Dr. Diana Girnita: A Physician Leader Breaking Barriers in Specialty Care

Dr. Diana Girnita is a pioneering force in the Direct Specialty Care movement, driven by a passion for improving access to rheumatologic care. 

She founded Rheumatologist OnCall® to address the challenges patients face when seeking specialized treatment for autoimmune and inflammatory conditions, and she co-founded the Direct Specialty Care Alliance to support other physicians in transitioning to the DSC model. 

Her approach breaks the mold of traditional healthcare, allowing patients to bypass long wait times and gatekeepers, connecting them directly with their doctor.

Meet Dr. Diana Girnita: Leading a New Era in Specialty Care

In this interview, you’ll learn more about her inspiring journey and how she’s redefining specialty care in the U.S.

Dr. Girnita, could you share with us your journey and what motivated you to choose medicine as a career?

Absolutely. I was born in Romania, in a small city called Kyoga. When I was growing up, I got very sick at one point and was admitted to the hospital with liver disease. That experience left a lasting impression on me. I think I was about 12 or 13 years old at the time. Seeing how things worked in a hospital really stuck with me. 

Although I had dreams of becoming a fashion designer while growing up, those faded as I became more focused on becoming a physician. I was the first doctor in my family and actually the first person to graduate from college. I worked hard to get into medical school, complete it, and then decided to pursue cardiology. 

During my training, I got involved in research and started my PhD, which opened up another path for me that eventually brought me to the United States. While working on my PhD, I wanted to expand my knowledge and have access to the best research opportunities in the world. It felt like a dream come true to conduct research in a place where it's not just a hobby but also a profession. 

In 2005, I was fortunate to come to the United States as I was accepted as a postdoctoral fellow at Harvard University. And that’s my journey up to the point where I came to the U.S.

In 2023, The New York Times featured you in a report on The Moral Crisis of America's Doctors. Can you tell us more about the report and your thoughts on the U.S. healthcare system?

About two years ago, I was contacted by a reporter to share my work in Direct Care and how I practice today in the medical field. I had no idea who he was or that he would publish the article in The New York Times. He didn’t disclose that to me, but he did mention that very few doctors in the United States were willing to talk about what is really happening within the system. All I did was explain to him what I observed wasn't working, and what I was doing to make it work for me and my patients.

The first thing I talked about was how patients are having an increasingly difficult time accessing care. There are multiple reasons for this. One is that there simply aren't enough of us – doctors. With more patients and fewer doctors, this shortage continues to grow year after year.

Another thing I explained was the lack of price transparency in the traditional healthcare system, both for doctors and patients. As a physician employed by the system, I had no idea how much my consultation would cost, or how much the tests I ordered would cost. 

On the other hand, patients often wouldn’t find out until they received their bill – sometimes 3 or 6 months later. When they were hit with a huge bill, which was actually generated by the hospital system, not by me, patients would think we were the problem. They thought we, the doctors, were greedy and responsible for their financial burdens.

These were just a few things I shared with him, and he was amazed. He didn’t know that we doctors had no idea about the costs of our consultations or the tests we ordered. He assumed we knew and were part of the problem. But he was aware of the financial difficulties patients were facing after visiting their doctors.

Dr. Diana Girnita, the Direct Care model is seen as a solution for physicians wanting more autonomy. Why did you decide to transition and start your own practice?

The transition came at a point when I was facing many challenges as a physician. I was successful in terms of seeing many patients, but over time, I became burned out from trying to address so many issues and document everything while caring for them.

It became overwhelming. I also noticed that patients were struggling to see me year after year. Insurance companies would often change, and patients would be forced to take a new insurance plan that required them to see a different doctor. If they wanted to continue seeing me, they would be penalized by having to pay more. I wanted to make things simpler and more straightforward for both myself and my patients.

I thought about how things worked in Romania, where the government controls the social system, but there is also a private system that is more transparent about the cost of care. Patients know exactly how much they will pay for a consultation or a test. So I started to think about how I could implement that approach here in the US. 

I remembered a colleague who was practicing Direct Primary Care, so I reached out to her. She told me it was possible to be transparent about the cost of consultations, and that I could contract directly with labs and imaging centers to get cash prices. This was mind-blowing to me. The cost difference she described was incredible. For the same test that patients were paying $60, $70, or $80 for, the cash price would be $2 or $3. For an MRI that cost patients $4,000 or $6,000, the cash price would be $400.

These significantly discounted prices were important not just for me, but also for my patients. In this model, I was responsible for knowing exactly how much my patients would pay. It was a long journey, but over time I was able to find these resources. Nobody hands them to you. Nobody knocks on your door and offers discounted prices. But by knocking on many doors and signing contracts, I was able to make it happen.

Today, I can offer these options to my patients. I’ll tell you sincerely, 99% of my patients have insurance, but they also have high deductibles. Because of this, they prefer to pay cash prices, which are 10 times lower than what they would pay through their insurance.

Throughout your career, you've helped countless patients. Could you share one of the most memorable experiences that stands out to you?

Sure. I have a telemedicine practice that sees patients in eight states today. I see patients from all these states, and most of them do not have the opportunity to meet me in person. 

On my way to Florida, one of my patients called my practice with some questions and concerns about her treatment. My assistant mentioned that I was at the airport but assured her that I would call her as soon as I was available. 

Right before I boarded the plane, I called the patient and spoke with her. I shared that I was coming to Florida, and she asked, "Where in Florida?" because she wanted to meet me. I told her I would be in Orlando, and she said, "I live in Orlando!"

So this patient took the time to come to the hotel where I was staying to meet me in person. She shared her story with me, explaining that, months before finding me through a Google search, she had been looking for a rheumatologist. 

She had seen two other rheumatologists in Florida in previous years but never received a diagnosis. After just a couple of appointments with me, she received a diagnosis, started treatment, and was feeling much better. 

She was crying tears of joy the whole time while sharing her story. It was a very emotional experience for me, knowing that I was able to help a patient from thousands of miles away. The fact that she was so moved by the care I provided that she took the time to meet me in person made it even more special. 

That’s a great story, Dr. Girnita! You mentioned your patient found you through a Google search. Can you share more about the work you do on the marketing side?

My strategy comes from my desire and ability to teach. For many years, I was a teacher. I taught medical students, residents, and fellows, and I was very passionate about teaching rheumatology. I’ve translated that passion into educating my patients as well. It’s something I love, but it also helps me educate both my patients and the general public. 

And yes, it does help me attract new patients because when they see that you’re providing them with valuable information, they’re more likely to seek you out. They know that the value you offer goes beyond the typical 7 to 10-minute appointment, where they're rushed out the door and not seen again for another four to six months.

So I use my teaching skills to create content. In the past two years, I’ve grown my YouTube channel, which is now viewed by people in over 102 countries. It brings me so much joy to hear from people all over the world saying, "Thank you, I didn’t know about this," or "I didn’t realize this was helpful." 

They told me that they had no other solutions, but my videos gave them new information. It’s incredibly fulfilling to be able to share my knowledge with people all over the world, and it’s not limited by location anymore.

For my practice, this is also relevant because I address common questions in my videos. I often direct my patients to my YouTube channel, saying, "Why don’t you watch this video about this medication?" or "Here’s a video about some exercises or diet tips related to your disease." Doing all of this helps my practice grow, and I’m very grateful for that.

You've also helped doctors transition to direct care and co-founded Direct Specialty Care. Can you share how the Direct Specialty Care Alliance supports physicians and the key benefits of joining?

When I started in the field of Direct Specialty Care, the term "Direct Specialty Care" didn’t even exist. I tried to keep things simple, and by chance – or by the grace of God – I met Dr. Lara Kenney. We connected through Facebook, and we became very good friends because we share the same values. 

At that time, I had a Facebook group that served as a light at the end of the tunnel for many physicians. But at some point, Laura and I decided to create a formal structure to support a community of physicians who wanted to embrace the direct care model. We wanted to specifically address the needs of specialists because our challenges are different from those of primary care physicians. We can’t all offer a membership model, so we have our own unique hurdles.

Together, Laura and I – and later, others like Dr. Tea Nguyen, a podiatrist – built this community. Over the last four years, we've brought in many physicians from all kinds of specialties. They’ve learned from us, and we’ve learned from them. 

"We provide sustained support, and I even created an online course to help physicians educate themselves about Direct Care. When you join our community, you gain access to a wealth of resources we've developed over time, and you also get visibility through our map, which helps patients and colleagues find you."

We also do marketing for you, and you can contribute blogs to our website, which has strong SEO. When people search for "direct specialty care," our website is one of the first results they find. 

These resources are invaluable for physicians because they not only provide hope but also a clear framework for what to do next. Additionally, we host webinars every 2 to 3 months, where physicians practicing Direct Care share their experiences and answer questions. 

We address challenges as a group, providing support throughout the journey. Instead of going through it alone, like Laura, I, and a few others did, you’ll have the backing of an entire community. And I think that support is priceless.

It truly is priceless. Dr. Girnita, how big is the Direct Specialty Care community now?

We have about 60 paying members, but in our Facebook community, we have more than 800 physicians. Many of them are interested in starting a Direct Care practice and are just educating themselves. In the group, we also have physicians who are actively practicing Direct Care. So, if you're interested in joining Direct Specialty Care Alliance, please visit our website. 

Dr. Girnita, my final question: how do you see the future of the Direct Care movement, and what do you envision for the next few years?

I think this is like a snowball. It started a few years ago for specialists, and in the last three years, as you can see, we’ve grown from zero members in my Facebook group to now over 800 physicians. 

Every week, I get at least five to 10 emails from physicians all around the country asking, "What is Direct Care for specialists? How can I practice this model? How can I build my own practice on my terms?" They ask questions like, "How do you get patients?" or "How do you do your marketing?" or "Do I need referrals?" or "Can I stay in Medicare?" We answer all of these questions for the members of our community.

As I said, this is like a snowball, and it’s going to keep growing. We don’t know how big it will get, but it will definitely be an alternative way of practicing medicine and doing what you love most. For example, I was able to write books, grow a YouTube channel, and build my practice, which I probably wouldn't have done if I had stayed in the traditional medical system.

Thank you, Dr. Girnita, for your time and dedication to patient care and the Direct Care movement!

Thank you so much for promoting our Direct Specialty Care movement. Thank you for the work you're doing to bring new solutions to Direct Care physicians and for building something valuable for patients. What you’re creating with SigmaMD is a fantastic product that will unite patients and physicians on one platform.

My experience has been great. I know you’re working hard to address all of our needs, and I love that because, finally, I feel like someone is asking physicians what they need. And I feel like you’re really listening to the other side – the patients – to understand their needs as well. Uniting these two perspectives is very important for us because, ultimately, we’re dedicated to serving our patients.