Direct Primary Care Pediatrics

[Dr. Hook]

Howdy y'all.

Med student here. I've been reading about the Direct Primary Care model, and honestly it seems like a step in the right direct for primary care docs. However, many of the threads (which have been very informative!) mainly focus on Family Medicine DPC. I have a growing interest in pediatrics and I've seen some Peds groups moving to the DPC model...but I have some questions.

General Questions

• Has this model been proven successful thus far in Peds? Any Examples?
• What is the maximum patient pool that a pediatrician would have in DPC? I've seen some folks saying around 1000-1200.
• Is the typical salary of a DPT Pediatrician mirror that of the average for the field?
• How long does it take to build up a successful population in DPC as a pediatrician (with pre-enrollment or just an ice cold start)

Questions Geared Toward Peds Docs in DPC

• How many patients do you see a day? Time spent with patients?
• What are your typical hours at the office? Hours seeing patients outside the office? Hours spent doing administrative or academic tasks?
• I've seen a good handful of "worrier" parents in my short time in various clinics. Has it been a problem with calls/texts/emails at odd hours, especially with a large patient pool? How might one handle these types of situations?
• What has been the benefits of using DPC as a Pediatrician? Drawbacks?

Thanks for any replies. Hope y'all are having a nice Saturday.

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[physicsnerd42]

What the heck is direct primary care (and isn't that what we normally do)?


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[Step Up]

I didn't know either, but figured it was similar to concierge medicine. I read more about it here: http://www.kevinmd.com/blog/2014/08/direct-primary-care-concierge-medicine-theyre.html

This smells of a total scam for patients. Unless it's directed at the super-rich. If you have insurance how would this be helpful? Medicine is NOT like dentistry where your only costs will be your visits to the dentist and minor procedures they perform. The real healthcare costs for patients are from medications, procedures and hospitalizations, and not from your visits to your PCP.

 

[VA Hopeful Dr]

What the heck is direct primary care (and isn't that what we normally do)?


Sent from my iPhone using SDN mobile app

No, it isn't close to what you normally do.

Granted I'm a family doctor, but I can clarify the basic concept.

Direct Primary Care is a mode of practice where the physician accepts no insurance. We operate based on the idea that the doctor-patient relationship should not have any other elements to it (no government or third-party influence).

There are numerous ways to set this up, but the most common and most talked about is a subscription-based clinic (what you do now as a resident is almost certainly fee-for-service). What this means is that the patients pay a set monthly fee (mine is $50/month for most adults, nationwide the average last I heard was $65 but I live in a fairly low cost-of-living location) that covers everything my office offers: unlimited same-day office visits, procedures, injections, ECG, spirometry, and some basic labs like U/A, urine HCG, strep, finger-stick hgb. All of my patients also get my personal cell phone number and e-mail address so they can get in touch with me any time they need to.

 

[VA Hopeful Dr]

I didn't know either, but figured it was similar to concierge medicine. I read more about it here: http://www.kevinmd.com/blog/2014/08/direct-primary-care-concierge-medicine-theyre.html

This smells of a total scam for patients. Unless it's directed at the super-rich. If you have insurance how would this be helpful? Medicine is NOT like dentistry where your only costs will be your visits to the dentist and minor procedures they perform. The real healthcare costs for patients are from medications, procedures and hospitalizations, and not from your visits to your PCP.

It is absolutely not a scam. Slightly over 50% of my patients are uninsured and they come to me because I provide better value than the other doctors in town.

Let's consider your average type 2 diabetic. Office visits every 3 months ($150/visit at current rates), an A1c every 3 months ($40 cash-pay in my area), yearly CBC, CMP, lipids, microalbumin, and TSH ($175) for a grand total of $950/year. This doesn't include any sick visits, injuries, other lab testing, x-rays or anything at all beyond basic diabetes care.

Let's contrast this with my office. 1 year of unlimited office visits at $50/month is $600/year (the same as 4 visits at a regular PCP). An A1c at my office is $8. CBC ($5), CMP ($5), lipid profile ($7), microalbumin (free) and TSH ($7). Put all that together and you get $632. I've saved this patient $200 right off the bat just on their diabetes care. Every additional sick visit, ankle sprain, laceration repair is just more money I save them.

Now, let's talk medication since many DPC doctors dispense their own medications. I'll even compare my prices to the Wal-Mart $4 list and not the usual pharmacy prices.

Metformin at Wal-Mart is $4/month no matter the strength (including the 500mg ER). 1000mg at my office for a month (meaning 60 tablets) is $1.44, the 500mg ER for a month is $2.52.

Lisinopril is $4/month at wal-mart no matter the dose. My 40mg tablets (the most expensive) cost $1.53/month.

The only statin Wal-Mart has is Lovastatin at $4/month. I can do a month of lipitor 80mg for $393, or even better a month of Crestor 10mg for $5.50.

Let's also look at some more common medication. Prescription Zyrtec can be had for $10/90 pills, OTC zyrtec is $45/365 pills. 365 tablets at my office cost $13.45. Sprintec, the new-name for Ortho Cyclen is $9/month at Wal-Mart. I have it for $7.28. Flonase is $20 OTC, I have it for $5.

I trust you get the idea.

Beyond that, let's look at a study from a large DPC group out in Washington state: http://stateofreform.com/news/indus...e-primary-care-model-saves-20-percent-claims/

Fewer hospitalizations, fewer ER visits, fewer advanced radiology tests, fewer specialist referrals, and shorter hospital stays. In fact, the only thing that went up is PCP visits.

As for how this can be helpful for patients, well that's easy. I have a high deductible plan, so its at least $100 every time I saw my former PCP. It takes me 3 days to get an appointment and I end up spending at least 2 hours there between waiting in the waiting room, waiting in the exam room, and waiting to check out. At my new DPC PCP, I get an appointment the day I call, I've yet to wait more than 5 minutes in the waiting room, and I don't wait at all to check out.

On average, people get 8-10 minutes with their PCP per appointment. My office and my new PCP have 30 minutes as the shortest appointment. I never need to go to urgent care again since I have 24/7 access to my PCP. My medications are cheaper through her office than using my insurance. I'm less likely to get turfed to a specialist since DPC docs have time enough to manage more complex conditions or figure out tricky cases.

 

[Step Up]

Va Hopeful: I appreciate your enlightening post. The idea of improved preventative medicine is fascinating and seems to have great potential. It's also great how you take in patients without insurance for a reasonable price. There are almost no pediatricians in my area that take the uninsured.

However, the economics don't add up. Saving $200 is chump change compared to the actual cost of yearly healthcare for the average American. To be a patient at your practice, you would still NEED to have insurance. What if your child get appendicitis and needs surgery? Or gets hospitalized for croup? Or simply is sick enough to require the emergency room... If you don't have insurance you are SCREWED. If you have a chronic disease, that requires subspeciality care and medication beyond the likes of albuterol, forget about it, no way can you go to your practice. Could this practice model work for the healthy upper-middle class to wealthy, whom also have insurance, sure.

Also, just to be clear, this is a pediatrics forum. It's hard to see how some of your examples translate to a pediatrician's office.

I'm interested to hear how you bring the costs for generic medications and common lab tests down so nicely. It would be nice if this model could translate to a larger group model, with surgical, inpatient and subspecialty care.

 

[VA Hopeful Dr]

Va Hopeful: I appreciate your enlightening post. The idea of improved preventative medicine is fascinating and seems to have great potential. It's also great how you take in patients without insurance for a reasonable price. There are almost no pediatricians in my area that take the uninsured.

However, the economics don't add up. Saving $200 is chump change compared to the actual cost of yearly healthcare for the average American. To be a patient at your practice, you would still NEED to have insurance. What if your child get appendicitis and needs surgery? Or gets hospitalized for croup? Or simply is sick enough to require the emergency room... If you don't have insurance you are SCREWED. If you have a chronic disease, that requires subspeciality care and medication beyond the likes of albuterol, forget about it, no way can you go to your practice. Could this practice model work for the healthy upper-middle class to wealthy, whom also have insurance, sure.

Also, just to be clear, this is a pediatrics forum. It's hard to see how some of your examples translate to a pediatrician's office.

I'm interested to hear how you bring the costs for generic medications and common lab tests down so nicely. It would be nice if this model could translate to a larger group model, with surgical, inpatient and subspecialty care.

Naturally people still need insurance, I encourage all my patients to have something for just the situations you describe: I actually use "hit by a bus" as my example. But people are angry at the very bad state of primary care in this country. DPC is one answer to that problem. I actually have quite a few just plain old middle class patients. Lots of teachers, nurses, blue collar workers; people that hate waiting an hour for 10 minutes of PCP time, or hate taking 3 days to get an appointment, or are tired of urgent cares with a different doctor each time. You don't have to be rich to afford $50/month for unlimited, same day, no waiting primary care.

Trick is, some people just can't afford insurance. No amount of convincing can change that. That's where I come in. Better good primary care than nothing. And saving $200 for, worst case, the exact same care is a pretty big deal. That's a car payment or new tires.

As for cheap labs/drugs, my prices are what they actually cost before hospital/pharmacy mark ups. CVS could charge the same prices, if not better, except they have to pay the pharmacist. I don't need to make money off the meds, so I don't. You'd also be surprised at how cheap many drugs are. If it's off patent, I can usually get it fairly cheap. Branded drugs are trickier, inhalers especially which is a pet peeves of mine.

Same with the labs: I charge the price that Quest has set as their breakeven point. The hospital labs could do it too but they have more expenses (like administrator salaries) to cover.

I'm working on a more peds-oriented post since that's what the OP asked for, but it takes time and some decent thought since it is more unusual than family medicine.

Plus a basic DPC primer is never a bad idea.

 

[SurfingDoctor]

Reduced labs and pharmaceutical costs are great and should always be at the forefront of reducing healthcare costs. The problem with pediatrics though is that most children are healthy (they don't have the ravages of 30+ years of bad health) so most check ups result in no diagnosis and require no tests or medications. Of course there are exceptions but they are just that and not the norm (the highest charge I ever generated in clinic was a removal of a cockroach from an ear canal). Additionally, because most sick visits are viral or can be diagnosed easily with little to no tests, the cost savings in pediatric primary care is unlikely to have much impact. I mean you are talking about concierge medicine for typically the healthiest population. And when they develop chronic conditions or become repeatedly unhealthy, it almost always requires specialists and hospitalization. If you are the only game in 100 miles, then maybe you can get by managing pediatric patients with specialty needs, but I've also seen families drive across a state for 4 hours 1 way to see the specialist for their child. In those cases, the pediatrician could live next door, but they would rather see the expert.

If you want a cash only pediatric practice you are welcome to do it, but the reality is pediatric care is generally cheap compared to adults. Of course having pediatric patients who don't have insurance is exceptionally uncommon with the ACA Medicaid and SCHIP expansion, though that may be going away. And also, if a pediatric patient actually gets sick and requires hospitalization or emergency care, the uninsured would essentially become bankrupt.

 

[VA Hopeful Dr]

Howdy y'all.

Med student here. I've been reading about the Direct Primary Care model, and honestly it seems like a step in the right direct for primary care docs. However, many of the threads (which have been very informative!) mainly focus on Family Medicine DPC. I have a growing interest in pediatrics and I've seen some Peds groups moving to the DPC model...but I have some questions.

General Questions

• Has this model been proven successful thus far in Peds? Any Examples?
• What is the maximum patient pool that a pediatrician would have in DPC? I've seen some folks saying around 1000-1200.
• Is the typical salary of a DPT Pediatrician mirror that of the average for the field?
• How long does it take to build up a successful population in DPC as a pediatrician (with pre-enrollment or just an ice cold start)

Questions Geared Toward Peds Docs in DPC

• How many patients do you see a day? Time spent with patients?
• What are your typical hours at the office? Hours seeing patients outside the office? Hours spent doing administrative or academic tasks?
• I've seen a good handful of "worrier" parents in my short time in various clinics. Has it been a problem with calls/texts/emails at odd hours, especially with a large patient pool? How might one handle these types of situations?
• What has been the benefits of using DPC as a Pediatrician? Drawbacks?

Thanks for any replies. Hope y'all are having a nice Saturday.

OK, now that I'm at work I can tackle this. Let me preface by saying that I am a family doctor doing DPC so my personal experience will not count for as much as a full pediatrician. That being said, I'd say that about 20% of my practice is children. I also know of a few DPC pediatricians so I'll be drawing heavily from their experiences..

• Yes, although admittedly it is more difficult for peds than adult medicine. I'll try and get permission from the successful docs I know and will post here if I'm allowed. Alternatively, you can google Direct Primary Care pediatrics.
• Generally speaking a pediatric practice does have more patients than an adult one for all the obvious reasons. At the same time, this is usually needed as you can't charge as much for kids as for adults. Some quick math tells me that 1000 patients, at $25/month (which seems reasonable for peds) gives you a gross income of $300,000 for the year. Overhead should run about 25-30% which leaves you with an income of roughly 200k. I don't know what the average pediatrician salary is to compare to that.
• Obviously this goes much faster if you have an existing practice and patients stay with you to your DPC one, but a cold start can be pretty effective if you market yourself well.

• That like everything else depends. Are you comfortable doing lots of e-mail/phone/Skype-type visits? If so, your office appointments will decrease substantially. If you want to see most sick kids in the office, you'll be busier. Generally speaking, DPC does have longer appointment times - kinda the standard is 30 minutes for sick/problem visits an hour for physicals/WCCs.
• Administrative burden is very very low, that's kinda the point. I bet I spend maybe an hour a week on the business end of the practice (paying bills mainly). The rest is all patient care. Even my notes don't take very long - most are 2-3 lines long, tops. I've started doing some precepting for the local med school which adds maybe 30 minutes/day of teaching when a student is here.
• Set boundaries from the start. Mine is something like "After 9pm you can still reach me by phone, but please remember that I do like to sleep too so try not to call unless you're really worried, like 'Should I take my son to the ER, let me call Dr. X and ask' type stuff". My phone mutes text/e-mail alerts at 9pm for just that reason. Most of my patients are happy to text most of the time anyway.
• The biggest hurdle I've seen is vaccinations. They are reasonably expensive to pay cash for, and with the ACA most people get them for free. The main way around this is to use the health department. My peds patients do and actually have all had very good experiences doing so - in and out pretty quickly, its clean and reasonably well kept up, and the staff love seeing healthy happy kids. You could potentially buy vaccines as needed from other local peds practices at cost but that will usually run around $150/vaccine series. The benefits are obvious. Most stuff that parents bring their kids in for doesn't actually need a full office visit, so you can manage a lot without needing to see the kid. If you do, you brag on your short (zero) waiting room time and the length of visit so no one ever feels rushed out the door. They never have to see one of your partners or midlevels, its always "their" doctor.

 

[VA Hopeful Dr]

Reduced labs and pharmaceutical costs are great and should always be at the forefront of reducing healthcare costs. The problem with pediatrics though is that most children are healthy (they don't have the ravages of 30+ years of bad health) so most check ups result in no diagnosis and require no tests or medications. Of course there are exceptions but they are just that and not the norm (the highest charge I ever generated in clinic was a removal of a cockroach from an ear canal). Additionally, because most sick visits are viral or can be diagnosed easily with little to no tests, the cost savings in pediatric primary care is unlikely to have much impact. I mean you are talking about concierge medicine for typically the healthiest population. And when they develop chronic conditions or become repeatedly unhealthy, it almost always requires specialists and hospitalization. If you are the only game in 100 miles, then maybe you can get by managing pediatric patients with specialty needs, but I've also seen families drive across a state for 4 hours 1 way to see the specialist for their child. In those cases, the pediatrician could live next door, but they would rather see the expert.

If you want a cash only pediatric practice you are welcome to do it, but the reality is pediatric care is generally cheap compared to adults. Of course having pediatric patients who don't have insurance is exceptionally uncommon with the ACA Medicaid and SCHIP expansion, though that may be going away. And also, if a pediatric patient actually gets sick and requires hospitalization or emergency care, the uninsured would essentially become bankrupt.

Yeah, in peds the name of the game is more geared towards convenience. No one likes sitting in the waiting room or the exam room waiting for the doctor. No one likes the phone-trees and on-call nurses that most practices have. No one likes having to come in to the office just to speak to the doctor.

From a cost angle, the high deductibles of the ACA do help. If it costs me $90 to bring my kid in (which it does), that's 3 months of concierge level care right there.

 

[SurfingDoctor]

I will say the economics (benefits and cost) seem unknown. The AAP seems non-committal but cautionary.

https://www.aap.org/en-us/professio...ation/economics/pages/concierge-medicine.aspx

There was also a policy paper released by the American College of Physicians. You can read it if you'd like. Again it addresses the lack of information on the true effect of the model. And of course, it doesn't specifically address pediatrics.

http://annals.org/aim/article/24688...ge-other-direct-patient-contracting-practices

There appears to be an American Academy of Concierge Pediatricians. They appear to tell you how to set up a practice. The membership is small though (and many of the practice website no longer work).

http://www.aacpeds.com/index.htm

One trend I have noticed over the years in pediatrics is outpatient clinics becoming part of an affiliated hospital network. The best examples I've seen are Texas Children Health Plan http://www.texaschildrenshealthplan.org/ and the Children's Physician Group (part of CHOA) https://www.choa.org/medical-services/childrens-physician-group but I have seen this intergrated model expanding. I would imagine that while patients would never be excluded from those services, physician groups would be and thus it would limit a physicians patient pool.

 

[VA Hopeful Dr]

I will say the economics (benefits and cost) seem unknown. The AAP seems non-committal but cautionary.

https://www.aap.org/en-us/professio...ation/economics/pages/concierge-medicine.aspx

There appears to be an American Academy of Concierge Pediatricians. They appear to tell you how to set up a practice. The membership is small though (and many of the practice website no longer work).

http://www.aacpeds.com/index.htm

That seems to almost 100% mirror the ACP's statement on the issue. The biggest take home is that we don't have enough research on the subject to really comment, which is fair.

The part that truly pisses me off is this one: "Practice models that, by design, exclude certain categories of patients should be understood to create a greater potential of being discriminatory against underserved populations."

As if most practices don't either limit their Medicaid patients or just not take Medicaid all together.

The other part that is a mild irritant at most is that this article seems to say that DPC docs want patients to be uninsured which is completely untrue. I encourage all of my patients to get some type of insurance for the unpredictable, high-cost things that happen - hit by a bus, appendix explodes, and so on.

 

[SurfingDoctor]

That seems to almost 100% mirror the ACP's statement on the issue. The biggest take home is that we don't have enough research on the subject to really comment, which is fair.

The part that truly pisses me off is this one: "Practice models that, by design, exclude certain categories of patients should be understood to create a greater potential of being discriminatory against underserved populations."

As if most practices don't either limit their Medicaid patients or just not take Medicaid all together.

The other part that is a mild irritant at most is that this article seems to say that DPC docs want patients to be uninsured which is completely untrue. I encourage all of my patients to get some type of insurance for the unpredictable, high-cost things that happen - hit by a bus, appendix explodes, and so on.

I have no dog in the fight. I added to my post during your reply, but I have noticed a trend in primary care pediatric groups vying to become part of a hospital affiliated network. I gave examples of the biggest ones I know, but it is happening more and more frequently. Again, people are going to choose what they what, but in my experience, if you have Pediatrician X, who is part of a large tertiary case children's hospital network, or Pediatrician Y, who is a single, unaffiliated practice, parents are far more likely to go with Pediatrician X to have an integrated healthcare network. Now availability and access may make Pediatrician Y the only game in town, but has the hospital affiliated networks expand, I think it will be far less common to have single unaffiliated pediatric practices.

 

[VA Hopeful Dr]

I have no dog in the fight. I added to my post during your reply, but I have noticed a trend in primary care pediatric groups vying to become part of a hospital affiliated network. I gave examples of the biggest ones I know, but it is happening more and more frequently. Again, people are going to choose what they what, but in my experience, if you have Pediatrician X, who is part of a large tertiary case children's hospital network, or Pediatrician Y, who is a single, unaffiliated practice, parents are far more likely to go with Pediatrician X to have an integrated healthcare network. Now availability and access may make Pediatrician Y the only game in town, but has the hospital affiliated networks expand, I think it will be far less common to have single unaffiliated pediatric practices.

I didn't assume you were anti-DPC, if I came off that way my apologies.

You're right about the general consolidation, but I think you're reading it wrong. Patients in general are finding that the consolidated practices aren't all they were sold as - many places have different outpatient/inpatient EMRs so records don't cross that well, when you're part of a large corporation you end up with more hassle trying to get anything done (centralized scheduling/referral centers), longer waits, higher costs. I actually get a lot of patients who come to me specifically because I'm not hospital-owned/employed.

Plus, let's face it, there is a lot to be said for having a dog in the fight. Employed (especially salaried) workers just don't care as much in general. This doesn't mean that they give poor care or are lazy, but they rarely go out of their way to do things for patients. If you know that your livelihood depends on getting and keeping patients, you are much more likely to do more outside the basic job requirements.

As far as pediatrics, what I'm seeing in my neck of the woods (meaning statewide, not just my city) is lots of smaller practices joining together. We have essentially 3 large practices in my area - each has 5 locations, none are hospital-owned, all still PP with physician ownership. They all still round at the Children's hospital but maintain independence.

 

[SurfingDoctor]

I didn't assume you were anti-DPC, if I came off that way my apologies.

You're right about the general consolidation, but I think you're reading it wrong. Patients in general are finding that the consolidated practices aren't all they were sold as - many places have different outpatient/inpatient EMRs so records don't cross that well, when you're part of a large corporation you end up with more hassle trying to get anything done (centralized scheduling/referral centers), longer waits, higher costs. I actually get a lot of patients who come to me specifically because I'm not hospital-owned/employed.

Plus, let's face it, there is a lot to be said for having a dog in the fight. Employed (especially salaried) workers just don't care as much in general. This doesn't mean that they give poor care or are lazy, but they rarely go out of their way to do things for patients. If you know that your livelihood depends on getting and keeping patients, you are much more likely to do more outside the basic job requirements.

As far as pediatrics, what I'm seeing in my neck of the woods (meaning statewide, not just my city) is lots of smaller practices joining together. We have essentially 3 large practices in my area - each has 5 locations, none are hospital-owned, all still PP with physician ownership. They all still round at the Children's hospital but maintain independence.

No need to apologize, my wording may have seemed biased, but I just wanted to convey I that I don't have any stake for or against the model.

I do think the nature of pediatrics is different from adult medicine for the many reasons eluded to above (general health, low cost, greater abundance of insured patients, more reliance on specialized care, pediatric healthcare networks, etc.) and so I would suspect the DPC model would be a challenge to translate successfully. There probably is a market for it, but I would imagine it would be small and very niche (most likely wealthy families in urban areas and very poor families in rural area, though knowing that they would still be eligible for Medicaid and SCHIP in most instances). I could easily be wrong in all of this, but I think this model would be unlikely to find common footing in pediatrics and I would caution someone from pursuing it without realizing the risks.

On a side note, most hospitals are moving away from having community pediatrician round in the hospital. There are certainly political reasons from the hospital-community practice standpoint to have a model of community pediatrician seeing patients in the hospital, but outside of the political aspects, there has been evidence that hospitalist systems provide more efficient care without a sacrifice to quality (and in some cases, improved quality, though no universally so). I suspect that over time, the amount of community pediatricians who having admitting privileges to continuously decline, especially in the current era of decreasing Medicaid reimbursements and possible defunding (since children's hospitals are dependent on that resource)

https://www.ncbi.nlm.nih.gov/pubmed/21592322

 

[VA Hopeful Dr]

No need to apologize, my wording may have seemed biased, but I just wanted to convey I that I don't have any stake for or against the model.

I do think the nature of pediatrics is different from adult medicine for the many reasons eluded to above (general health, low cost, greater abundance of insured patients, more reliance on specialized care, pediatric healthcare networks, etc.) and so I would suspect the DPC model would be a challenge to translate successfully. There probably is a market for it, but I would imagine it would be small and very niche (most likely wealthy families in urban areas and very poor families in rural area, though knowing that they would still be eligible for Medicaid and SCHIP in most instances). I could easily be wrong in all of this, but I think this model would be unlikely to find common footing in pediatrics and I would caution someone from pursuing it without realizing the risks.

Yeah, I do think that's partially why DPC peds practices are unusual - more importantly though, most peds offices are run pretty efficiently: lots of same day acute visit slots, waiting room time is usually limited (I've never waited more than 10 minutes, and usually they call my girls back before I've finished with the paperwork), the only area they're not great at is non-office visit doctor communication.

 

[mcworbust]

That seems to almost 100% mirror the ACP's statement on the issue. The biggest take home is that we don't have enough research on the subject to really comment, which is fair.

The part that truly pisses me off is this one: "Practice models that, by design, exclude certain categories of patients should be understood to create a greater potential of being discriminatory against underserved populations."

As if most practices don't either limit their Medicaid patients or just not take Medicaid all together.

The other part that is a mild irritant at most is that this article seems to say that DPC docs want patients to be uninsured which is completely untrue. I encourage all of my patients to get some type of insurance for the unpredictable, high-cost things that happen - hit by a bus, appendix explodes, and so on.

That pisses me off too, and I'm not even in residency yet. It seems to me that the direct primary care model incentivizes BOTH the patient and physician to engage in activities and practices that have the best possible outcome for the patient. The DPC practices I have read about also do seem to provide discounted care for lower SES patients who actually are interested in their health, and if we really wanted to encourage this practice, we should 1) provide tax credit for taking care of patients who don't pay and/or 2) make medicaid easier to use with less risk of government retribution if physicians bill something wrong.

Thanks @VA Hopeful Dr for your insights!

 

[VA Hopeful Dr]

That pisses me off too, and I'm not even in residency yet. It seems to me that the direct primary care model incentivizes BOTH the patient and physician to engage in activities and practices that have the best possible outcome for the patient. The DPC practices I have read about also do seem to provide discounted care for lower SES patients who actually are interested in their health, and if we really wanted to encourage this practice, we should 1) provide tax credit for taking care of patients who don't pay and/or 2) make medicaid easier to use with less risk of government retribution if physicians bill something wrong.

Thanks @VA Hopeful Dr for your insights!

There is a pilot program in Washington state between a large corporate DPC group and Medicaid, basically paying for Medicaid patients to join that practice. This group usually publishes results after 2 years (which will be the end of this year), so should be interesting to see how this plays out up there.

 

[mcworbust]

There is a pilot program in Washington state between a large corporate DPC group and Medicaid, basically paying for Medicaid patients to join that practice. This group usually publishes results after 2 years (which will be the end of this year), so should be interesting to see how this plays out up there.

Interesting, I'll keep an eye out, thanks!

 

[Dr. Hook]

Thanks for your thoughtful replies y'all. Definitely some articles to read up on and def some things to keep an eye on. @VA Hopeful Dr, your insights are extremely valuable. Thanks for showing up. While DPC doesn't have the big feasibility studies going for it as of now, I hope that ongoing analysis can find it to be a new route for primary docs.

Somethings gotta give for primary care.

I'll definitely be keeping an eye out for how this model is evolving as I progress through med school.

 

[Sushirolls]

I wish there was Peds DPC in my area. Current big box shop peds, you can't ever get in for same or next day appointments. So the only option is to use the urgent care associated with the big box shop.