When Ivory Tower Idiots Attack DPC

A recent JAMA article called Direct Primary Care One Step Forward, Two Steps Back recently came out and they did their typical routine of attacking DPC.  In the article they say:

Proponents of DPC argue that the model generates system-level cost savings, improved patient outcomes, broader access to care, and clinician and patient satisfaction. Because DPC models do not rely on fee-for-service reimbursement, physicians are able to devote resources to previously nonbillable care coordination efforts. With a smaller patient panel and because DPC physicians do not bill third-party payers, physicians can focus on building therapeutic, longitudinal relationships with patients. DPC advocates suggest that these changes yield significant improvements in both patient and population-level health outcomes, reducing the rates of hospital readmissions, specialist visits, radiologic and laboratory testing, and emergency care.

Okay, so far, so good but then they go on to say:

“Individual DPC practices have indicated that practice-level data on outcomes support these claims; however, no study, to our knowledge, has produced data to support anecdotal claims by individual practices.”

Okay, to their knowledge, there is no evidence but then they go ahead and basically say we are going to cause tons of problems including:

  • Targeting healthier patients and declining coverage to the ill.
  • It is unlikely that patients most in need of care would be willing or able to afford an appropriately risk-adjusted retainer in a DPC setting.
  • DPC fails to address fundamental market inefficiencies and facilitates a substantial gap in catastrophic coverage
  • DPC circumvents the quality metrics and incentive structures designed to improve population health and reduce national health care expenditures. DPC practices once held accountable through value-based payment systems have no obligation to report or measure quality metrics.
  • Lessons learned from DPC—mainly the potential utility of global capitated payments—should be applied when developing new payment reform models and envisioning a new future for primary care delivery. However, DPC is not the answer to the problem

Remember when they said there was no evidence? So, all their “conclusions” are based on what?  Fear and hatred.  This article was written by ivory tower “doctors” from Warren Alpert Medical School.  They do not want DPC to succeed but it is succeeding and that pisses them off. In fact, this article in Medical Economics by Kimberly Corba DO shows that DPC may be the link to the “fourth aim”, which is “improved clinician and staff work life.”  Now you can really see why his makes them mad. These non practicing doctors do not want practicing doctors to enjoy their patients and their career. They want us stuck under their control and to be their guinea pigs as they experiment on us with any new bogus fad like quality metrics and healthcare teams.  But again, these are NOT proven either.  Their logic is ridiculous.

Our jobs are simple.  Doctors see patients directly without the interference of the insurance companies, the government or these ivory tower idiots.  Their big complaint is that we cherry pick but the truth is that everyone one of us see very complicated patients of all races and socioeconomic status and most of us give away 5-10% of free care. And we do a better job with these patients because we spend time with them. For the rest we charge a very reasonable price, less than a cell phone bill or a cable bill.

I for one would like to respond to these authors, and every other critic of DPC, by saying “Be Well”.  You can try all you want to stop us but it’s not going to happen.  We get the last laugh while you are stuck in your miserable windowless office trying to make yourself feel important.  The truth is…you aren’t.

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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]

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5 Responses

  1. PW says:

    Quality metrics and data outcomes are killing practices and burning out doctors.
    Of course we need to circumvent this crap. These guys need to crawl back into their caves.

  2. Steve O' says:

    I suspect that DPC 2.0 will arise after the crash of medicine just like it did after the Soviet Union and its “universal healthcare” ended.
    DPC is incomprehensible to the authorities in medicine, as whatever is not mandatory is forbidden. No approved facts about it exist. Therefore it exists only in the nightmares of established medicine.
    It is “black market medicine,” in the spirit of disquiet that troubles the Authorities.
    Nearly every criticism the article makes about DPC is actually an unintentional analysis of the beast in the mirror – inefficiency, neglect of the seriously ill, no credibility of quality measures. DPC actually illuminates the decline of American medicine. It must somehow be abolished.
    DPC 1.0 can be destroyed using licensure, certification and denial of malpractice insurance. Nobody needs to think about, for instance – if a doctor is paid per visit, what’s it matter if the hour is spent on end-stage heart failure or shin splints? Why would it appeal more to the well than to the infirm? It is safer for the Authorities to crush DPC by rumor and innuendo. That’s how black markets are suppressed.
    The American medical authorities’ goal is modeling the Soviet grocer’s – the prices are great, but the shelves are bare.
    If you understand how DPC exploits patients by offering them care, please explain it.
    “DPC” didn’t exist by name in 1950-it was merely medical care which never needed a second glance. As American healthcare became more sclerotic and crippled, it needed an adversary to blame. Thus, the traditional method of care must be blamed as evil and counterrevolutionary.
    Perhaps DPC 1.0 can be crushed and driven out of the USA. as in the Third World, ill persons just go to the drugstore and the pharmacist sells them product. Our future is here already-in Guyana and Togo and rural Brazil. But they are striving to be better; we strive to be worse.

    • Pat says:

      Steve, you often put your finger on it, as now. I will put the great blame for now on … the patient. As I have frequently said, it was the patient who set their lawyers on us, and demanded their politicians control us, and who trusted their insurance companies before us, and who refused all self-accountability. While doctors abdicated their own responsibility when they embraced Medicare, it was the patients who demanded perfect, cheap health care as a right. I have long feared your prediction, and as it comes true, I will blame they mob who thought they had a right to own me.

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