Simon Prince Has a DPC Moment of Clarity

direct_indirect

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.

 

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Simon Prince Has a DPC Moment of Clarity

  1. Kurt
    July 13, 2016 at 5:48 pm

    DPC = great if you’re in the right area like Dr. SH or Doug.

    Bad, no spell that = bankruptcy if wrong economic climate.

    That’s the deal. Pick the right place and honky dory otherwise could lose your shirt.

    • Doug Farrago
      July 14, 2016 at 6:41 am

      I respectfully disagree. DPC depends on the doctor and his motivation to be involved in hustling, marketing and getting the word out. The price point is working in all markets.

      • Kurt
        July 14, 2016 at 9:53 am

        Doug, if a poor, economical, rural area, you’ll lose your shirt. Public aid people are not
        going to pay your modest fees when they can get it for free. I stand by if you go DPC you
        better do your homework on the economics of the area or it doesn’t matter how much of
        a hustler you are. People have to have money coming in and they’ll not be giving up cigarettes or booze to pay you.
        Granted, if one takes care to research possible places to start, they have a better chance of success.

  2. DoctorSH
    July 13, 2016 at 10:01 am

    I too had a similar thought process way way back in 2007.
    Loved my interaction with patients.
    Loved my control of my future.
    Hated the third party disruptions.

    I had choices to make:
    1- Continue doing the same and get grinder into the ground eventually by third parties.
    2- Join a large group and have them negotiate contracts with strength in numbers.
    3- Sell out to a hospital and become an employee.

    So….
    As is usually the case with m=e, when I am given 3 options, I make up my own option, #4.

    I created my own DPC practice in 2008, before DPC had a name.
    It was 98% of the patient benefits of Concierge at 1/3-1/4 the cost, and no dealing with insurers.

    Back in 2008 no one was doing DPC.
    Patients had never heard of it.
    But if you have a true loyal following, keep your overhead down and your services upo, live up to your word on same day apps, longer appt times, etc, then you have a chance to succeed.

    I am quoted often today a few times:

    ” I have my dream practice.”
    “I love going to work every day. How many docs can say that?”

  3. Sir Allyagottadois
    July 11, 2016 at 7:56 am

    Love my career. Hate my job.

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