page under development May 2019, thank you for your patience, I'm working on it! ...
1. Information for my Primary Care Physician Colleagues.
I created this page for my Physician colleagues. Those Doctors out there who are seeking information about Direct Primary Care. For those seeking a better way to enjoy their career. For me, it has been a better way to practice medicine. I'm happy to share my experiences with other Doctors. DPC has been better for my patients and that's what it's all about. We have a healthcare system that is less than ideal and I believe, very strongly, that DPC fixes a big part of it. Certainly not all of it, obviously, but remember about 85% of what our patients need throughout the lifespan is considered Primary Care. If we make that better we've certainly made a contribution to the greater good.
2. Why consider Direct Primary Care?
Doc, it depends on what you value. Not everyone agrees with me but I hold the belief that the Doctor is responsible for the patients. I hold the Doctor responsible for everything. Our first rule of ethics is don't harm the patients. That includes financial harm. Currently our system is causing financial harm to our patients. I believe it is the responsibility of the Physician to fix it. I do not accept "we can't." That's not good enough. If we are in a position that we can not fix a problem, then we must quite simply not be in that position. DPC removes you from the situation of capitulation to inappropriate sources. If you value Physician autonomy, authority, and sovereignty then you should consider DPC. It is a very simple business model to run. You do not need to fear running this business. It's not hard. There's lots of help.
3. Advantages to our patients
So often we hear about this "triple aim" for healthcare. The system wants better cost, care, and outcomes. How's it going? I don't think cost is doing well. Quality of "care" depends on who's definition we are using. I've spent many years as a "highest quality provider" for various insurance companies. I fail to find that useful or meaningful to me or to my patients. Outcomes, personally I think that's not to bad! But for me, DPC does a better job on not only those 3 things but also on the "quadruple aim". That 4th parameter being an environment that is an ideal place for healthcare professionals to do their work. To do their work unmolested and without moral injury. DPC does that.
In DPC my patients have better access to me, lower wait times for appointments, very low wait times on day of appointments (usually they don't even sit in my waiting room) and more face to face time with me (which creates better outcomes). By the patients definition of quality care (which is important) my patients are getting better care. By my definition of quality (which is important) my patients are getting better care. They save money on Doctor visits, lab work, imaging, and medications. Overall, I've found in DPC my patients have a better experience for a better price. I find it easier to create better outcomes. I practice medicine without interference, without delays or denials in their care. I don't spend my day asking permission to take care of my patients. That's just a few advantages to them, there are many more!
4. Advantages to the Physician
Capture, Control, and Capitulation. Those are the steps used to kill Physicians in the current system. With heartbreaking resultant statistics of burn out, helplessness, depression and suicide. We average one Doctor dead by suicide EVERY DAY in the USA, most of them Primary Care Physicians. Doctors are captured into contracts and told you can not be autonomous. We then have our behavior controlled by those who have inappropriate authority over us: effectively used by others to serve their profit driven motives rather than the well being of our patients, (whether it be bucah or an employer). Then driven into capitulation: you must bow down and obey or be denied payment for your efforts, punished for non-compliance.
For me, it boils down to ethics and truths. What do you truly need to practice Primary Care Medicine? A Doctor and a patient. That's it. I suggest that if anything is going to participate in the patient-doctor relationship it must bring value and lower costs, preferably both. If it does not, then it is not permissible. DPC is a proven, simple, sustainable business model for Primary Care Physicians to remain in Private Practice. Private Practice offers the Physician autonomy and freedom to practice medicine on their own terms directly with their patients. DPC Doctors enjoy not being under the thumb of administrators, the protocols of hospitals, or the asking permission from insurance companies to take care of patients. DPC Doctors practice medicine they way they were trained to do, with freedom and authority. DPC Doctors feel better about their work because they are able to give patients better access, more time with them, and many cost saving opportunities. Most issues that practicing Physicians classify as a waste of time are a non issue in a DPC practice. Paper burden, ICD/CPT, prior auths, etc. All. gone.
5. Advantages to Employers
Here's a fact many Physicians don't understand: Health insurance companies do not pay for healthcare. Health insurance companies pay their investors. They are highly profitable companies (you can look, they are publicly traded). A middle man. Most of our patients have health insurance, most of them get it through work. It's those employers who pay for the majority of healthcare. State the obvious: it's to expensive. Employers can find value for money when working with Direct Primary Care Doctors. Working with DPC helps them build a more cost effective benefit for their employees. There is a very rapidly growing interest in DPC for employers and I think it represents the path to a better healthcare system; or at least a good start.
6. Advantages to the Health Insurance companies.
Why do we have a deductible? Why do we have a co-pay? Why do we have co-insurance and an out of pocket maximum? Reasons...or excuses? One of the principles of Direct Primary Care is that you don't need to use insurance for inexpensive things. Primary Care is not expensive and you don't need to use insurance for that. Insurance companies know that. They have no intention of paying for Primary Care. Primary Care meets about 80% of peoples healthcare needs for 6% of total healthcare costs! Insurance does not need to be used for that 6%. Health insurance companies are much more interested in the larger expenses in healthcare: admissions, surgeries, Cancer treatments, etc. In fact, if Primary Care was removed from insurance plans those health insurance companies could build a more appropriate and cost effective insurance product that could meet the needs of an individual or family. Don't believe me? Here's evidence: Christian Healthcare Sharing Ministries. It is not expensive and it functions as a catastrophic insurance plan should. It does not pay for Primary Care (mostly). DPC combined with a ministry can meet the needs of most people for much better cost. It can be done.
7. Advantages to our Healthcare system.
The historical "triple aim" of healthcare has proven inadequate. DPC offers a quadruple aim. Physician autonomy is a good thing. Physician authority is a good thing. Empowered patients will get better care. Empowered by price transparency and a Physician that works directly for them. Direct Primary Care can help our healthcare system by driving down the cost of care. It can improve patients access to care. There is growing evidence of very favorable healthcare outcomes in Direct Primary Care.
8. Know thy enemy.
Show me the evidence. That is something a good Physician will always ask for. We have enough evidence to clearly demonstrate Direct Primary Care lowers the cost of healthcare. We have lower admissions, lower ER visits, and higher patients satisfaction scores as well. DPC is also growing rapidly, despite critics proclamation that is will not go to scale, It's going. If we lower the cost of healthcare for our patients it means someone is getting less money. Who? Those are the opponents of DPC. Unfortunately, those opponents collectively give more than half a billion dollars to politicians every year! It's no wonder our patients are being stolen from. Again, it's my belief that Physicians have the responsiblity to make this better. It's my belief that they can. Step up Doctor!
9. Answers to criticisms.
There are a handful of critiques of the DPC model that continue to circulate. In the future I intend to set up a separte webpage to address those concerns. Some of them are a misunderstanding of the DPC model, some are flat out false, and some of them are spot on correct but not really a criticism. I think they are important concerns that should be addressed if a Physician is considering a transition into Direct Primary Care.
10. Where to learn more. How to take the next step.
One of the things I have enjoyed most about my transition in Direct Primary Care is the help, advise, fellowship, and support of other DPC Doctors. I recommend joining our groups on Facebook, follow on Twitter, follow and make friends on LinkedIn, read Doug Ferrago's book "The Official Guide to starting your own Direct Primary Care Practice." Go to DPC conferences, I like the one by Doc 4 Patient Care Foundation, but the AAFP one was helpful. Learn from the DPC Alliance and the DPC Frontier. Don't be afraid to approach a DPC Doc and ask for help or ask questions. I've found them to be pretty awesome Doctors.
11. Tell me the bad stuff!
A DPC practice is typically a solo Doctors office, at least to start. It can be lonely! You need entrepreneurial blood in your viens. You need to know how to run a business, manage people, manage resources, manage money and to be able to negotiate like a beast. You need to know marketing. You need a lawyer, banker, accountant, and business mentor on a first name basis. You need to fiercely value Physician independence. You need to know how to manage fear and how to stand strong when you're going against the grain. Not all Physicians will be confortable with this. It can feel as though it's a lot to learn. It's not. It can feel difficult. It's not. I promise it's easier to learn than physiology of the kidney!
12. Ethics, Rights, Privileges, Obligations & Invictus!
web page still under development / edits- May 2019...