Simon Prince Has a DPC Moment of Clarity

A year ago I wrote a blog hammering Simon Prince DO after he trashed us independent doctors. What he wrote was published on KevinMD and made such claims like we independent were negligent and on and on. Let’s just say that I ripped him pretty good.  Simon got in touch with me and tried to made things better:

I regret using that term and deeply regret offending you and any of the independent docs out there. It was certainly not my intention. I think we are on the same team, although admittedly it didnt appear so. I am all for keeping docs independent and empowered. I just think in markets like ours where Medicare is one of the best payers, and there’s so much other consolidation that it’s really hard if the independent docs dont find a way to come together. I do however agree that there are a great many docs who can do it completely on their own, it’s just hard.. and there are market, practice and physician specific variables that come into play. Anyway, I shouldnt have generalized and you roasted me pretty good for it!

I want to be totally transparent here.  I made a deal with him.  I give him credit for getting in touch with me. I told him I will take my down post from last year if he writes something for me supporting direct primary care.  Here it is:

Direct Primary Care: It’s Like Concierge Medicine, Only Better

Recently I met with a primary care physician I’ve known for years to have drinks. After catching up on our families, mutual acquaintances and commiserating about the recent NBA finals (we were both rooting for the Warriors), I asked him about his medical practice. He shared that he was unsure about the future and struggling with what to do.

Like many of his contemporary independent primary care practice colleagues, the usual suspects were courting him. He and his partner have a busy practice and loyal following. Furthermore, they have everything that would make one of the typical pursuers salivate. Beyond their stellar reputation and obvious patient volume, they have (and “meaningfully use”) a top electronic health record, have been recognized for quality and operate in a perfect central location. The problem, he really, really didn’t want to become an employee.

Running an independent medical practice isn’t easy, but it can be extremely rewarding. Things however have been getting tougher and a bit less enjoyable for him recent years. He still loves patient care. He said, “it’s just everything else and the insurance companies that are killing me”.

Other primary care docs he knows seem to be working less hard and making more money. They may not be as happy and that isn’t lost on him… but, having more time and making more money doesn’t sound bad. He is a human after all.

He asked me about concierge medicine. One of the aggregators in the concierge space had just invited him to learn more at a conference in a much nicer hotel and location than he usually frequents. We talked about it. Cutting down his volume, spending more time on the patient care that he loved, and getting paid more for it was attractive. But, he was also encouraged to continue to stay credentialed on the insurance panels and maintain his relationship with the payers that were killing him with ever increasing demands.

“What about direct primary care?” I asked. He said that he heard about it, but admitted he didn’t know much. I replied, “it’s like concierge medicine, only better… especially for someone like you”. Then I added, “if the insurers are indeed killing you, DPC (direct primary care) may be a better option for you than concierge”. I went on to explain the similarities and differences. Both non-traditional approaches are relatively new coming on the scene in the 1990s-2000s (concierge predating DPC) and both focus on giving a more personalized approach to care with smaller patient panels in exchange for a subscription fee. A key difference is that DPC doesn’t involve any third party insurance payers. The insurers in DPC are completely cut out of the equation; patients pay directly (hence the name). In contrast, concierge physicians get paid by insurers in addition to the patient’s subscription fees. Lastly, I pointed out that direct primary care was even highlighted in the Affordable Care Act whereas concierge medicine was left out.

I cautioned him that DPC isn’t for everyone. He shouldn’t underestimate the effort required to start up and recruit the necessary patient base nor should the fact that it could alienate some of his long-term established patients, who may not understand the value. But, there was support out there to help with the transition, a growing interest nationally and after a few drinks we concluded that DPC may very well be the answer he was looking for.