Dr. Diana Girnita: My Story of Leaving Insurance to Rebuild Medicine

I am Dr. Diana Girnita, a board-certified rheumatologist, researcher, and author, and I left the insurance system to rebuild specialty medicine on transparent, direct-pay terms. I founded Rheumatologist OnCall, the first direct-pay telemedicine company in rheumatology in the United States, and co-founded the Direct Specialty Care Alliance.

I am still standing after six years of doing this. That sentence does not sound like much until you know what it costs to say it. I have helped thousands of patients across the United States, many of them people no one else would see, and I did it by walking away from the system I spent my whole life training to join.

This is the story of how I got here and why I now spend my time helping other physicians do the same.

Quick answer: I am Dr. Diana Girnita, a board-certified rheumatologist, researcher, and author. I founded Rheumatologist OnCall, the first direct-pay telemedicine company in rheumatology in the United States, in 2020. After years of treating thousands of patients on transparent, direct-pay terms, I co-founded the Direct Specialty Care Alliance to help other physicians leave the insurance system without doing it alone.

Dr. Diana Girnita at a glance

• Role: Rheumatologist; founder of Rheumatologist OnCall; co-founder of the Direct Specialty Care Alliance
• Born: Craiova, Romania; first person in her family to graduate from university and the first doctor in her family
• Training: Medical school in Romania (graduated 2001), PhD in immunology and transplant immunology, postdoctoral research at Harvard University, then the Thomas Starzl Institute at the University of Pittsburgh, rheumatology at the University of Cincinnati
• Founded: Rheumatologist OnCall in 2020, the first direct-pay telemedicine rheumatology practice in the US
• Reach: Thousands of patients treated across the United States; profiled by the New York Times in 2023; roughly 35 million views and 250,000 subscribers on YouTube
• Author of: Two books on autoimmune disease and the role of nutrition (gout, and rheumatoid arthritis)
• Mission: Faster diagnoses, coordinated care, and honest pricing, for patients and the physicians who serve them

Where I grew up

I was born in Craiova, a small town in Romania, into a modest family. My mother was an accountant, my father a sub-engineer, and I have a brother. We grew up in the communist era with nothing special, except one thing that shaped everything: a family that loved to give.

My grandparents moved the whole family from Moldova to southern Romania in the 1960s to escape poverty. My mother was one of the most generous people I have known. She gave to her friends, her parents, her brothers, and to us. The biggest lesson I ever learned, I learned from her: always give back.

Why I became a doctor

I did not always want medicine. As a teenager, I loved design and fashion, but Romania offered almost no path into that world. Then a viral illness put me in the hospital for two or three weeks with severe liver disease. Frightened and in need, I watched the doctors move in and out of the rooms, helping patients and earning real respect. That was the moment I decided. I would become the person who walks in when someone is that afraid.

I was the first in my family, on either side, to graduate from a university, and the first doctor in my family. I went straight from high school into a six-year medical program and graduated in 2001.

How I got from a Romanian residency to Harvard

Two moments defined those early years. My father had a heart attack, and because I recognized it and had the relationships to act, I got him a treatment that few in the country could access at the time. It saved his life. And my parents took out a bank loan to buy me my first computer, a year before I applied abroad. Without that computer, I would never have reached the United States.

My residency salary in Bucharest was about $80 per month, and my parents paid my rent so I could keep training. I was not satisfied, so I pursued a PhD in immunology and transplant immunology alongside my residency, and in 2004 I began applying to institutions abroad, certain no one would answer. Several did. One was a professor at Harvard University, who interviewed me by phone and, two weeks later, invited me to join his team in Boston. I had never let myself dream of an American university, let alone that one.

How I became a rheumatologist

I thought I would stay in the US for a couple of years. I stayed almost five years, doing research, my life split between my children here and my parents in Romania. When I returned to clinical work, I had to start over: another residency and the USMLE exams, which I passed while pregnant with my second child. My parents took turns flying in, six months at a time, to help. I could not have done it without them.

During my internal medicine residency, I attended a lecture on lupus, and everything connected. My years of immunology and transplant research were the exact foundation for my work on autoimmune disease. I had always planned to return to cardiology. Instead, I did a rotation in rheumatology and fell completely in love with it. I stopped Professor Larry Hauk of the University of Cincinnati in a corridor and asked to do a rotation with him. He looked at me like I was crazy, and then he said yes.

The loss that shaped my mission

After my fellowship, I finally let myself feel that I had arrived. I brought my whole family together for a vacation in Florida, the happiest we had been in ten years. A few months later, my mother was diagnosed with metastatic colon cancer.

I was the doctor, and I believed I could save her. I pushed her through a year of surgeries and chemotherapy, treatments that were terribly hard on her, and she passed away anyway. She had been the one who told me that if I truly wanted something, I would achieve it. And when it mattered most, I could not change anything for her. That grief is part of why I could not look away from the next thing I saw.

Why I left the traditional system

Inside the traditional system, I watched patients get hurt, and not only by medical mistakes. They were hurt financially. One day a patient came to me after a visit holding a bill for about $4,000, in tears, believing I had charged her that money. I had not. But what stayed with me was what I had been told about my own role: that my job was to see patients and not to question the business behind the process. I could not accept that. We are responsible for what happens to our patients, including what care costs them and how it is explained.

That refusal to look away is the same instinct now driving so many specialists to leave insurance and build their own practices. I was simply early.

Why I started Rheumatologist OnCall in 2020

I kept asking one question: why are doctors limited to a single office when we do everything else online? So in 2020, I started Rheumatologist OnCall, the first direct-pay telemedicine company in rheumatology in the United States, treating autoimmune diseases and arthritis. When I described it, people looked at me as if I were a doctor from Star Trek.

I built it around a simple idea: the patient should know the cost of their care and be able to choose it. Use your insurance if you want to. If you have a better option, take it. The pandemic arrived, and the whole country understood at once what I had been trying to explain. I later wrote about that shift in Medscape, where I first called this model direct specialty care in print.

How direct specialty care actually helped my patients

One patient tells the story better than I can. He is a waiter in Florida who could not get in to see a rheumatologist near him for about six months. His wife found my practice online. We spoke, I saw him within a week, I started treatment, and two weeks later he was back to normal. He could not believe a doctor on the other coast had opened a door that the doctors in his own area could not. In 2023, the New York Times wrote about this work and the idea that where you live should not decide whether you get help.

Why I built the Direct Specialty Care Alliance

Here is what six years taught me. The hardest part was never the medicine. The hardest part was doing it alone. I once wrote to a major laboratory roughly 50 times just to reach one person who could help my patients. I built every process from nothing and made every mistake myself.

No physician should have to build this alone. That is the entire purpose of the Direct Specialty Care Alliance. It is the room I wish I had walked into in 2020: physicians who have already left the insurance system, physicians one step ahead of you, physicians who made the mistakes so you will not have to, like the anesthesiologist who left insurance to build Renovo Health. It is not a complaint about medicine. It is the replacement. Faster diagnoses, coordinated care, honest pricing, and patients treated as people, not claims. Patients can even find a direct care specialist in the national directory we built for exactly that purpose.

I created the Direct Specialty Care Alliance because I never want another doctor to feel as alone as I did.

I created it because a patient should never leave an exam room in tears over a bill no one will explain. Because a doctor should never be told to see patients without questioning the business behind their care. Because being able to reach a specialist should not depend on your zip code, your insurance, or your luck.

I created it because I proved, over six years and with thousands of patients, that another way works. And because the only thing harder than leaving a broken system is leaving it by yourself. So I built the room I wish I had walked into, and I am holding the door open for you.

The Alliance is how I give back now, the way my mother taught me.

We built this, and now it has a home.

For years, there was no specialist-specific home for direct care. So we built one. Explore the new platform at dscalliance.org: the full webinar library, the DSC Starter Course, the monthly newsletter, a private community of specialists, and a national directory built so patients can actually find you.

This is the opportunity, and the door is open. Founding membership is free for your first 12 months for verified physicians, with your founding price locked for life. Come be part of our family before the founding round closes on December 31.

Create your free founding account → dscalliance.org/membership

Key takeaways

• Dr. Diana Girnita left a conventional medical career to build direct-pay care after seeing patients harmed financially by the insurance system.
• In 2020, she founded Rheumatologist OnCall, the first direct-pay telemedicine rheumatology practice in the US, and has since treated thousands of patients nationwide.
• She co-founded the Direct Specialty Care Alliance so that physicians can leave the insurance system with support, shared playbooks, and a community, rather than starting from scratch.
• Direct specialty care means a direct relationship between doctor and patient, with the patient free to use insurance or not.

Frequently asked questions

Who is Dr. Diana Girnita? Dr. Diana Girnita is a rheumatologist, Harvard-trained researcher, and author. She founded Rheumatologist OnCall, the first direct-pay telemedicine rheumatology company in the United States, in 2020, and co-founded the Direct Specialty Care Alliance. She has treated thousands of patients and reaches millions more through her educational work.

What is Rheumatologist OnCall? Rheumatologist OnCall is the first direct-pay telemedicine rheumatology practice in the United States, founded by Dr. Diana Girnita in 2020. It treats patients with autoimmune diseases and arthritis remotely, with pricing shared so patients can see and choose the cost of their care.

What is direct specialty care? Direct specialty care (DSC) is a model in which a specialist contracts directly with the patient rather than billing insurance for the care provided. Fees are known in advance, there is no insurance claim for the visit, and the doctor is accountable to the patient rather than to a billing department.

How is direct specialty care different from traditional insurance-based care? In traditional care, an insurer sits between the doctor and patient, shaping pricing, coverage rules, and visit length. In direct specialty care, the relationship and the price are direct. Patients can still use insurance for outside labs, imaging, or medications when they choose to.

Why do doctors leave the insurance system? Many physicians leave because insurance-driven medicine limits their time with patients, hides true costs, and forces them to ignore the financial harm patients experience. Direct specialty care lets doctors set honest prices, spend real time with patients, and take responsibility for the whole care experience.

Can a telemedicine rheumatologist really treat serious autoimmune disease? Yes. Rheumatology relies heavily on history, symptom review, lab work, and imaging, all of which can be coordinated remotely. Dr. Girnita has treated thousands of patients with autoimmune conditions and arthritis by telemedicine, often reaching people who could not access a local specialist for months.

Does direct specialty care mean I cannot use my insurance? No. Direct specialty care simply removes the insurer from the direct doctor-patient relationship. Patients remain free to use their insurance for outside services such as labs, imaging, or prescriptions, and to choose the cash-pay option whenever it is the better value.

What conditions does Dr. Girnita treat? Dr. Girnita is a rheumatologist who treats autoimmune diseases and arthritis, including rheumatoid arthritis, lupus, and gout. She has written two books on autoimmune disease and the role of nutrition, one focused on gout and one on rheumatoid arthritis.

What is the Direct Specialty Care Alliance? The Direct Specialty Care Alliance is a physician community co-founded by Dr. Diana Girnita to help specialists build direct-pay practices. It provides education, webinars, a member directory, and a network of doctors who have already left the insurance system, so no physician has to start alone.

How can a physician start a direct specialty care practice? A physician can start by learning the model, setting clear pricing, and building the systems for scheduling, payments, and patient communication. The Direct Specialty Care Alliance shortens this path with a Starter Guide, recorded and live webinars, and a community of specialists who share what already works.

Disclaimer: This article is for educational purposes and does not constitute medical, legal, or financial advice.

About the author

Dr. Diana Girnita, MD, PhD, is a board-certified rheumatologist, the founder of Rheumatologist OnCall, and co-founder of the Direct Specialty Care Alliance. Born in Craiova, Romania, she completed a PhD in immunology and transplant immunology, trained at Harvard University, the Thomas Starzl Institute at the University of Pittsburgh, and the University of Cincinnati, and is the author of two books on autoimmune disease and nutrition. Her patient education work reaches millions, and she was profiled by The New York Times in 2023. She built the DSC Alliance so that no physician has to leave the insurance system alone.

Ready to practice medicine the way it was meant to be? Join the founding round at dscalliance.org.