DIRECT PRIMARY CARE: THE NOT-SO-UNSURPRISING HERO AMERICA NEEDS

You ever heard the saying, ‘if it ain’t broke, don’t fix it?’ Well, I’m not sure it applies to our healthcare system. In fact, the opposite is applicable because our healthcare system is clearly broke. Some may even say beyond repair, but I wouldn’t go that far. Yet. Every time I write about the American healthcare system, I very rarely get a positive feeling. So much so, that I have to think and think before getting to anything that will make me happy in the slightest. And sadly, I’m not the only one who feels that way; there are thousands of other physicians in this elite category.

Am I talking about physician burnout? Of course, I’m talking about physician burnout. The number keeps increasing with every passing day. And can you blame them? There is no one large reason for the burnout, just a million little reasons. Okay, maybe they aren’t so little. Still, you get my point – from the electronic health records, which just keeps getting more frustrating to all of the burdensome administrative tasks undermining the encounter of physicians with patients. Saying the future of America’s healthcare system is bleak is understating it, especially the primary care services. 

Fewer and fewer doctors are moving into the primary care field, particularly DOs, and this is creating a shortage that is only going to get worse. Right now, according to the United Health Group, close to thirteen percent of the population of the United States live in a county with too little primary care physicians. The number stands at one PCP per two thousand people. That’s bad, right? Wait till you hear that by 2030, that number could stand at one per six thousand if urgent actions are not taken. I hate to be the bearer of bad news, but right now, that’s all we have. 

Fortunately for America, there is still hope. A hero that emerged in the mid-2000s, one that can solve the problem of ridiculous costs and keep physicians happy. It goes by the name of direct primary care. I called it not-so-surprising, and you’re about to find out why.

Before I continue, let me share a brief overview of direct primary care. I promise not to bore you. Direct primary care is a financial agreement made directly between a patient and a healthcare provider. It essentially removes the need for insurance companies and all the other baggage that comes with them, particularly for primary care services. If you follow my writing, you’ll know my view on insurance companies, but I’ll state it again as clearly as possible – they are ruining our healthcare system. With that said, patients under direct primary care don’t pay monthly insurance premiums and all of that. They pay directly to their healthcare providers. That alone is enough to sell this idea to many, but this model goes far beyond just cutting insurance companies. I cannot possibly oversell this idea even if I tried. But I’ll try anyway.

Direct primary care fosters enduring relationships between doctors and patients, which improves the quality of healthcare. The reason doctors are doctors is to care for patient’s needs, and that is one of the first things direct primary care brings to the table. It allows doctors to spend more time with their patients, which corresponds to better healthcare. Typically, a DPC practice will have six hundred patients or thereabouts. A fee-for-service practice, on the other hand, averages over two thousand patients. This means the number of patients these practices attend to is usually very high, as much as thirty a day, meaning less time with their patients, and the end is a reduction in the quality of healthcare and an increase in headaches of doctors. With the DPC practice, physicians can attend to ten, maybe twenty patients a day, and properly attend to them at that. When the patients a doctor attends to are few, the relationships between the patients and the doctor develops, and this leads to better healthcare. 

Many DPC practices are also open throughout the week. Doctors can attend to their patients at any time of the day, if not by appointments, by audio and video calls, emails, texts, and through other telecommunication means. Not to mention that there’s the opportunity for same-day and next-day visits. This level of accessibility is rarely found in traditional fee-for-service practices.

DPC is a doctor’s friend as much as it is a patient’s. Medicine generally aims at enhancing the experience of the patient, improving the general health of the population, and lowering healthcare costs. These three are what has been heralded as the triple aim of medicine. But there’s one factor that is often neglected, and it is the fact that the success of all these hinges on the physicians—the happier and more satisfied the physician, the better the healthcare service. Trust me when I say this, you do not want to be a patient under an emotionally, physically, and mentally burned-out doctor. Just take my word for it. DPC makes doctors happier, and that will only cause better healthcare services.

This article will not be complete if I don’t talk about how much better DPC is financial-wise. When we talk about the financial state of the healthcare system, you just know health insurance companies are implicated. They always are. With DPC, there’s financial transparency because of the upfront pricing system. Financial transparency is something you can rarely ever get with insurance companies. Rather than just visit physicians and not know the details of what and many times how much you are paying for, the upfront pricing system will tell you how much you’ll pay before-hand. No hidden charges. No cloud whatsoever. Everything is out in the open, and why wouldn’t it be? You are going to be dealing with people that actually care more about your health than their profits. The fee is usually around 85 dollars a month. It’s similar to that of your gym membership or Netflix. You use it as much as you want or need.

This pandemic has exposed America as a nation. You cannot exactly prepare for a pandemic of this nature, but still. The damage this virus has caused to us and our economy is simply staggering. A lot of people lacked access to basic healthcare services because of the fee-for-service model of our healthcare system. People couldn’t make appointments, and many practices tried, hastily and shoddily, to string a few things together to make providing healthcare easy, but rather expectedly, it proved largely futile. Many DPC practices didn’t feel the effect as much because means were already in place to cope with situations where appointments aren’t possible. DPC delivers, pandemic or not. I can’t say the same for our traditional fee-for-service insurance-laden healthcare system.

We need a change now. If we continue like this, our healthcare is only going to get worse, and that’s a colossally scary site to imagine. 

References

  1. https://mobilemedicinenj.com/blog/direct-primary-care-is-the-future-of-primary-care?ref=GPct1j7H
  2. https://mobilemedicinenj.com/blog/my-journey-to-keep-my-sanity?ref=VPJhg6Iy
  3. https://www.darkdaily.com/direct-primary-care-is-emerging-as-a-new-healthcare-model-in-the-us-but-are-clinical-laboratories-prepared-to-bill-patients-directly/
  4. http://allstarhealthdpc.com/how-does-direct-primary-care-work/
  5. https://www.kevinmd.com/blog/2020/05/why-direct-primary-care-is-thriving-in-covid-19.html
  6. https://thedo.osteopathic.org/2019/03/5-things-to-know-about-direct-primary-care/
  7. https://www.aafp.org/about/policies/all/direct-primary-care.html

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1 Response

  1. Kurt says:

    I retired from the old model: Office practice, Hospital practice and taking 24 hour and weekend call. Totally impossible to maintain in the EHR age. I burned out but also had fatigue issues from salvage therapy from prostate cancer. Get “Luproned” for 2 years and you’ll know what I mean. Androgen deprivation is no fun but hey, one does what they have to do to try to extend the lifespan. Besides, I saw patients who didn’t take the Lupron as recommended and they had tumor recurrences right and left. There’s a reason why oncology folks do studies to optimize therapies!
    Anyhow, my take on DPC is this: As long as one goes to an area where there are people/families etc. who can afford to cover the monthly fees then ok, their practice will do acceptably. Go to an area where there is a large number of public aid and/or Medicare then I can see a DPC practice fail miserably. I was in that sort of area with a group practice and any doc who was in an independent private practice, FAILED! If they would have tried to do DPC, they would have still failed as the payer mix sucked.
    Everyone thinks DPC is the end-all to do-all but be aware, setup shop is a lousy payer mix area and they will go bankrupt period. Oh and let the government get involved with paying the monthly fees and one will see a sh!$load of rules that will negate the advantages of DPC. Bottom line: Stay the heck away from primary care medicine!

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