Maine Going Direct Primary Care


I am kidding.  Only two doctors in the whole state are doing it.   Why?  I think I know.  I was in Maine for 18 years.  There was a lot to like there (and a lot not to like).  It’s a place where medical monopolies run amuck and hospital administrators get paid ridiculous salaries.  I always wanted to start a direct primary care model practice when I was there but felt that there would not be enough patients to support it.  With 1 in 4 on Medicaid, only places like Portland or the coast would have enough population NOT getting free care already.  I wasn’t in either place.   I am excited that two doctors are trying this and I pray they become huge successes.  One was actually a resident, Jack Forbush, who had visited my practice when I first started.  A great guy. Anyway, their attempts to change the healthcare world scares the powers that be.  For example, in this article in the Bangor Daily News, Mitchell Stein is quoted a lot.  Who is he?  It states that he is an independent health policy consultant yet when you do a google search you see he was a major advocate for the Affordable Care Act.  Not so independent, huh?  Anyway,  here is a summary of his comments (my thoughts in parenthesis):

  • Those patients should know direct primary care doesn’t satisfy the requirement under the federal health reform law that all Americans have health insurance this year or pay a penalty. Those patients could wind up with mountains of debt if a serious illness or injury lands them in the hospital.  (All patients are told to get catastrophic care)
  • By saying that they’re going to take care of your needs up to a certain point, it leaves people very exposed (exposed to what? Most insurance plans have huge deductibles that leave them exposed anyway)
  • Some patients can’t afford direct care plus insurance, even a bare bones policy (and that is the doctor’s fault?)
  • The direct care approach highlights the need for payment reform in health care, he said. Doctors aren’t paid for connecting with patients through lengthy visits, phone calls and email. (and that is going to change?  Not!)
  • One-doctor shops will be increasingly hard-pressed to keep up in future years, as the health reform law focuses resources on big systems tasked with reducing costs and improving care (they will not be hard-pressed if idiots like you stop knocking direct primary care models)
  • I’m sympathetic to the idea that doctors want to be able to spend more time with their patients, but I think we need to figure out how to do that for the whole system, not on this piecemeal basis (what does that even mean?)
  • Health care dollars may also be more wisely spent employing providers at other levels, such as nurses and nurse practitioners, Stein said. A doctor with multiple years of graduate education, rather than answering questions about the flu, for example, could focus on medical problems more suited to his or her training (so now we have his agenda.  he wants to industrialize medicine like we do food and let the LELTs do most of the work and be paid less)
  • These individual physicians who want to go back to the country doctor model, I don’t think it’s either practical from a cost perspective or appropriate from a care perspective, in terms of providing the best quality care at the lowest price (he has no evidence of this.  in fact, any bullshit indicator would still be blown away by these models because these docs have less patients!)

What Stein says is exactly what the government believes.  In other words, they are scared shitless because this model would destroy the monetary gravy train for idiots like Stein.  I can only hope more family docs do the same.

  11 comments for “Maine Going Direct Primary Care

  1. tad hominem
    April 21, 2014 at 12:14 am

    OK, I get it. 3rd party payors and Obamacare are evil. so we want to go to a direct pay model. Just for Family practice docs ?? but now I need a triple by-pass. how do I cover the cost out-of-pocket ? or I now have stage 2 melanoma. how do I cover the costs of treatment ?? or I have MS and do lots of high-tech meds + a bunch of ordinary meds and see 3 specialist MDs. how do I cover the cost ? my PCP visits are the cheapest part of my medical care so going to my pcp is not a big deal. my PCP does not coordinate my care for any of these conditions.

    • April 21, 2014 at 10:19 am

      The example/s you shared are representative of those potential situations for which we recommend patients have some type of catastrophic coverage.

      While a direct care model does not cover every conceivable ill that a patient may experience, it is a cost-effective solution for the overwhelming majority of care patients require.

      With regard to your comment that “my PCP does not coordinate my care for any of these conditions”, let me first express my regret that you have not had the advantage of having a collaborative relationship with a Family Physician. It is not clear by your posting exactly what kind of “PCP” you have, but the coordination of care with specialists is a key part in delivering comprehensive care.

  2. April 17, 2014 at 8:00 am

    Excellent article. Kudos to my colleagues and pals Drs. Forbush & Ciampi for braving DPC. I dropped medicaid in 2006, medicare/tricare in 2014… Still playing the commercial insurer game however. You guys are brave and i believe as they do that the only real “fix” for healthcare reform will come once ALL third party payors diasappear. Until that day occurs, we will have a mess. We never had a mess until third parties got involved. ALauer, D.O.

  3. Sean Duffy
    April 16, 2014 at 11:31 am

    Hello Dr. Farrago and All,

    This is my first time posting to Authentic Medicine, but I’ve been an avid reader for a few years now.

    As a guy working to get into medical school after working for 5 years post-graduation, this post goes out to Dr. Farrago, Dr. Forbush, Dr. Ciampi, Dr. Josh at Atlas MD, Dr. Rob Lamberts, and all other doctors pushing for direct pay primary care. I have this to say: *Please* keep doing what you are doing.

    As a person who (despite what everyone tells me) wants to go into family medicine but has seen FM, primary care, and medicine in general get pressed more and more by outside influences, I want to see this model succeed. I want to get to my 4th year of medical school and see this having taken off, so I can apply for residency knowing that it’ll be possible to to start a DPC practice and change primary care to what patients want and need, rather than what some bureaucrat thinks will keep people going in and out of the revolving door at the hospital.

    A lot of prospective medical students/future doctors find out about DPC and see hope and a win-win solution for patients and doctors alike. If through all of your hard work this takes hold, there will be more of us ready to take it and run with it. I know every time I discuss with friends and family about what DPC is, they say “Wow, wish it was like that already!”

    Keep up the great work!

    • Jack Forbush
      April 16, 2014 at 1:30 pm

      Thanks for your kind words. The battle continues!

    • Pat
      April 16, 2014 at 10:23 pm

      Bravo Sean!

  4. April 16, 2014 at 9:14 am

    Non-medical people like this Stein guy get all the press, but they have no clue.
    If all the third parties involved in healthcare went away, there would still be doctors, nurses and other healthcare professionals available to provide care. If all healthcare professionals shrugged, do you think Mr. Stein could help you with your medical needs?

    Good post, but we need our patients to understand that the third party -govt takeover of healthcare is causing harm to them directly. Come up with a plan to take our issues direct to our patients and we can win this battle.

  5. April 16, 2014 at 7:55 am


    Thanks for posting this!

    • Doug Farrago
      April 16, 2014 at 8:21 am

      Please keep us updated. Would love a quick or even regular blog entry on your success!

      • April 16, 2014 at 8:20 pm

        Sure thing! I just started blogging for the local newspaper and intend on sending out an “open letter” in response to Mr. Stein. I’ll invite him to comment, but suspect he will decline.

        • Doug Farrago
          April 16, 2014 at 8:58 pm

          Awesome. We need you to succeed.

Comments are closed.