Editor’s note: For more on how direct primary care is gaining a foothold in health care, see the feature “Direct Primary Care Gains Traction” in the May issue of Leadership.
I was 38 and almost 10 years into my career as an employed family physician when I could feel burnout beginning to creep into my mind, body, and soul.
From Day One of my career, I had felt that the way in which primary care was paid for—and the complete lack of value placed on it by society and the medical establishment—was troubling. Why was medical insurance being used for something that should be encouraged and not unexpected? Why was it being used to pay for something that was affordable and routine? Why was it even called “insurance” when in truth it was really nothing more than prepaid care?
Why had patients been trained to think that primary care—which should be the foundation of all medical care—was worth nothing more than a $10 or $20 copay? How was I expected to provide evidence-based, individualized, and holistic care when it was being doled out in approximately two-dozen 15-minute increments a day? And how could I deliver care empathically when half of that 15 minutes was spent staring at a computer screen, entering mostly useless data at the expense of actually conversing with my patients?
I knew two options were ahead: I was either going to quit medicine entirely or find a better way to practice primary care.
The right option began to emerge in the fall of 2013, when I saw the hashtag #DPC in a Twitter post by Josh Umbehr, MD. He owns Atlas MD, a direct primary care (DPC) practice in Wichita, Kan., and his website tells patients what they can expect from DPC:
- Personalized care tailored to your comfort level
- A physician who knows your story inside and out
- The choice to be seen at our office or, via virtual care, at your home
- The knowledge that you are one of only about 500 patients to whom each physician is giving attention
- Same-day scheduling with little to no wait time and, if desired, extended visits of an hour or more
- Quality time with your doctor, with plenty of time to ask questions (and with questions actually encouraged!)
- Your doctor’s cell phone number, in keeping with a commitment to around-the-clock service
- Inexpensive and direct service that cuts out insurance entirely
I was on the phone with Dr. Umbehr within a day—and I was immediately sold on the idea that DPC was what I wanted for my patients. This delivery and payment model completely avoids fee-for-service payment and insurance. A DPC practice charges a monthly retainer—typically $40 to $80—per patient for unlimited access to primary care, preventive care, and chronic care management, including after-hours access by telephone, email, or text.
I think of it as a Netflix-like model of primary care, and it makes more sense than the way primary care is typically practiced in the United States. DPC focuses on the two groups of people who have borne the brunt of our complex, opaque, and bloated healthcare system: patients and physicians. It returns primary care to relationship-based care rather than reducing it to a series of transactions that benefit only insurance companies that have nothing to do with the actual care.
In 2015, I opened Gold Direct Care, and I am thrilled to be part of the DPC movement that is sweeping across the country. Because I am not spending time hassling with insurance companies, I have time to talk with my patients. I can treat patients whether they are in-office or out-of-office—using text messages, phone calls, email, Skype, and FaceTime—and see patients when they need to see me. I can focus on doctoring rather than being a data clerk.
I am thrilled to see that citizens, doctors, policy makers, and health system executives are beginning to listen and learn about DPC. Some health systems offer DPC to their employees, recognizing that they can lower the cost to their self-funded benefit plans while improving employees’ access to care. Why not add DPC to your self-funded plan—and reap the benefits for your organization?
Jeffrey Gold, MD, is owner, Gold Direct Care, Marblehead, Mass.
