Flexible treatment options

Direct primary care: A path to achieving the Quadruple Aim of health care

The autonomy and flexibility of direct primary care practices have alleviated some of the frustration and exhaustion physicians are feeling due to the COVID-19 pandemic.


The COVID-19 pandemic exaggerated the frustration and exhaustion of physicians within standard health care systems. Some physicians in direct primary care (DPC) practices have especially appreciated the autonomy and flexibility of DPC during a pandemic.

DPC practices typically offer patients direct, unlimited access to their services, including longer appointment times, for a flat monthly fee, and they don’t bill insurance.

At Plum Health DPC in Detroit, clinic founder Paul Thomas, MD, and his colleagues Raquel Orlich, DO, and Leslie Rabaut, DO, became more flexible in their health care delivery during the height of the pandemic. They shifted to more curbside testing and virtual care for concerns surrounding COVID-19 to ensure the safety of patients who continue to be seen in clinic for typical health care concerns.

The doctors of Plum Health feel fulfilled in their calling to medicine through their collaborative doctor-patient relationships and steady compensation thanks to the flexibility and autonomy built into the DPC model. In many ways, the DPC model is a win-win for both patients and primary care physicians.

Improving the health of populations

The lower patient load (500 patients vs ~2,000 patients) in the DPC model, doctors can get to know their patients’ stories, health care goals, and priorities. This also grants physicians more time with their patients to thoroughly address each concern. There is one office manager/medical assistant, the three physicians, and often two medical students rotating at Plum Health, DPC. Patients do not have the same barriers to get their questions answered directly by their doctor compared to a traditional clinic.  This clinic even offers same-day urgent care appointments.

Reducing the per capita cost of health care

Because of monthly membership costs ranging from $10 for children up to $89 for older adults, the doctors care for a diverse patient panel ranging from uninsured to insured patients of all ages and nationalities.

Although insurance plans are not accepted in the DPC model, patients are still encouraged to have an insurance plan for medical services outside of a primary care setting. The membership covers unlimited office visits or telehealth visits each month as well as access to their doctors at night and on weekends.

Additional out-of-pocket expenses include medications and laboratory tests, which the clinic offers at wholesale cost. Should patients need referrals to specialties, the doctors have partnered up with specialists in the area who offer reasonable cash-pay prices for patients. They can also use their insurance to see a specialist.

Enhancing the patient experience of care

At Plum Health, one-hour initial appointments and thirty-minute follow-up appoints are scheduled so that the physicians can have enough time to really get to know their patients. Without the pressure of time, both are engaged in shared decision making, thus empowering patients to make choices best for their health, wellness, families and budgets.

The autonomy DPC physicians have over their schedule and practice allows them to pursue further training within their interests, which results in enhanced patient care. During the early stages of the pandemic, Dr. Orlich recognized how obesity increases the risks of severe COVID-19 infection, so she pursued a fellowship in obesity medicine.

With this additional training, she not only encourages her patients to maintain a healthy lifestyle with diet and exercise, but also offers them the option of taking prescription weight-loss drugs when appropriate. In addition, she continues to provide osteopathic manipulative treatment.

Improving the work life of clinicians and staff

After graduating from her family medicine residency in July 2020, Dr. Rabaut was discouraged by the positions available at larger health care systems asking for six days a week with 12-hour days and minimal compensation in comparison to other states. It was with pure serendipity that she connected with Dr. Thomas and joined Plum Health in early 2021.

“I love the autonomy I have as a physician to schedule my own patients, to determine the amount of time needed for each patient, and to regulate my own interactions with my patients,” she says. “I love that I am not constantly checking boxes and jumping through hoops for a big health care system.”

In having a high level of autonomy in her job, she feels an immense sense of job satisfaction, which in turn allows her to enjoy her time outside of work with her family, dog and hobbies and be an active community member.

As a physician and new mom, Dr. Orlich balanced both roles by seeing patients virtually during her transition from maternity leave back to full time in office. Patients were able to get care and follow up via video chat or phone call.

DPC practice model gaining momentum

The DPC practice model may be gaining momentum as an option for entrepreneurial and tech-savvy doctors graduating from residency.

To trainees and doctors interested in the DPC model, Dr. Thomas says, “You do not need an MBA to be a successful as a DPC doctor. If you’re smart enough to finish medical school, gritty enough to complete residency, and compassionate enough to choose primary care, then you have all of the ingredients of a successful DPC doctor and business owner.” 

There are many resources available to learn more about how to open and manage a DPC practice, including the Direct Primary Care Summit, sponsored by the ACOFP, AAFP, DPC Alliance and Family Medicine Education Consortium, Inc.

The doctors of Plum Health want to see the DPC practice model taught to more physicians in training and offered as a rotation option for all medical students.

Learn more

The following resources are available for those who want to learn more about direct primary care.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Related reading:

5 things to know about direct primary care

Quiz: Is direct primary care right for you?

One comment

  1. Dr. John Spine

    I don’t understand how so many medical students and resident physicians a) have the time to write opinion articles, and b) think that they have the experience that warrants anyone appreciating those opinions. Please go back to work and learn how to be a doctor.

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