The Medical Practice Playbook common characteristics, and I share four of them with you here. First, patients have direct access to their physician through a combination of email, texts and phone call, including after hours. Questions and concerns are not left to interpretation of a call center. Second, visits are designed to meet patient needs, not insurance requirements. Visits are often longer and can address many issues regardless of what the appointment was scheduled for. Instead of jumping to a prescription for every complaint, we have time to fully discuss each concern and weigh options for treatment. All good primary care doctors know that lifestyle counseling should be the first treatment approach for most chronic conditions; they just don’ t have much time to do it anymore. Because we don’ t bill insurance for our visits, our notes are only what they need to be to provide care to the patient. I spend more time caring for patients and less time sitting at the computer writing notes and entering diagnosis codes to satisfy insurance. Third, direct primary care is comprehensive. In my practice, we do skin biopsies, mole removals, lacerations repairs, abscess drainages, pap smears, hormone replacement therapies and joint injections in addition to providing typical primary care needs. Having an in-house pharmacy and lab means we are a one-stop shop for most of our patients.
Last, most direct primary care practice models enable patients to receive care they otherwise could not afford. Many people consider direct primary care similar to concierge care,“ medicine for the rich.” While those with adequate insurance may choose this care model, a large percentage of patients cared for in the direct primary care model are those who are uninsured or underinsured. The cost of insurance is too high for much of the working population. The comprehensive nature of direct primary care allows these patients to invest in a“ medi-share” or“ catastrophic event health plan” and otherwise receive their care through us. The low monthly rates in most direct primary care practices are 5-20 % of what insurance companies want to charge monthly. While many people think of any model of health care with a monthly fee as the sign of a greedy physician, the reality is that many direct primary care doctors make less money than they would working for the health systems. We are merely choosing to protect the values that brought us into primary care in the first place, in an affordable way.
These four common characteristics of direct primary care( direct access, visits that meet patient needs, comprehensive care and affordability) are all centered around what drives so many to want
to do primary care in the first place, a desire to provide good care to the people in our communities. Direct primary care does not come without challenges, however. Direct primary care practices are typically owned and managed by the physician( s), requiring an initial monetary investment and a thoughtful business approach in addition to ongoing marketing, financial management and staffing needs. That said, the growth of this model throughout the U. S. is an indicator that physicians without prior entrepreneurship or business experience can be successful in starting their own practices, if desired.
Ultimately, I suppose I chose this model of care to protect my childhood vision of what primary care was and should be; comprehensive and accessible care with a doctor whom you know and trust. I anticipate that this model will continue to grow in popularity and may find itself a place within the health systems, too. After all, big change starts small.
Dr. Deptola is an internal medicine physician and primary care physician at 502 Direct Primary Care in Crestwood, Kentucky.( non-member)
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