“When you think of Andy Griffith-style medicine, the doctor had a clinic in the local town. It’d be strange for him to say, ‘What kind of insurance does Opie have?’” (Michael Tetreault, quoted in DirectPrimaryCare.com)
When I compare medical care from when I was growing up to the medical care of today, today’s version falls far short. I remember having appointments with our family doctor as a child. He knew me and wasn’t distracted by the hubbub of computers, insurance requirements and the like. It felt like an authentic relationship and that made me want to become a doctor.
I’ve now been practicing medicine for 20 years, and I genuinely struggle with today’s insurance-based model where so little time is spent on listening, on building relationships, on disease prevention. With only a few minutes allotted per doctor-patient visit, time is typically spent trying to alleviate current symptoms rather than delving into root causes of problems. So, not surprisingly, money is spent after the problem occurs – after the heart attack, after diabetes has already developed, after the patient receives a discouraging diagnosis.
Because of this model of medicine, insurance policies where I practice (in South Carolina) are going up an average of 25 percent for 2017, for a total increase of about 70 percent over the past five years. And, as costs skyrocket, deductibles are also increasing along with restrictions that can prevent patients from getting the medicines they need. It’s fair to say that doctors and patients alike are extremely frustrated, and that’s why I’ve made a big change in how I practice medicine.
I’ve switched to a direct primary care model which quite literally is a direct relationship between patients and physicians. In effort to provide high quality healthcare, I will take on fewer patients, be available to them when they need me and spend more time with my patients.
Direct Primary Care is sometimes confused with Concierge Medicine. Though Direct Primary Care physicians do provide concierge level care, we are an insurance-free, lower cost primary care membership model. Don’t let insurance free scare you; we are not anti-insurance by any means. We just don’t believe that your primary care should be determined by the type or level of insurance that you have; and by not accepting insurance as payment we are able to offer lower costs, longer visits, more access, low costs medicines, lower costs ancillary services (x-ray, ultrasound, etc), wholesale labs; none of which would be possible if insurance was accepted. Direct Primary Care isn’t available everywhere in the country although participation is growing. The first physicians to offer this were practicing in Seattle, Oregon and Bellevue, Washington – and that was in 1996. Today, there are approximately 400 group practices existing with this model, with about 1,300 total doctors. Approximately two percent of the American Academy of Family Physicians’ 68,000 members currently offer direct care.
Direct Primary Care Analogies
With this form of medicine, patients pay a monthly fee to their primary care physician which covers the costs of all visits, annual physicals, in-office procedures and offers other benefits such as wholesale costs on medications and labs. You can compare this to having a gym membership. You pay a monthly fee and then do what’s right for your health without worrying what else the gym will charge you for that day’s work out. With direct primary care, you typically only pay extra for lab work or prescriptions, and prescriptions are often at wholesale prices. You can also compare direct care to auto insurance. If we used auto insurance for vehicle maintenance the way we are using health insurance, your auto insurance premiums would be unaffordable. Your flat tire, wiper blades and gasoline may be covered (after a significant deductible), but they would dictate where to go, how much is covered, what brand is allowable and to what extent. Some Direct Care patients find extra financial value through purchasing a less expensive, high deductible insurance plan for hospitalizations and catastrophic events while other just simply find value in the personal service and high quality care.
Advantages and Disadvantages of Direct Primary Care
With rising insurance and medical costs, finances are front of mind for many patients. And, an MDVIP study (network of private physicians) revealed a 72 percent reduction in hospital visits for patients using direct primary care and a savings of $2,000 per patient annually. Without the need for insurance paperwork and unnecessary overhead, doctor office costs are reduced, and these savings can be passed along to patients. Wholesale prescription prices are another benefit. Collectively, this is estimated to save the economy billions of dollars.
Next, patients and doctors can sit down and actually communicate with one another, with the result being individualized care, not what the insurance company dictates a person should have. Instead of looking at a computer screen, entering in data and codes for the insurance company, your doctor can actually look at and listen to you.
Your physician can focus more on preventive medicine because there is enough time. As just one example, I have studied nutrition in some depth and often recommend the Mediterranean diet. Science shows it lowers your risk for heart attacks, cancer and stroke. It lowers inflammation naturally, which has a significantly positive effect on overall health, and I will now be able to talk to my patients about its benefits and personalize how to integrate it into their life.
With direct primary care, you don’t have to worry about switching doctors if you need to switch health care insurance policies, because they’re no longer connected. The doctor-patient relationship doesn’t have to be disrupted. You don’t have to start all over explaining health care concerns and medical history to a brand new person.
Although this model is beneficial for most people, no one model is ideal for everyone. You might think that people who are seriously ill are one of the exceptions, but they in fact can greatly benefit from the personalized attention and wholesale prescription prices associated with direct care. People who won’t necessarily financially benefit from direct primary care include people with excellent insurance coverage from their workplaces with low copays and no deductibles. If these people have doctors that can provide them with enough access, time, and attention, then switching to direct primary care probably isn’t financially beneficial. However, receiving high quality, personal primary care and really taking control of your health has long lasting value.
Some people on Medicaid wouldn’t benefit from direct primary care, either, although that may change as the current insurance model is being reviewed for overhaul by the new administration. Note: in the state of Washington, contracting out for direct care for Medicaid patients is estimated to save the state between 15 and 20 percent.
8/8/2018 09:36:37 pm
Thanks for sharing such an informative blog. The difference shared is a very good piece of information. It can help many people and save many lives as well.
2/7/2019 09:46:21 pm
If direct primary care physician services will help in cutting down costs, I might go for a checkup by going to a primary care physician. I like that doctors can sit down and communicate with their patients as you mentioned which I think is vital to keeping my health so I might go for a visit to those people instead. Should I switch doctors and no longer need to worry about my records, I'll definitely be convinced to go to primary care since that seems more convenient.
7/24/2019 07:42:59 am
I liked that you mentioned that being able to communicate with your doctor and be heard is essential in primary care. I have recently moved and I have been in need of finding another primary care provider. It was also great that you mentioned that your physician can focus more on preventative medicine cause they have the time to do so.
It was very interesting for my mom to read this article and learn that 72% is reduced from hospital visits for patients that use direct primary care. My mom had to have both her legs amputated, so it has been hard for her to get around and out of her house without help. I think this sounds like a good option for her, and now we should try to find a service that can provide her with these benefits.
10/2/2019 10:12:19 am
I always wonder regarding the difference between traditional medicine and direct primary care. It's interesting to learn that when it comes to direct primary care, I will have to pay monthly fees to a physician which covers all visits, annual physicals and many more. I think it's best if I'll choose primary care, because as you've mentioned there's no need for insurance paperwork, therefore, the doctor's office cost is less.
11/25/2020 09:13:04 am
I really like how you mentioned that having a primary care center that takes care of you directly means you don't have to worry about changing your care even if your insurance were to change. My dad and mom are both getting very old and have lots of problems but they don't have consistent insurance either. It seems like getting a primary care provider who will be willing to work with them no matter what would be a great option for them so that they don't have to worry about potentially losing any coverage.
1/4/2021 06:11:35 pm
You made a good point when you shared that patients and doctors can sit down and discuss with one another regarding the right treatment. My sister just mentioned the other day that she is worried about her son who is always sick lately ever since they just moved to their new house a few months ago. I will suggest to her looking for a reliable clinic that she can always go to so she can get the right treatment for her son.
1/15/2021 04:43:49 pm
My brother has been thinking about taking better care of his health by getting the right providers for it. Making sure that he can get some help from a professional could allow them to be more effective with their doctors. It was interesting to learn about how patients can have more savings because there isn't as much overhead, or insurance paperwork.
3/31/2021 06:13:25 am
I've been feeling a bit sick, so I want to see a doctor. It makes sense that seeing the right primary care physician would be important. I'll be sure to choose a doctor that I can trust.
4/21/2021 09:33:04 pm
I like the idea that the benefits of seeking a primary care provider is that we will be blessed with experienced professionals. I do believe that when we need medical attention, it is also important to seek someone who is qualified rather than trusting Dr. Google or self-diagnose. Since my wife and I just moved to a new town, I will make a point to familiarize with all the available facilities in town.
Thanks for the advice that you don't need to worry about switching doctors with primary care. I am looking for a care center that my family can go to now that we have finished settling down in a new area. Not having to switch doctors will be convenient, so I'll make primary care a top priority for my family.
5/13/2021 05:43:27 am
Wow, I'd love a 72% reduction in hospital visits and to save $2,000 every year. I'll talk to my wife about it first though. But I think we could easily find a primary care doctor near us so we could reduce our medical bills.
9/3/2021 02:03:37 pm
It's good to know that with primary care, you can sit down face to face with a doctor and get personal help. I just moved with my kids to a new state, and we need a doctor for them. I think for now I'd like to find a primary care physician that can take care of us.
9/14/2021 05:04:40 pm
I like that you talked about how patients and doctors can sit down and communicate with each other to get the right care they need. I hope we can find a trusted acute health care facility for my dad to really get him treated. It's for his lower back pain which might be a nerve issue now since it has been like that for a week now.
10/17/2021 10:01:30 pm
It's very reassuring to know that a direct primary care enables doctors to still do preventive care since diseases can be caught earlier, giving enough time to cure it. I am definitely considering this since I am not getting any younger. It would be nice to have a specialist I can always reach directly.
1/7/2022 09:06:23 am
This is very informative! Thank you so much for doing such a great job. keep sharing good content.
7/29/2022 11:28:42 am
I loved how you said that you can get individualized care with a primary doctor. My cousin was at my house last night for dinner, and she talked about how she's thought of getting a primary care doctor for a while now. I'll have to let her know this information so that she can know more about the advantages of primary care.
9/16/2022 10:37:21 am
I loved how you said that you can have a direct relationship with a primary care doctor. My sister was at my house a couple of weeks ago, and she talked about how she needed to find a doctor and was wondering what she should search for. I'll pass this information along to her so that she can look into seeing a primary care doctor.
9/29/2022 03:25:50 pm
Excellent post! So much useful information in a single content. I like everything! Thank you for sharing!
9/30/2022 10:38:57 pm
I like that you pointed out that we don't have to worry about looking for other doctors that we need and basing on our insurance plans if we choose direct primary care clinics. I will consider that when I look for those that offer concierge medicine treatments, because it might be what my grandfather needs at the moment. He has been having painful issues in his body, so I hope that we can get him checked tomorrow at a reputable clinic near us.
11/9/2022 03:13:34 pm
My favorite part is when you said that a direct relationship between the patient and the doctors would be provided in a concierge medical practice. My cousin told me he was looking for more personalized health care for my uncle who needs assistance with his medications. He asked if I had any suggestions. Thanks to this instructive article. I'll tell him he should consult a trusted concierge medical service as they can provide information about their services.
1/16/2023 10:06:31 am
when it comes to our health, it's important to seek out experienced professionals who can provide us with the care we need. The benefits of having a primary care provider are many, and I believe that everyone would be blessed with experienced professionals in their lives.
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