We have a new Direct Primary Care critic. Edmond S. Weisbart, MD is a family physician in St. Louis, Mo. He is chair of the Missouri chapter of Physicians for a National Health Program. So, right off the bat we know Sir Edmond is delusional and hates anything associated with capitalism or hard work.
What is Sir Edmond’s experience? Well, he worked several years in “various safety net clinics” for what that is worth. Oh, and he spent seven years as the CMO of ExpressScripts so that really must have helped him stay in touch with the common man. Would a National Health Program need Express Scripts?
Sir Edmund decided to rip us DPC docs in the AAFP rag called Family Practice Management. I will summarize his thoughts (with my responses in parenthesis) but go to the original article for all of his points as I had to cut a bunch of it out:
- DPCs exacerbate the growing physician shortage. DPC promises physicians more time with each patient, which it accomplishes by reducing physician panel size. Were the nation committed to the DPC strategy, it would take decades to “grow” enough new physicians. (Simple answer. Maybe if family medicine didn’t suck so much there would be residents wanting to go into it? Oh, and who says the large panel sizes doctors have today is the right size? I would say it is excessive).
- DPCs are essentially unregulated insurance, capitating physicians and removing vital patient protections. Yet pure DPCs operating completely outside of the insurance industry are not as constrained by parts of HIPAA, the Health Information Technology for Economic and Clinical Health (HITECH) act, and the Affordable Care Act that protect patients’ confidential medical information. In fact, there is little preventing DPCs from selling patient data to marketers. As the DPC model grows, the demand for this high-value data will undoubtedly drive increasingly irresistible financial offers. Additionally, there is no organized strategy for driving DPC practices toward best practices, guideline adherence, public health data collection, etc. (Exactly….wrong. We are not insurance companies. That is obvious. We don’t sell data. Who does? The AAFP, the non DPC practices, employed practices, insurers and on and on. Sir Edmund, your data is being sold right now. You are just not getting the money for it. And the quality metrics you mention are unproven and have done nothing to help patient care. It is what is breaking the backs of present day family docs and you want to continue that. Not me.).
- DPC relies on an erosion of medical benefits. One of the key selling points of DPC is that it reduces health insurance premiums for employers. This encourages further adoption of high-deductible health plans, which have been shown in some studies to produce blanket reductions in utilization, of both needed and unnecessary care. (What the hell are you talking about? Everyone is going for HDHPs because they can’t afford anything else. Then they never see a doctor because they can’t afford to. Most DPC patients will each see us about 6 times a year. This is great care. Your system – you know the one you voted for when you voted for Obama – sucks. You failed.)
- DPCs exacerbate disparities in care. Although the evidence is still emerging, DPCs may be choosing to locate in areas most able to financially support the model. (Untrue. You use studies based on concierge care, which is a different animal. Our practices are located everywhere. Our patients’ incomes span the whole spectrum. For many, we are all they have. Also, a lot of us doctors give a ton of care away for free).
Sir Edmund is a clown who is just jealous. I get that. I just wish his points were valid but the dude is so clueless that it is laughable. If you have an opinion on this then I highly recommend you leave a comment on the AAFP site because I cannot. Why? I refuse pay dues to them and I need to pay them to have the luxury of leaving my opinion.
All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.
Looks like we are in stage two now. I love it.Tweet