A path to revitalizing primary care: direct primary care

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As a primary care physician, I am all too familiar with the challenges of modern health care. The increasing administrative burdens, shrinking reimbursement rates, and the looming threat of physician burnout can feel overwhelming. My journey from a fee-for-service model to direct primary care (DPC) was transformative, offering not just a professional revival but a renewed connection to the essence of patient care.

When speaking with colleagues, from social workers to physicians and all those caregivers in between, it is clear that DPC also delivers on the quintuple aim described by Dr. Garrison Bliss, the Father of DPC, as "happy doctors, happy patients, lower costs, better health outcomes and consumer-driven regulation."

Burnout driven by fee-for-service

Maryal M. Concepcion, MD
_{© My DPC Story}

My medical career began in a traditional fee-for-service setting, where the pressure to see more patients in less time, with mandates coming from non-physician "leadership," often conflicted with my desire to provide comprehensive, personalized, and thoughtful care. The system's demands left little room for meaningful patient interactions, and much of my time was consumed by paperwork and bureaucracy. I experienced everything I disliked about medicine when not with the patient. The practice's financial and operational constraints drove patient care.

It became increasingly clear that this model was unsustainable for me, professionally and personally. The relentless pace contributed to burnout and a sense of disillusionment, which led me to explore alternatives that aligned more closely with my values and vision for patient care.

The promise of direct primary care

Direct primary care presented itself as a solution at a time when I needed it most. I had been under negotiations to try and hold on to my salary and not go to the relative value unit system, where each time you see a patient, a clinician needs to represent that diagnosis or service into a code. That code represents a dollar amount the physician gets paid for. It's like collecting as many tickets as one can at Chuck E. Cheese – the more tickets you have, the larger the prize you can get.

The DPC model removes the middleman of insurance companies and third-party payers dictating what care is allowed and what reimbursement is given for the care provided. It allows physicians to focus on patient care directly without the constraints of billing codes and reimbursement games. DPC patients typically pay a monthly membership fee covering a wide range of primary care services. Without coding and reimbursement games, physicians can spend more time with their patients, and when primary care doctors have the time they need, 80% to 90% of everyday issues can be handled in the clinic without a referral. Going back to the happy doctor in the quintuple aim, this model also supports a more sustainable practice by ensuring predictable revenue and allowing for more personalized patient care.

The DPC leap of faith

The transition to DPC had its challenges. It required a leap of faith, a willingness to learn new business skills, and a commitment to practicing medicine differently. For anyone who has seen “Indiana Jones and the Last Crusade,” it's sometimes akin to Indy crossing the invisible bridge to try to reach the Holy Grail. However, the rewards have been profound. The ability to spend more time with each patient, focus on preventive care, and build stronger patient relationships has rekindled my passion for medicine.

Benefits for physicians and patients

The benefits of DPC extend beyond the practice's financial stability. For patients, the model provides enhanced access to their physician, including extended visits, direct communication, and a focus on preventive health as well as same and/or next-day care. This highly proactive approach improves health outcomes and fosters a more trusting and collaborative doctor-patient relationship.

For physicians, DPC offers a reprieve from the high-pressure environment of traditional practices where only one issue can be discussed at a time, and a doctor can sometimes be double or triple-booked per allotted time slot. The model alleviates many sources of burnout by reducing administrative duties and increasing job satisfaction because DPC physicians are not working for codes. They are working for their patients. Physicians regain control over their practice, allowing them to prioritize quality of care over quantity of visits.

A call to action

The health care landscape is ripe for innovation. As primary care physicians, we must seek models that restore the joy of practice and prioritize patient well-being. DPC is one model that is already delivering a sustainable alternative to today's challenges.

While not a one-size-fits-all solution, DPC provides a viable path for those seeking to reclaim their practice and reconnect with their patients on a deeper level. It requires courage to step away from the familiar and embrace change, but the potential for professional fulfillment and improved patient care is worth the risk.

For those considering the transition, I encourage you to explore the DPC community, learn from others who have made the shift, learn how it differs from concierge medicine , and assess how this model could work for you and your patients. In a health care system that often feels impersonal and overwhelming, DPC offers a chance to return to the roots of primary care – where the focus is on healing, caring, and making a difference in the lives of our patients.

Maryal M. Concepcion, MD, is a family medicine physician who transitioned from a fee-for-service model to direct primary care. She is the host of the award-winning @MyDPCStory podcast, a DPC advocate, and a mom of two.