The Direct Primary Care movement has picked up steam over the last seven years since we started Direct Doctors in RI. According to DPC Frontier, a site owned by a DPC physician/lawyer who was a founder of the movement, there are now over 1500 clinics doing pure Direct Care across the nation. There are likely many more than have been officially labeled on the map. Looking back to 2014, when we began, there were less than 100.
The strength of the movement comes from a grassroots force of physicians who are unhappy with the care they can provide in the traditional fee-for-service model of medicine which depends on the patient coming in for a visit and being billed through insurance for each encounter. The strength also comes from a group of physicians who want something more and something better - improved work-life balance, return of joy to practicing medicine, and a renewal of the pure physician-patient relationship where the doctor knows his or her patient well.
As we look toward the future of our healthcare system, we continue to see a majority of care provided by huge hospital/corporate systems that employ doctors (and now, more and more, employ PAs and RNs to take the place of doctors) to staff their clinics and run their businesses with profit in mind. Doctors (and other types of “providers” of healthcare) are tasked with seeing 20-25 patients in an 8 hour day, writing notes that are geared toward insurance billing, and charging for every extra they can manage - all to make the corporate system more profitable. The larger the system, the more an insurance company will pay them per visit and per procedure - pushing toward larger and larger corporations and fewer options for patients.
On the other hand, Direct Primary Care is pushing the other direction. Clinics are often owned by solo doctors or, as in the case of Direct Doctors, by 2-3 physicians in a small group practice. Patients are seen directly by doctors in many cases. Care is individualized with the incentive to keep patients healthy and keep the patient experience pleasant. Doctors are driven to make care more convenient, cost-effective, and clinically relevant for patients who are the only critics of the clinic. In other words, rather than the goal of each visit being to make more money for the system (through billing for extras that may not be indicated i.e. EKGs, breathing tests, & point-of-care labs; and through referring to specialists inside the system rather than handling the care themselves), the goal is to keep the patient happy, healthy, and heard.
As the future unfolds, DPC doctors believe more and more patients will choose our style of practice as the fee-for-service clinics become less personalized and more staffed by mid-levels. This free-market choice will push more doctors to take the leap into Direct Care. As the market speaks, the corporations and governments will eventually have to listen. We will see many government and corporate attempts at a Direct-style of practice (many will fail but maybe some will succeed). Most of the movement will stay small practice/grassroots. There will always be medicare and medicaid for those who need those coverages but we envision more employers realizing the savings they can achieve with self-funding their own insurance and signing on to Direct Care practices. A system more balanced by small practices mixed into larger hospitals will bring us back to a time when patients and doctors were happier with care and corporations didn’t dictate medical choice.
If you’re ready to be part of the movement, check out how we practice primary care differently as one of the earliest practices in New England, at www.directdoctors.org.
Lauren Hedde, DO; James Hedde, DO and Mark Turshen, MD are Family Physicians and Co- Founders of Direct Doctors, Inc. a Direct Primary Care Practice.