What Does an All-Physician Practice Mean?
An all-physician practice means that every patient visit is conducted by a physician.  That physician holds either an MD (Doctor of Medicine) or a DO (Doctor of Osteopathic Medicine) degree and has completed the full medical training required to practice independently.
At Direct Doctors, patients see a physician at every visit.  Care is not delegated to non-physician providers. Your doctor manages your care directly.
For many families searching for an all-physician practice in Rhode Island, this model provides reassurance that their care is always guided by a physician with extensive medical training.
 
Why Many Practices Use Nurse Practitioners and Physician Assistants
It is helpful to understand why many healthcare systems rely on teams of providers.  Primary care demand has increased significantly over the past decade. At the same time, physician shortages have made it difficult for some practices to keep up with patient needs.
To address this gap, many clinics employ nurse practitioners and physician assistants to help expand access to care.  These clinicians can play valuable roles within healthcare teams, especially when working alongside physicians.
However, some patients prefer a model where their care is always delivered directly by a physician.  For those patients, finding an all-physician practice in Rhode Island becomes an important priority.
 
Understanding the Difference in Medical Training
Healthcare professionals bring different types of training and experience to patient care.  Understanding these differences can help families make informed decisions about their healthcare.

Physicians (MD or DO)
Physicians complete the most extensive medical education in healthcare.
Their training typically includes:

• four years of undergraduate education
• four years of medical school
• three to seven years of residency training

During residency, physicians manage complex patient cases while training under experienced specialists. By the time physicians begin independent practice, they have accumulated well over 10,000 hours of clinical training.
This depth of training prepares physicians to diagnose complex conditions, interpret subtle symptoms, and manage multiple health issues at the same time.
 
Nurse Practitioners (NP)
Nurse practitioners are advanced practice nurses who complete graduate-level training after becoming registered nurses.
Their education usually includes:

• a nursing degree
• clinical nursing experience
• a master's or doctoral nurse practitioner program

Clinical training hours vary widely depending on the program. Many programs include several hundred to around one thousand hours of clinical training.
NPs often work within collaborative medical teams and provide important support in many healthcare environments.

 
Physician Assistants (PA)
Physician assistants complete graduate-level medical training designed to prepare them to work alongside physicians.
Typical training includes:

• undergraduate education
• a two-to-three-year physician assistant program
• supervised clinical rotations

PAs are trained using a medical model and often work under physician supervision in many healthcare settings.
 
Why Physician-Led Care Matters
For many families, the difference in training influences how they choose their primary care practice.
Physicians spend years learning how to evaluate complex symptoms, identify patterns across multiple health conditions, and make difficult diagnostic decisions.
Primary care physicians manage a wide range of medical concerns including:

• chronic conditions such as diabetes or hypertension
• mental health concerns
• medication interactions
• preventative screenings
• unexpected symptoms that require investigation

Because of their extensive training, physicians are often best equipped to evaluate situations where multiple factors may be influencing a patient's health.
 
Why Families Choose an All-Physician Practice in Rhode Island
Many Rhode Island families choose physician-led care because they value the relationship that develops with a doctor over time.  Seeing the same physician consistently allows your doctor to understand your health history, lifestyle, and long-term goals.  This continuity can make a significant difference in medical decision-making.  Over time, a physician who knows your baseline health can recognize subtle changes that may signal emerging health concerns.
Families searching for an all-physician practice in Rhode Island often want that level of familiarity and trust with their doctor.
 
The Direct Doctors Difference
Direct Doctors was founded on a simple belief.  Primary care should be delivered by physicians who know their patients well.  That is why Direct Doctors operates as an all-physician practice in Rhode Island.
Patients do not rotate between different providers depending on availability. Every visit is conducted by a physician who is responsible for the patient's care.  This model allows patients to build long-term relationships with their doctors while benefiting from the expertise of a collaborative physician team.
 
Care Designed Around the Patient
At Direct Doctors, care is structured to support thoughtful medical decision-making.
Patients benefit from:

• unhurried appointments that allow meaningful conversation
• direct access to their physician when questions arise
• continuity with the same doctor every time
• evidence-based treatment decisions

This approach allows physicians to focus on quality care rather than rushing through high volumes of appointments.  For many families, this creates a very different experience of primary care.
 
The Benefits of an All-Physician Practice
Families who choose an all-physician practice in Rhode Island often value several key benefits.
These include:

• every visit conducted by a physician
• deeper medical training guiding care decisions
• continuity with the same doctor
• stronger long-term doctor-patient relationships

For patients who prioritize expertise and continuity, this model can provide a more personal and reassuring healthcare experience.
 
Choosing the Right Primary Care Practice
Every family has different priorities when selecting healthcare.  Some patients focus on convenience or appointment availability. Others place greater importance on physician expertise and continuity.  If you value seeing a physician at every visit, understanding how a practice structures its care team can help you choose the right environment for your family.  For many Rhode Island families, an all-physician practice in Rhode Island offers the consistency and medical expertise they want from their healthcare.
 
Experience the Difference of an All-Physician Practice
​Primary care works best when patients and physicians develop long-term relationships built on trust.  That relationship is easier to build when patients know they will see a physician every time they visit.
Direct Doctors has been serving Rhode Island families since 2014 with a model built around physician-led care, thoughtful appointments, and strong patient relationships.
If you are looking for an all-physician practice in Rhode Island, sign up today and complete the new patient form. Because when it comes to your family's health, who provides your care matters.

​First of all let’s break this down.  The way they have it structured you have to select your condition first.  Well that is great as long as you already have your diagnosis figured out!  As physicians, our 8+ years of training are focused on understanding what symptoms could be related to what diagnoses and helping patients navigate the many possibilities and narrow it down with appropriate testing and treatment to better understand what their final diagnosis may be.  So, if you, for example, have already gone through that and know your cough is from “GERD” then you could select the GERD button on Amazon’s landing page and get medications prescribed for you.  In the fine print, you will notice that you may be redirected after your paid visit to see your own physician to discuss this further.  The cost for this visit is $77 (not including prescriptions).  You will be logged into a video visit with a “clinician” - so you may not always see a doctor.  You also may get a different clinician each time you go on for your single issue.  If you want to discuss anything else, you would sign back on for an additional problem-related visit at that same cost.  There is no offer for any long term follow-up (which is what most medical conditions require to be safely managed!).

Meanwhile, if you were a member of a Direct Primary Care practice, like Direct Doctors, your visit would be free with your monthly membership fee (which averages $85 for adults).  You would not be isolated to one single problem type and you wouldn’t be required to arrive with your diagnosis already in hand.  If you needed preventative care (ie. you’re due for a mammogram or colonoscopy, you require a tetanus booster, or you need labs done soon) you would receive all of that care during your visit.  With Amazon, you can reach back out regarding your single issue for the next 14 days.  With Direct Doctors, as long as you are a patient member (which we hope is for your lifetime!), you can access your doctor (not a “clinician” of their choosing) in an unlimited fashion! 

While Amazon’s new offering might be great for very focused, well-defined, previously diagnosed, or simple acute issues that don’t require any in-person care or followup, it is not a solution for the primary care needs that 90%+ of your healthcare tends to be.  If you need a refill in a pinch and don’t have a PCP, this might be helpful for you.  But, nothing will replace the long term relationship with a doctor who knows you well and is available when you need him or her!

To find out how we practice primary care differently, check us out at www.directdoctors.org.

​As we all know, the pandemic seems far from over.  With variable data coming out about the newest variant - omicron - uncertainty looms.  This has caused many patients to remain concerned about going out to medical facilities for routine care.  Many patients push off screening tests and visits because they worry that being out and about increases their risks of being infected with COVID-19.

The rollbacks of telehealth coverage are not helping.  If you have asthma, and your lung doctor wants you to come in (because insurance is no longer paying them if they do a phone visit), and you don’t want to go in for safety and health related reasons, you may run out of your asthma meds and get much sicker from that alone.  This concept can be repeated for thyroid medications from your endocrinologist, antibiotics for your skin infection, and on and on.

At Direct Doctors (and at other DPC practices across the country), we have provided remote care before, during, and certainly will continue to do so after the pandemic is over.  Our practice model is based on the ability to care for patients in ways that insurance companies often do not support.  By eliminating the insurance middle men, patients can contact their doctor directly (by text, cell phone call, email, or patient portal) whenever and however it suits them best.  Of course, certain things still need office visits, but many do not require them clinically.  If you are sick of dictations by insurance about how you can reach your doctor and as rollbacks of these telehealth coverage allowances continue, you may find it is time for something more convenient and more reliable.  Check us out at www.directdoctor.org to find out more about how we practice primary care differently.

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To add to this concerning timeline, it can take 2-3 weeks to be seen for an acute issue at a practice you have already been established as a patient. Because the panel of patients at a typical PCP’s office is over 2000, and because doctors are still expected to see 20-30 patients a day, the wait times have only worsened since 2019.
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As more primary care physicians become “burned out” with the day to day grind of a typical primary care practice. Many docs are moving out of medicine and fewer medical students and residents want to pursue primary care. This has led to a “shortage” of primary care doctors, both in Rhode Island and nationally.


Since the COVID pandemic, the issues above are now being compounded by staff shortages.  Medical offices are really struggling to fill their existing medical assistant, nurse and secretarial roles because of changes in the workforce and vaccine mandates.  What does this mean for primary care (and specialist offices for that matter)?  It means when you call to schedule a visit, you may not even be able to get through to talk to someone.  It means when you reach a person, your wait time may be longer than ever for a visit to be scheduled.  Hospitals are reporting decreases in ability to keep floors and beds open and procedures on schedule with a lower level of available supportive staff.


At our Direct Primary Care office, we are lucky to have no reliance on staff. Our micropractice style DPC puts the patient directly in touch with the doctor.  So when we told you two years ago you could text or email us directly - we meant that.  No one is serving as middle man and our ability to give you the care you deserve in a quick, thorough, and direct manner has remained unchanged.
So, if you know someone who’s had a hard time finding a new PCP, tell them they can check out how we practice primary care differently at www.directdoctors.org and schedule their own appointment right there on the website - no hold times, no waiting and no middle men.

The short and sweet of it is that HMOs are very restrictive and want you to remain in their “network” - which means you need a Primary Care Physician who participates in the network with them.  Such a physician has signed paperwork saying they will follow the insurance companies rules, only refer you where the insurance company says, and receive payment when they bill your insurance of a set rate.

On the other hand, PPOs are flexible.  They allow you to go “out-of-network” - including not only any specialist you’d like to see but also any primary care doc!  That’s why we encourage patients to check their insurance plan before joining our practice.  If your plan is an PPO, it lets us (as out-of-network doctors) care for you as you and we see fit.  The gist is that we can see you, you can see who you want, and we are only paid by your monthly membership fee to be part of the practice.  

If you’re a patient who has lots of specialists and needs help with coordination, likes the idea of a doctor who is not “on the hook” with the insurance companies, or just plain likes the idea that you can choose who you’d like to see - a PPO plan alongside a DPC doctor - like the docs at Direct Doctors! - might be the perfect match for you.  And no we don’t think this is paying twice for your healthcare - we think it’s making a smart choice for your health!  For more on how we practice primary care differently, check us out at www.directdoctors.org.  

We have mountains of evidence that whenever this happens, costs go up! When there is a monopoly on services and reduced choice for consumers, patients (or their insurers which eventually trickles down) end up getting charged more for the same services. There is evidence that the same thing happens when physician practices merge or get bought by larger organizations. You want more data? Here’s an article from 2018 showing that though hospital operating costs are reduced 15-30% by this kind of merger, costs still go up!  And how about that “increase in patient care” that is touted. Here’s an article from Harvard just last year that indicates that hospital performance does not improve and patient satisfaction actually goes down. 
 
Interestingly, we do know that one of the only things that does decrease health care costs is access to good primary care. Neither Lifespan nor CNE have ever prioritized primary care, which is consistent among most large health care providers.
 
What is the incentive for large hospitals to have great primary care that keeps patients away from their biggest revenue generators? 
 
Care New England allowed Memorial Hospital to close, displacing the main Family Medicine Residency in the state, which disproportionately affected the large minority population in the Pawtucket/Central Falls area (despite everyone's calls to improve health disparities). Brown Medical School, like many large academic institutions, loves to highlight their students who go into flashy specialties as opposed to holding those who love primary care in similar esteem. So those who are interested in primary care medicine are really exposed only to corporate medicine, PCMH and the types of practices we think need to be changed in the first place. 
 
Rhode Island, as a whole, already has a primary care shortage due to many factors which drives more patients to urgent care and ER facilities subsequently driving up costs for everyone. To combat this, these large organizations are turning more to mid-level providers (PAs and NPs) in their primary care setting. These providers historically order more tests, refer more to specialists, etc… which, you guessed it, also drive up costs. To assist with all of this “continuity,” these large organizations turn to bloated, insanely expensive, electronic medical record and billing software. Then to make up for these costs, primary care doctors are forced to see more patients, leaving little time for good medicine or pension for over prescribing, ordering and referring (as we’ve mentioned in the past)

We do understand that there can certainly be an increase in academic research and improved specialty consultation within these institutions, so it’s not all bad. But in the end, the combination of poor primary care, hospital monopolies and the introduction of more HMO plans into the mix are setting our Rhode Island health care system up for increasing costs, decreasing patient choice without any change in outcomes or patient satisfaction. At Direct Doctors, we will continue to do our part in assisting patients with quality primary care access, lowering their medical costs and improving their overall care!

​Direct Primary Care practices like ours have always offered remote access to your doctor directly.  Video calls, phone calls, text and email have always been a part of our services.  We do not farm out phone calls to answering services at Direct Doctors - when you need something you will hear from your doctor, or in rare cases one of our other doctors who is covering.  You will know who this person is and you will already have a relationship with them.  This is important - when you get sick and want to avoid coming into an office for a visit, you can reach your doctor to have a remote visit and have your questions answered and testing and medications prescribed, if indicated.

Services like Teladoc offer on-call physicians who are working remotely and calling in for phone calls when a patient requests it.  While they can answer quick and easy questions, they cannot order tests and they can prescribe a limited portion of medications.  They can recommend you go be seen elsewhere, when they feel it is outside their scope - because ultimately they don’t know you and your history.  This service is very minimal and works in a pinch for folks who have no remote access to their doctor.  But, clearly this does not replace a video visit with your own PCP.  

Next time you wish you could just call or text your own doctor with a question, think about how great it would be to be a patient at Direct Doctors.  To get the access to your doctor that you need and deserve, check out how we practice primary care differently at www.directdoctors.org.

As long as your insurance is not an HMO (which requires an in-network PCP for referrals and advanced imaging orders), we can make all the same orders/refills/referrals for you that your in-network PCP could make.  The best part is, we can do it for you quickly and without the usual hassle of being on the phone and waiting to ask for what you need.  You can text us for your med refill and we’ll send it right over.  You can remind us you want to go forward with colon cancer screening, and we can order that right away.  You can tell us you need your flu shot soon, and we can email back with a time/date option that works for you.  

So, yes you can use your insurance for all your medical needs, but the way we get paid to be your doctor remains different.  We do it this way so that we do not have to abide by all the regulations and paperwork requirements of taking insurance.  We are paid by you - directly - to be sure we can give you time, access, and attention when you need it.  

To find out more about how using your insurance works with a DPC membership, check us out at www.directdoctors.org.

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