As a pre-med student, Matthew Abinante, DO, MPH, shadowed 10-12 physicians and each told him to not go into medicine due to their disillusionment with the profession.
For Dr. Abinante, who was passionate about his career choice, this level of burnout was disheartening. But the last physician he shadowed had a different story to tell. He loved what he did and told Dr. Abinante to definitely go into medicine. That physician practiced a version of concierge medicine for which he charged patients a flat monthly fee in exchange for a higher level of service.
Dr. Abinante began researching and discovered a more affordable primary care practice model called direct primary care (DPC). For a monthly fee that is typically under $100, DPC patients have direct, unlimited access to their primary care physicians with longer appointment times and no insurance billing.
Physicians have more time to spend with patients and the simplified fee structure leads to decreased practice overhead and reduced administrative burdens. Dr. Abinante opened his own DPC practice in 2016.
If this growing practice model has piqued your interest, read on for five things to know about DPC today and take our quiz on whether DPC is right for you.
1. DPC docs foster an enduring doctor-patient relationship
Developing an enduring doctor-patient relationship through adequate appointment time is a hallmark of DPC. A typical DPC practice has about 600 patients, compared with 2,500 patients for an average fee-for-service primary care practice. Instead of seeing up to 30 patients a day, DPC providers typically see less than 10. “A lot of medicine can be done electronically,” says Dr. Abinante, who has capped his practice at 450 patients.
“I know all my patients by name. I have time for them,” he says. “I probably interact with about 20 patients a day when you factor in the electronic communication.”
The longer appointments in the DPC model allow time for discussions between a physician and patient that encompass lifestyle choices with the aim of long-term health and well-being.
“What everyone really needs to know is that patients do get better care when their doctor is more satisfied with what they’re doing. And that takes time. That is what the [fee-for-service] system cannot provide us, is time with the patient,” says Tiffanny Blythe, DO, who runs a DPC practice in Kansas City, Missouri.
2. DPC is growing and DOs are joining in
In the past decade, the DPC model has grown from just 21 practices to over 1,000 practices in 49 states that care for an estimated 500,000 patients, according to the Direct Primary Care Coalition (DPCC), an advocacy group.
“The movement has been particularly popular among DOs,” says Jay Keese, executive director of the DPCC, who estimates that 30-40 percent of the group’s members are DOs, osteopathic residents and medical students.
The high level of interest in DPC by DOs may be attributed to an already higher percentage of DOs practicing primary care, says Keese. “But DOs also tend to be a bit more entrepreneurial and independent,” he adds.
3. Efforts are underway to enhance DPC
The AOA supports the DPC model, and urged Congress at DO Day on Capitol Hill last week to support a Primary Care Enhancement Act (PCEA) that includes a DPC model which would allow physicians to provide health care to the full extent of their scope of practice, including providing diagnostic services and dispensing prescription drugs.
Currently, the IRS views DPC as a type of health insurance and bars the use of health savings account funds to pay for DPC. The PCEA would allow patients to use the funds from their HSA to pay for DPC.
One of the downsides of direct primary care is that it can be challenging to find patients who can afford their membership dues, particularly in medically underserved areas.
“An arrangement like direct primary care or concierge medicine … is a great option if you’re in an environment where people can afford it,” Seger S. Morris, DO, MBA, told The DO recently. “In many areas, especially rural and underserved areas, either there are not enough people to make it work or [the patient population] doesn’t have the money to do it.”
For a primer on the AOA’s DPC advocacy, see these frequently asked questions.
4. DPC offers upfront pricing
DPC practices offer transparent pricing upfront. A monthly membership fee (typically under $100 per member, often with family discounts) covers unlimited primary care office visits and services. Patients are encouraged to buy a complementary insurance plan, such as a high deductible health plan, to pay for any complex or catastrophic medical services outside of primary care.
While both concierge and DPC charge a periodic membership fee to the patient, most DPC physicians don’t accept insurance. Concierge practices, on the other hand, typically still bill insurance and often add an annual retainer fee.
At Dr. Abinante’s Elevated Health in Huntington Beach, California, patients pay an average of $75 monthly. This includes same- and next-day visits, 30-60 minute appointments, and the ability to call, email, text or video chat with a physician 24/7.
Elevated Health offers patients free diagnostic EKG and spirometry testing, as well as procedures such as laceration repair, skin lesion removal and ear lavage. Labs, medications and imaging are available to patients at contracted wholesale prices.
5. DPC embraces the ‘quadruple aim of medicine’
The triple aim of medicine—to enhance the patient experience, improve population health and reduce health care costs—is well-documented, says Dr. Abinante, but he and other DPC providers are focused on “the quadruple aim of medicine,” which acknowledges that improving the work-life balance of physicians is necessary in order for the other three aims to happen.
For Dr. Blythe, who was on the verge of leaving the medical profession after spending three years employed by a hospital-owned clinic where “the only thing that mattered was the numbers,” she says discovering the DPC model made medicine a viable option again.
“I needed to feel like I was being the doctor I intended to be,” Dr. Blythe says.
One of the criticisms of direct primary care is that its doctors’ smaller patient loads will only add to the primary care physician shortage.
But Dr. Blythe is hopeful that DPC will revive interest in primary care among today’s future physicians.
“With DPC, we’re recruiting a new generation of doctors who wouldn’t even consider primary care before,” she says.