As the November 1, 2021 “open enrollment” date approaches, many Americans will have the opportunity to switch health plans and personal physicians.
One option gaining popularity is the “direct primary care” (or DPC) practice. Unlike the traditional model for primary care, DPC practices typically run on a subscription model. The patient pays a monthly fee to be part of the physician’s panel. In exchange, the fee covers in-person (or virtual) patient consultations, and often other laboratory and clinical services. Many DPC practices also offer flexible scheduling as well as after-hours text and/or video access to medical staff.
According to the American Academy of Family Physicians, “DPC benefits patients by providing substantial savings and a greater degree of access to, and time with, physicians. DPC allows family physicians to care for the whole person while reducing the overhead and negative incentives associated with fee-for-service third-party-payer billing.”
Instead of a hurried 10-15 minute appointment with a physician, patients typically enjoy an extended 45-60 minute discussion, where the physician can delve more deeply into the patients’ questions and concerns.
DPC practices typically do not accept insurance. Hence, most DPC practices still recommend that patients combine their subscription with a high-deductible “wraparound” insurance policy to cover emergencies and less commonly used specialized services not provided by the DPC practice.
Denver-based DPC practitioner Dr. Brieanna Seefeldt explains it this way to her patients: “With the direct primary care model your insurance is used for what it is intended to cover: catastrophic health events, hospitalizations, specialist care, imaging and surgery. You can continue to use your insurance for medications and labs as well. However, we have found discounts on medications, labs, imaging and supplements and we pass our tips on to you. We are here to help you manage the health care system so you get the most out of your money and time.”
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Physicians who have switched to the DPC model appreciate being able to spend more time with patients and address their deeper needs, rather than trying to rush through a hectic day full of too-brief appointments. And because they avoid most insurance hassles, DPC physicians endure fewer bureaucratic headaches, thus allowing them to spend more time doing what they went to medical school to do — to practice medicine.
Critics of DPC (and the related “concierge medicine” movement) note that DPC physicians typically see fewer patients than more traditional primary care physicians. Dr. Russ Phillips, Director of the Center for Primary Care at Harvard Medical School has said, “That reduction in the number of patients — often from nearly 2,000 to 500 to 600 — means that many patients are left without primary care physicians at a time of increasing shortages in primary care clinicians.”
Although the growing shortage of primary care physicians (as well as of many other specialists) is a real problem, this was not created by DPC physicians. Furthermore, traditional primary care physicians “experience more burnout and anxiety than other healthcare professionals” due to dissatisfaction with the current climate of medical practice, including “compliance with numerous regulatory and payer requirements.” To the extent that switching to a DPC model helps professional satisfaction, this can alleviate burnout and keep them in the pool of practicing physicians.
The Access Healthcare Direct network of DPC physicians notes that the DPC model helps physicians protect practice autonomy as well as allowing “income potential similar to other specialists like cardiology or gastroenterology.” This could make the DPC option more attractive to medical students choosing between a career in primary care vs. becoming a specialist.
As more patients sign up for DPC practices, this will also help create a demand for more primary care physicians. At present, the bottleneck in creating new physicians is the fixed number of Medicare-funded “residency” training programs in various fields (family practice, surgery, etc.) Patients who opt for DPC practices will thus help signal to regulators and legislators of the need for more resources devoted to primary care residency programs.
In other words, if patients feel that signing up for a DPC practice is best for themselves and their loved ones, it might create increased pressure on non-DPC primary care physicians in the short term, but could also improve things for all primary care physicians in the long term.
DPC is not a panacea for the imperfections of the current US health system. But it is an important option for many Americans, and one well worth looking into.