By: Dr. Ken Teufel
Is there such a thing as a "stress-free" way to practice medicine? Not really. But many primary care physicians are rediscovering the joy of practicing medicine by shifting from the stress-filled fee-for-service model to the more relaxed pace of direct primary care. In its purest form, direct primary care cuts out the "middle man,"--the insurance industry--and eliminates the incentive to squeeze more patients into the workday. From 2005 to 2012, the number of doctors providing direct patient care has grown from a mere 146 to 4,400 (heritage.org).
Also referred to as "retainer medicine," direct primary care has been called "concierge medicine for the masses." But, instead of catering only to the wealthy, DPC appeals to a much larger audience of middle and low income patients who pay a monthly membership fee--typically $50 to $150--for unlimited office visits, usually same-day or next-day appointments. Phone and email consultations are usually part of the plan. For health care needs outside the practice, insurance coverage is still needed for emergency room visits, specialty referrals, and hospitalization.
Frustration with third-party reimbursement is the driving force behind the DPC movement. "One of the biggest benefits cited by DPC physicians is the ease of the payment system, says the American Academy of Family Physicians. DPC practices don't need staff dedicated to organizing, reviewing, filing, and managing third-party payment claims" (medical economics.com). By eliminating the hassles of dealing with the health insurance bureaucracy, administrative costs can be cut by up to 30 percent or more. Whereas insurance-dependent practices usually require a patient panel of 2000 to 3000, the established direct primary care practice averages 600 to 800 patients. Consequently, more and better quality time is available for each patient.
Direct primary care is not without its critics. It's argued that if primary care doctors are spending more time with fewer patients, the current shortage of access to primary care physicians will be made even worse than it is today. On the other hand, the argument can be made that going into primary care will become more attractive to newly minted physicians who would have otherwise chosen another career path.
Is the direct primary care model right for you? Several factors need to be considered:
- The regulation of direct care practices varies from state to state. Get legal advice or check with your state medical association.
- Will your patients "buy in" to the idea? In other words, will there be enough patients in your panel to ensure adequate and stable income?
- Should you perhaps consider a "hybrid" kind of practice, one that offers a membership option but also accepts a select few insurance plans?
Rather than doing it all yourself, another way to establish a direct primary care practice is under a franchise agreement. Several national franchise chains now provide startup DPC practices with proven business models, marketing material, and legal support staff. They are paid a percentage of the practice's membership fees.
To learn more about direct primary care, go to...
The Direct Primary Care Coalition (www.dpcare.org)
The Direct Primary Care Journal (www.DirectPrimaryCareJournal.com)
DPCMH Association (www.dpcmh.org)
About the author: Dr. Ken Teufel is the medical director at Interim Physicians, a pioneer locum tenens physician staffing firm based in St. Louis, MO that has provided quality physician coverage to hospitals, clinics and other healthcare facilities since 1979.