As per the American Academy of Family Physicians -
The Direct Primary Care (DPC) model is a practice and payment model where patients/consumers pay their physician or practice directly in the form of periodic payments for a defined set of primary care services.
Typically, these periodic payments provide patients enhanced services over traditional fee-for-service medicine. Such services may include real time access via advanced communication technology to their personal physician, extended visits, in some cases home-based medical visits, and highly personalized, coordinated, and comprehensive care administration.
- I am looking for more thorough appointments with my doctor and don't like the thought of being rushed.
- It is typical for my requests to my current traditional PCP to go unanswered. On the other hand, DPC doctors would be reachable by direct messages or texting without any intermediary.
- I want my doctor to be available for video or in-person visits within 48 hours.
- I wish to see my doctor give me a more personalized service. I should not be one of the 3000 patients they see.
- No questions are silly. I value the opportunity to have my follow-up questions answered with patience.
Most primary care doctors want to, but they just are not left with enough time at the end of the day to return the sheer volume of calls and queries they receive. This burden is in addition to the insurance preauthorizations, denials, med refills, and pharmacy clarifications they must deal with daily. They are also bogged down by the documentation requirements that are increasingly expected to be detailed. Most of this documentation does not contribute to better patient care or more accountability for the doctors. I am all for accountability and being detail-oriented, but this is straining the doctor-patient relationship. The face-to-face time (no, the time you spend typing in front of your patient does not count!) with the patient gets squeezed out inadvertently.
This is where we can make an argument for a direct care model in which patients may pay a flat fee per month for access to their doctor. However, generally, this does not mean these patients can quit carrying their insurance altogether. You would still need that for specialist visits, or, god forbid, if you have a significant MVA or get sick and end up in the ICU, or for a major procedure like hip surgery, etc.
Opponents of this model may argue that you are charging patients extra (on top of their insurance premium) for better access to the doctor - something that the doctor should be doing in the first place for their patient panel. Only a select few could afford this level of access - and the most vulnerable and needy would get even more ignored. If more and more doctors turn their practices into DCP, those who cannot afford DCP would not have access to any service now, unlike the current state of poor quality of service from their doctor. If more physicians start doing DPC, getting a new PCP would be even more difficult for patients who don't currently have one.
Suppose you are already a part of an extensive hospital system where you see all specialists and get recurrently admitted to the same hospital system- and your PCP has been doing an excellent job coordinating care. In that case, DPC is not for you. Fragmentation of your care would do you more harm than help from better accessibility to your PCP.
Insurance companies decide what is medically unnecessary and choose not to cover certain services without evidence-based backing. We can complain a lot about how insurance companies tell your doctor what is right and what is not - but they do an excellent job of preventing your doctor from practicing snake oil medicine. More than half of the DPC doctors are pushing useless solutions - vitamin infusion, B12 shots, and costly genetic panels. They are selling feel-good medicine at a premium price for those who can afford it. I have a problem with that - as a doctor, you are to be fiduciary to your patients. Patients may feel entitled and push the doctor to order an MRI that they don't need. The doctor would have no choice but to oblige. They charge these patients a premium and don't want to alienate them. Since their patient panel is small, to begin with, they need to keep them happy and stick around with them.
