldn't trade my 'system' for anything!
This is exactly why I want to go indie. I know so many authors making literally millions (and others making a very nice living as midlisters) that I find these pieces about the death of publishing extremely confusing.
This reminds me of an anecdote that Haruki Murakami recounts (I unfortunately can’t remember in which book). Before becoming a novelist his main passion was music and he opened a small jazz coffee shop/bar. His attitude was not to court everyone. It didn’t matter if he got a ton of people passing through if no one became a regular. Thus if only a handful of people came, if he made a connection to one of them and what he did appealed enough to form a personal connection then that was better than being popular. He brought the same attitude to fiction. His novels are eccentric and certainly not for everyone. But it’s so distinct that his fan base is not going to find something similar anywhere else. That is his success is due to NOT dominating the market. As someone who has spent most of his professional life in hospitality upper management rarely appreciates the fact that it’s the staff that turns people in regulars, not the decor. The personal touch matters.
Murakami’s been on my mind. Rereading his book on the Japanese gas attack “Underground” is on my to-do list. We have reached the point where we really need to revisit the 90s and ask some hard questions about the era. Murakami began before many did and his accusation that people wrote off the attack as a cult rather than the underlying causes has obvious resonance.
...the only thing i can't get over in the new paradigm is how many of the new systems for creators are gatekept similar to the old forms but just by new owners...want an audience for your videos head to tiktok/youtube/twitter...for your writing how about substack/beehiv...your music...pray those platforms (spotify/bandcamp/pandora/god) put you into an algorithm any algorithm...we have more options to democratize the advertising of the personal, and more tools to cheapen the capability to look "pro", but nothing about these platforms scream "creator power" to me...i appreciate your optimism though, and hope that the next iteration of distribution is ease of community construction...substack is somewhat there but we need more discovery tools so that we can be closer to where folks might want to see us, not just where an algorithm thinks we fit...
That’s a relevant stream of thinking. I’m still waiting for web3, and its promises of making blockchain a big deal. It sounds like the better tech invented to get rid of algorithms and platform policies. But it’s only promises by now
This tracks. The reason Penguin Random House wanted to buy S&S was for its distribution clients.
Also any movie angels out there: Maplewood NJ has a great old movie house that's closed but with other thriving retail spaces that's available for sale. Please buy it and turn it into a place that can compete with the theaters in Montclair. But don't toss the other retailers.
Inspiring post, Ted. We are the media now. The system and its gatekeepers are lashing out as they fade into irrelevance. The four reasons you listed for bypassing the system sound exactly like the reasons why Substack was created. Drucker smiles from above as we get down and dirty at the grass roots. Substack is more than a cultural engine - it is a serendipity engine: https://yuribezmenov.substack.com/p/substack-serendipity-engine-notes-debates
"You have to understand, most of these people are not ready to be unplugged. And many of them are so inert, so hopelessly dependent on the system that they will fight to protect it." - Morpheus
Several times a week I would sit in Stan's Doughnuts, eating one of their ethereal maple bars, like no other maple bar I've ever eaten, or perhaps a "Wooden Blueberry" doughnut (named after the Wizard of Westwood), and look right at that theater. At night, I'd often see a film there. I was very glad when I read that the theater had been saved. I only wish someone had done the same for Stan's, which closed for good in 2020.
LA. The ever-changing city. One of the great atrocities of LA is that there is not a great long-standing repertory movie theater. For a time, Cinefamily was that for my friends and I until MeToo exposed things that–well, couldn’t be ignored and it had to close. Thus, the reopening of Vidiot through the tireless efforts of the unsung heroes that endure the endless B.S. of entertainment is cause for celebration.
(P.S. Ted, aka the honest broker, please let me believe that at least one person from your era in media is not an uncaught sexual predator. If allegations come out and this Substack closes I’m giving up on a just, fair, honest world)
Before Cinefamily, in the 1950s, in L.A. there was an "arthouse" cinema on La Cienga that showed indepemdant films, foreign films, Leni Reifenstahl Olympic films, and films that today would be considered porn. There was also, in the 60-70s, a cinama on Santa Monica Blvd., in W.L.A. that showed the same type of films. The Fox Venice did the same as well as having live concerts. It was a time.
A close, dear friend of mine’s father worked at the Fox Venice. It was a hotbed for New Hollywood and the counterculture. Now, of course Venice, is called “Silicon Beach” and has identical looking stores all selling upscaled “coolness”. When he told his son “You should spend more time in Venice” he had to break it to his father that a lot had changed.
I left Venice in 1980. I went back to visit friends around 20 yrs. later and it looked like a trash heap, I played at the Fox Venice on the bill with Canned Heat and John Lee Hooker. We were playing 3 nights a week, to packed houses, at the Comeback Inn. It was a wonderful time to be in L.A. Alas, it is no more.
This is fascinating to me. I’m a millennial. My friends and I were haunted by a nostalgia for a counterculture that no longer existed. That’s why so much hipster millennial music references older eras. A lot of friends’ parents had entered the industry during the counterculture so this history was a reference point. They were also very opposed to the streaming model and immediately spotted its unsustainablilty. Venice became down and out but gentrification turned it into tech’s idea of cool – homogeneous, no edges, extremely expensive and just for them.
The New Beverly fits the bill, doesn't it? For as long as I can remember (and according to a Google search, since 1978) that theater has been programming a different double feature daily. I can't count the number of great films I've seen there over the years. There are a number of other such theaters in L.A., though many have closed. The Silent Movie Theater, which became Cinefamily after its owner was murdered, was a treasure, and I believe by the time it closed it was the last theater in the U.S. that showed exclusively silent films.
You are right that there still great places to see movies, esp. old movies. But what I meant by repertory movie theater is a place that has a mixture of old movies, weird movies, new independent film, Q&As with the cast and director, etc. That is, a temple to film. Cinefamily did all those things and a really beautiful scene emerged around it. The leadership was terrible but it was the staff that suffered the abuse in order to fulfill a communal role in LA that made it special. Places like that are really disappearing from LA and the struggle to keep them seems to be getting harder and harder.
Boston and Cambridge were once full of them. They were killed by the video stores in the 1980s. Suddenly, everything was coming out on video tape, and you could rent it for a modest fee. The real estate boom of the era didn't help, but it was home video.
There are benefits and tradeoffs to all these changes from theater to tape to streaming. What’s frustrating is that none of them seem to build off one another. Why can’t I have a repertory theater, rental store, and social media platform dedicated to movies? Don’t we all want this? Instead I have a Starbucks next to a Starbucks within walking distance.
I suspect most areas of culture and society will be won soon through thinking small. In my field, therapists are increasingly breaking away from health insurance companies to directly serve clients, without them needing to jump through all the hoops and red tape to receive help. More of my generation and younger need to think small and affect change where we are, rather than trying to fix the grand stage all at once. Before we know it, the rain drops have created the flood.
The concierge model for medical doctors as well. I just jumped from my old primary care within a large hospital system to join my husband’s GP in a smaller concierge office. Pay either a monthly or yearly fee, no going through insurance, and your doctor is available whenever you need her. It’s been so refreshing.
In China it used to be that you paid the dr. when you were well, and not when you were sick. That meant his motivation was to help you get and stay well.
Concierge Doctor Offices. Great for the providers, I am sure, and for the well-heeled patients who can afford a membership in a half-dozen specialists’ offices and ditch their medical insurance coverage … until that patient needs a hospital. Then, best they be very well-heeled, indeed.
Most of the concierge practices I know rely on medical insurance payments. They just charge monthly fees to stabilize revenue and limit patient load. Insurers are notorious for dragging their heels and the bureaucracy can be insane. This allows them to schedule longer visits for a smaller number of patients. It's great if you can afford it, but it doesn't make anything better for anyone else. If anything, it removes some of the better doctors from the local pool.
Until fairly recently, doctors tended to be small businessmen running practices by themselves or with a small number of partners. The increasing sophistication of medical billing and related technologies made it harder for them to operate. They'd need at least one full time staff member just to hassle insurance companies and someone who could deal with the technology as records moved electronic.
More and more doctors, and especially new doctors, gave up and became salaried workers for large hospitals or clinics. Often they'd work for a medical subcontractor rather than the facility directly. The pay was still good, but the modern workplace is hellish with an ongoing squeeze for more revenue and acceptance of crappier working conditions. You can relax your private practice if you don't mind making a bit less money. (Our town ophthalmologist works one day a week.) You can't go 80% or 50% time with the big employers.
It was worst for GPs. Some of them became in-hospital specialists. Many older ones retired. Others formed concierge practices.
Thanks for one inside view. Practitioners rarely bother to reveal how they run their practices to patients like me. It’s another case of trust erosion on both sides of doc/patient relationships.
In the model you describe, patients pay a concierge fee for more personalized service, maybe services not covered by insurance, nicer surroundings, more attractive staff, or whatever, but they apparently still carry insurance. So nobody here is entirely free of their control, cost, or the overhead and friction they add to doctor/patient transactions.
We went with a concierge practice because that's where our GP went, and we were very happy with him. The real perks are continuity and shorter wait times for appointments.
I haven't made the switch yet, but am looking at models. I like the thought of a concierge model, which is essentially self-pay at time of service (credit card/check/cash). No insurance, no diagnosis needed. Nice for avoiding red tape, but expensive for clients, as usual self-pay rates are $120-$200+ per hour depending on level of license and experience from clinician. This model tends to target higher-income clients with less intense needs and mental health concerns. Problem is, this tends to leave out the majority of people who can't afford these rates and/or have higher-acuity needs.
The model I've seen that intrigues me the most is a similar concierge approach, but income-based. This way, people who don't have as much money can still have access to the simplistic self-pay model, avoid the health insurance industry, and still receive a professional level of care you can't get from the unregulated coaching industry. You'll have some people who pay whatever your lowest rate offered is (I've seen as low as pro-bono to the $20 range per session) all the way to the $200+ range for those can afford it. People who can pay more partially subsidize those that can't. The downside here is, of course, clinicians will average a lower amount depending on what the floor is they offer.
For me, this is ideal because while I want to certainly make money, my professional values are being able to provide services for the under served. The insurance industry can provide this, too, but there are many who need help who make too much for Medicaid/Medicare but who don't have good enough health insurance at their jobs to avoid having a high deductible plan. This middle class of people who need care are getting squeezed badly right now, in addition to those needing crisis care (which is a whole other topic).
No fluke, Ted. Your readers are real people who are also learning about smaller, slower and better as creators. I LOVE Substack and use it as my Go To Place for all things creative and intelligent. It is the best place I have found on the Internet so far.
My motto for 2024 has been “the future is local and personal.” You’ve made a good case for this with creatives! I was actually thinking about audiences – with the rise of AI, we can’t trust anything that we can’t physically touch or smell or have a personal relationship with.
Someone like myself, a small indie author/musician who joined Substack just recently, hoping to finally have found a way to build an audience, can only hope that you (and Peter Drucker) are indeed correct. So far, I've found Substack to be a pretty snazzy place, filled with positive people, plenty of helpful advice, interesting articles, and lots of read-worthy goodies... I definitely appreciate your encouraging post.
Sir Gioia, you thrive on Substack because you're a damn good writer saying important things that your audience wants to hear. Many on Substack won't make it. It's competitive. The distribution is important, but so is content. You've written plenty on how the content sucks, because the gatekeepers are lousy at recognizing or even caring about true talent. Just the numbers and algorithms.
Sears made a bunch of blunders. The tower is almost irrelevant. Plenty of retailers went under, they just didn't build a tower. Sears was the biggest, but plenty did not see what was coming. I used to drop my sister off at her job working at K-Mart headquarters in Troy, Michigan. Not a tower, more like a campus. Ford was the primary tenant in the Ren-Cen, Detroit's "tower" if you will. Their fortunes mostly went downhill because they couldn't see many things coming. In what might be a one-off as far as I know, Ford left the Ren-Cen as their corporate HQ . . . and GM moved in. Fwiw it was a terribly designed building that still gets mocked in articles on office design. Not the appearance from outside, or the views inside. It's just a nightmare to navigate, a labyrinth where you have to ask for directions and still get lost. So, way to go GM. I used to joke that the tallest building in every city was generally an insurance company's. At least Sears broke that mold.
But the list of companies that don't see changes coming and eventually fade from dominance is a long one indeed. The stodgy ones will fight the newcomers upsetting the established order any way they can. Lobbying in Congress, going to court so vegan meat and dairy alternatives can't call their product beef/milk/cheese, trying to make the new kids on the block offer$ they can't refu$e. You've written about that too.
If anyone goes to that theater in Westwood, have a calzone at the pizza joint kitty corner from there. You can prego me later.
Hancock was plenty tall, the tallest before the Sears in Chicago. I believe both had observation decks, Hancock was on the north end of Miracle Mile. Bit more scenic neighborhood, Sears was more business district. I'm from Detroit but CHI was the big city within driving distance, mom would shlep us to those touristy places even though she was terribly afraid of heights and never so much as went near the windows to marvel at the view.
I really appreciate your writing and your ideas, but the frequent referencing of Taylor Swift does bother me. I know others will feel differently, and I know that your reasons for doing so are well considered and studied, but it irks nonetheless. Although I take the point about Swift in some small sense working outside of the system, there is so much that is so extraordinarily problematic and destructive about her influence and activity globally that it seems disingenuous to so readily and superficially cite her as an example. Swift is a case study unto herself, and is at the centre of a maelstrom of corporate, capitalist machinations. I often feel encouraged and elated by your oblique thinking, only to be left with a bitter taste in the mouth at yet another hint that Swift may be my saviour, not a manifestation of a grotesque and cynical contemporary artistic sphere.
Would it help comparing the careers of Madonna and Swift? Madonna worked the machine. She figured out how to play it extremely well. (I can't say much about her music, but I admired her as a businessman.) Swift decided to ditch the machine. She could have played it, but it wasn't worth it when there was an alternative. It's one thing when the small players are sick of the system and willing to try alternatives. It's another when even those who could win with the machine don't think it is worth it.
From a successful indie author, I want to say: thank you. Thank you. Thank you.
I'm also an 'overnight success' 20 years in the making. I just published my 20th novel. The last 14 were within the past 3 1/2 years. I could not have done this successfully within the traditional publishing system, where I banged my head against the gate for almost two decades, told I needed a platform before I could get a publisher to look at my books. But I needed to be published in order to get a platform. So I did the work myself and now I have enough wonderful fans to earn enough to support a family of four on one paycheck. I'm not special -- I'm a midlister at best in my genre -- but every book outsells the last one and the only way I see right now is up.
So I get cognitive dissonance every time I read an article about how people aren't reading, aren't buying books, etc., and that authors are making nothing and publishers are dying off. The media and trad publishers choose to put on blinders and stick with the 'hollow system' of bureaucracy while us indies are killing it -- and it's a joy because we get to interact with our fans the way it sounds like J.J. Abrams et al want to. I wouldn't trade my 'system' for anything!
Hey you just inspired the shit out of me (and Ted did too, obviously). Thanks and congrats on the success!
Yay! I live to inspire everyone who has a book or ten in them to write and publish! It's never been better overall for us. Good luck!
Feeling this too, Olivia. I'm behind you by a few books but I'm loving the journey.
So pleased to read this 👏🏻👏🏻👏🏻
This is exactly why I want to go indie. I know so many authors making literally millions (and others making a very nice living as midlisters) that I find these pieces about the death of publishing extremely confusing.
This reminds me of an anecdote that Haruki Murakami recounts (I unfortunately can’t remember in which book). Before becoming a novelist his main passion was music and he opened a small jazz coffee shop/bar. His attitude was not to court everyone. It didn’t matter if he got a ton of people passing through if no one became a regular. Thus if only a handful of people came, if he made a connection to one of them and what he did appealed enough to form a personal connection then that was better than being popular. He brought the same attitude to fiction. His novels are eccentric and certainly not for everyone. But it’s so distinct that his fan base is not going to find something similar anywhere else. That is his success is due to NOT dominating the market. As someone who has spent most of his professional life in hospitality upper management rarely appreciates the fact that it’s the staff that turns people in regulars, not the decor. The personal touch matters.
Double-checked and the anecdote appears in What I Talk About When I Talk About Running. And a blogger did the tireless gumshoe journalism of finding it: http://www.ageekinjapan.com/haruki-murakami-jazz-club/
Thank you! This is a great story.
I have Murakami's book Sueño (Spanish translation....I live in South America) and it is fantastic.
Murakami’s been on my mind. Rereading his book on the Japanese gas attack “Underground” is on my to-do list. We have reached the point where we really need to revisit the 90s and ask some hard questions about the era. Murakami began before many did and his accusation that people wrote off the attack as a cult rather than the underlying causes has obvious resonance.
...the only thing i can't get over in the new paradigm is how many of the new systems for creators are gatekept similar to the old forms but just by new owners...want an audience for your videos head to tiktok/youtube/twitter...for your writing how about substack/beehiv...your music...pray those platforms (spotify/bandcamp/pandora/god) put you into an algorithm any algorithm...we have more options to democratize the advertising of the personal, and more tools to cheapen the capability to look "pro", but nothing about these platforms scream "creator power" to me...i appreciate your optimism though, and hope that the next iteration of distribution is ease of community construction...substack is somewhat there but we need more discovery tools so that we can be closer to where folks might want to see us, not just where an algorithm thinks we fit...
Work to the algorithm!
Slave to the algorithm!
Live to the algorithm!
Love to the algorithm!
...this is my favorite Grace Jones song...
There is a post or seven waiting to happen.
That’s a relevant stream of thinking. I’m still waiting for web3, and its promises of making blockchain a big deal. It sounds like the better tech invented to get rid of algorithms and platform policies. But it’s only promises by now
This tracks. The reason Penguin Random House wanted to buy S&S was for its distribution clients.
Also any movie angels out there: Maplewood NJ has a great old movie house that's closed but with other thriving retail spaces that's available for sale. Please buy it and turn it into a place that can compete with the theaters in Montclair. But don't toss the other retailers.
Inspiring post, Ted. We are the media now. The system and its gatekeepers are lashing out as they fade into irrelevance. The four reasons you listed for bypassing the system sound exactly like the reasons why Substack was created. Drucker smiles from above as we get down and dirty at the grass roots. Substack is more than a cultural engine - it is a serendipity engine: https://yuribezmenov.substack.com/p/substack-serendipity-engine-notes-debates
"You have to understand, most of these people are not ready to be unplugged. And many of them are so inert, so hopelessly dependent on the system that they will fight to protect it." - Morpheus
We’re actually working on our first full-length film. This is very heartening.
Several times a week I would sit in Stan's Doughnuts, eating one of their ethereal maple bars, like no other maple bar I've ever eaten, or perhaps a "Wooden Blueberry" doughnut (named after the Wizard of Westwood), and look right at that theater. At night, I'd often see a film there. I was very glad when I read that the theater had been saved. I only wish someone had done the same for Stan's, which closed for good in 2020.
LA. The ever-changing city. One of the great atrocities of LA is that there is not a great long-standing repertory movie theater. For a time, Cinefamily was that for my friends and I until MeToo exposed things that–well, couldn’t be ignored and it had to close. Thus, the reopening of Vidiot through the tireless efforts of the unsung heroes that endure the endless B.S. of entertainment is cause for celebration.
(P.S. Ted, aka the honest broker, please let me believe that at least one person from your era in media is not an uncaught sexual predator. If allegations come out and this Substack closes I’m giving up on a just, fair, honest world)
Before Cinefamily, in the 1950s, in L.A. there was an "arthouse" cinema on La Cienga that showed indepemdant films, foreign films, Leni Reifenstahl Olympic films, and films that today would be considered porn. There was also, in the 60-70s, a cinama on Santa Monica Blvd., in W.L.A. that showed the same type of films. The Fox Venice did the same as well as having live concerts. It was a time.
A close, dear friend of mine’s father worked at the Fox Venice. It was a hotbed for New Hollywood and the counterculture. Now, of course Venice, is called “Silicon Beach” and has identical looking stores all selling upscaled “coolness”. When he told his son “You should spend more time in Venice” he had to break it to his father that a lot had changed.
I left Venice in 1980. I went back to visit friends around 20 yrs. later and it looked like a trash heap, I played at the Fox Venice on the bill with Canned Heat and John Lee Hooker. We were playing 3 nights a week, to packed houses, at the Comeback Inn. It was a wonderful time to be in L.A. Alas, it is no more.
This is fascinating to me. I’m a millennial. My friends and I were haunted by a nostalgia for a counterculture that no longer existed. That’s why so much hipster millennial music references older eras. A lot of friends’ parents had entered the industry during the counterculture so this history was a reference point. They were also very opposed to the streaming model and immediately spotted its unsustainablilty. Venice became down and out but gentrification turned it into tech’s idea of cool – homogeneous, no edges, extremely expensive and just for them.
The New Beverly fits the bill, doesn't it? For as long as I can remember (and according to a Google search, since 1978) that theater has been programming a different double feature daily. I can't count the number of great films I've seen there over the years. There are a number of other such theaters in L.A., though many have closed. The Silent Movie Theater, which became Cinefamily after its owner was murdered, was a treasure, and I believe by the time it closed it was the last theater in the U.S. that showed exclusively silent films.
You are right that there still great places to see movies, esp. old movies. But what I meant by repertory movie theater is a place that has a mixture of old movies, weird movies, new independent film, Q&As with the cast and director, etc. That is, a temple to film. Cinefamily did all those things and a really beautiful scene emerged around it. The leadership was terrible but it was the staff that suffered the abuse in order to fulfill a communal role in LA that made it special. Places like that are really disappearing from LA and the struggle to keep them seems to be getting harder and harder.
Boston and Cambridge were once full of them. They were killed by the video stores in the 1980s. Suddenly, everything was coming out on video tape, and you could rent it for a modest fee. The real estate boom of the era didn't help, but it was home video.
There are benefits and tradeoffs to all these changes from theater to tape to streaming. What’s frustrating is that none of them seem to build off one another. Why can’t I have a repertory theater, rental store, and social media platform dedicated to movies? Don’t we all want this? Instead I have a Starbucks next to a Starbucks within walking distance.
Land is expensive. No need for rental stores. But then again, no need for physical banks either and there's still one of those on every corner.
Cinefamily is now Brain Dead and still plays some fantastic old/weird/art/horror/sci-fi/etc films.
I suspect most areas of culture and society will be won soon through thinking small. In my field, therapists are increasingly breaking away from health insurance companies to directly serve clients, without them needing to jump through all the hoops and red tape to receive help. More of my generation and younger need to think small and affect change where we are, rather than trying to fix the grand stage all at once. Before we know it, the rain drops have created the flood.
The concierge model for medical doctors as well. I just jumped from my old primary care within a large hospital system to join my husband’s GP in a smaller concierge office. Pay either a monthly or yearly fee, no going through insurance, and your doctor is available whenever you need her. It’s been so refreshing.
In China it used to be that you paid the dr. when you were well, and not when you were sick. That meant his motivation was to help you get and stay well.
Concierge Doctor Offices. Great for the providers, I am sure, and for the well-heeled patients who can afford a membership in a half-dozen specialists’ offices and ditch their medical insurance coverage … until that patient needs a hospital. Then, best they be very well-heeled, indeed.
Most of the concierge practices I know rely on medical insurance payments. They just charge monthly fees to stabilize revenue and limit patient load. Insurers are notorious for dragging their heels and the bureaucracy can be insane. This allows them to schedule longer visits for a smaller number of patients. It's great if you can afford it, but it doesn't make anything better for anyone else. If anything, it removes some of the better doctors from the local pool.
Until fairly recently, doctors tended to be small businessmen running practices by themselves or with a small number of partners. The increasing sophistication of medical billing and related technologies made it harder for them to operate. They'd need at least one full time staff member just to hassle insurance companies and someone who could deal with the technology as records moved electronic.
More and more doctors, and especially new doctors, gave up and became salaried workers for large hospitals or clinics. Often they'd work for a medical subcontractor rather than the facility directly. The pay was still good, but the modern workplace is hellish with an ongoing squeeze for more revenue and acceptance of crappier working conditions. You can relax your private practice if you don't mind making a bit less money. (Our town ophthalmologist works one day a week.) You can't go 80% or 50% time with the big employers.
It was worst for GPs. Some of them became in-hospital specialists. Many older ones retired. Others formed concierge practices.
Thanks for one inside view. Practitioners rarely bother to reveal how they run their practices to patients like me. It’s another case of trust erosion on both sides of doc/patient relationships.
In the model you describe, patients pay a concierge fee for more personalized service, maybe services not covered by insurance, nicer surroundings, more attractive staff, or whatever, but they apparently still carry insurance. So nobody here is entirely free of their control, cost, or the overhead and friction they add to doctor/patient transactions.
I feel my cynic gland pulsing.
We went with a concierge practice because that's where our GP went, and we were very happy with him. The real perks are continuity and shorter wait times for appointments.
I'm curious to hear more about how you're doing this. Something quasi-structured like a concierge model, direct payments at time of service, or...
I haven't made the switch yet, but am looking at models. I like the thought of a concierge model, which is essentially self-pay at time of service (credit card/check/cash). No insurance, no diagnosis needed. Nice for avoiding red tape, but expensive for clients, as usual self-pay rates are $120-$200+ per hour depending on level of license and experience from clinician. This model tends to target higher-income clients with less intense needs and mental health concerns. Problem is, this tends to leave out the majority of people who can't afford these rates and/or have higher-acuity needs.
The model I've seen that intrigues me the most is a similar concierge approach, but income-based. This way, people who don't have as much money can still have access to the simplistic self-pay model, avoid the health insurance industry, and still receive a professional level of care you can't get from the unregulated coaching industry. You'll have some people who pay whatever your lowest rate offered is (I've seen as low as pro-bono to the $20 range per session) all the way to the $200+ range for those can afford it. People who can pay more partially subsidize those that can't. The downside here is, of course, clinicians will average a lower amount depending on what the floor is they offer.
For me, this is ideal because while I want to certainly make money, my professional values are being able to provide services for the under served. The insurance industry can provide this, too, but there are many who need help who make too much for Medicaid/Medicare but who don't have good enough health insurance at their jobs to avoid having a high deductible plan. This middle class of people who need care are getting squeezed badly right now, in addition to those needing crisis care (which is a whole other topic).
Interesting! I can definitely see the pros/cons to the sliding scale. And good on you for looking to help those traditionally underserved!
Hooray for independents (in all fields).
No fluke, Ted. Your readers are real people who are also learning about smaller, slower and better as creators. I LOVE Substack and use it as my Go To Place for all things creative and intelligent. It is the best place I have found on the Internet so far.
Same here. The quality (and quantity) of talent on Substack is incredible.
Fantastic piece. Gives me hope!
My motto for 2024 has been “the future is local and personal.” You’ve made a good case for this with creatives! I was actually thinking about audiences – with the rise of AI, we can’t trust anything that we can’t physically touch or smell or have a personal relationship with.
Someone like myself, a small indie author/musician who joined Substack just recently, hoping to finally have found a way to build an audience, can only hope that you (and Peter Drucker) are indeed correct. So far, I've found Substack to be a pretty snazzy place, filled with positive people, plenty of helpful advice, interesting articles, and lots of read-worthy goodies... I definitely appreciate your encouraging post.
Sir Gioia, you thrive on Substack because you're a damn good writer saying important things that your audience wants to hear. Many on Substack won't make it. It's competitive. The distribution is important, but so is content. You've written plenty on how the content sucks, because the gatekeepers are lousy at recognizing or even caring about true talent. Just the numbers and algorithms.
Sears made a bunch of blunders. The tower is almost irrelevant. Plenty of retailers went under, they just didn't build a tower. Sears was the biggest, but plenty did not see what was coming. I used to drop my sister off at her job working at K-Mart headquarters in Troy, Michigan. Not a tower, more like a campus. Ford was the primary tenant in the Ren-Cen, Detroit's "tower" if you will. Their fortunes mostly went downhill because they couldn't see many things coming. In what might be a one-off as far as I know, Ford left the Ren-Cen as their corporate HQ . . . and GM moved in. Fwiw it was a terribly designed building that still gets mocked in articles on office design. Not the appearance from outside, or the views inside. It's just a nightmare to navigate, a labyrinth where you have to ask for directions and still get lost. So, way to go GM. I used to joke that the tallest building in every city was generally an insurance company's. At least Sears broke that mold.
But the list of companies that don't see changes coming and eventually fade from dominance is a long one indeed. The stodgy ones will fight the newcomers upsetting the established order any way they can. Lobbying in Congress, going to court so vegan meat and dairy alternatives can't call their product beef/milk/cheese, trying to make the new kids on the block offer$ they can't refu$e. You've written about that too.
If anyone goes to that theater in Westwood, have a calzone at the pizza joint kitty corner from there. You can prego me later.
You were sure right about the insurance company rule. Wasn't the Sears tower the Hancock tower for a while?
Hancock was plenty tall, the tallest before the Sears in Chicago. I believe both had observation decks, Hancock was on the north end of Miracle Mile. Bit more scenic neighborhood, Sears was more business district. I'm from Detroit but CHI was the big city within driving distance, mom would shlep us to those touristy places even though she was terribly afraid of heights and never so much as went near the windows to marvel at the view.
As a Chicagoan, what’s this Willis Tower of which you speak?
Lol. Right?
I really appreciate your writing and your ideas, but the frequent referencing of Taylor Swift does bother me. I know others will feel differently, and I know that your reasons for doing so are well considered and studied, but it irks nonetheless. Although I take the point about Swift in some small sense working outside of the system, there is so much that is so extraordinarily problematic and destructive about her influence and activity globally that it seems disingenuous to so readily and superficially cite her as an example. Swift is a case study unto herself, and is at the centre of a maelstrom of corporate, capitalist machinations. I often feel encouraged and elated by your oblique thinking, only to be left with a bitter taste in the mouth at yet another hint that Swift may be my saviour, not a manifestation of a grotesque and cynical contemporary artistic sphere.
Would it help comparing the careers of Madonna and Swift? Madonna worked the machine. She figured out how to play it extremely well. (I can't say much about her music, but I admired her as a businessman.) Swift decided to ditch the machine. She could have played it, but it wasn't worth it when there was an alternative. It's one thing when the small players are sick of the system and willing to try alternatives. It's another when even those who could win with the machine don't think it is worth it.