DPC is here to stay

It was 15 years ago that Brian Forrest, MD, a primary care physician in Apex, North Carolina, founded Access Healthcare-a practice considered one of the earliest direct primary care (DPC) practices in the U.S. and put Forrest on the map as a pioneer of the new practice type.

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Medical Economics spoke with Forrest on his motivations for starting a DPC practice and where he sees the movement heading.

Medical Economics: What drove you to start a DPC practice?

Brian Forrest: You know at the time, this was 17 years ago and there was no such thing as DPC around at that time. I read an article about Gordon Moore, who started the micro practice concept, and he was an internist who had been seeing maybe 30 or 40 patients a day and he was really tired of that pace and felt like he couldn’t provide good patient care and felt like that volume was mostly driven by his overhead. 

So, he decreased his staffing basically to zero. Instead of having four or five staff, he rented one exam room from another physician and got a headset and became his own receptionist, his own nurse and he was able to go from seeing that high volume of patients down to about 10 a day and make the same salary.

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That was the first thing that I took some inspiration from. And then the second thing was, I sort of had this idea that, why couldn’t family medicine be more like a gym membership? 

When I was in residency I actually did an elective, and I interviewed practice managers and physicians from all over, and really found out that the biggest problem was all the administrative burden associated with filing insurance. So I had a hypothesis that if I got rid of all that administrative overhead and basically just focused on taking care of patients, I would be able to charge patients a lot less.

I got paid for what I was doing and it was taking at least half of my brain power to do that versus spending all of my efforts trying to optimize patient care. 

Q: Why do you think DPC has become such a strong movement and do you think it’s going to keep growing?

Forrest: Yes, I do think it’s going to continue to grow. The reason I think there’s a push is that doctors want to see patients, they want to take care of people. No doctor went to medical school to be a professional coder.

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In my opinion, the third party payer should not get between the doctor and the patient. And I think more and more physicians are feeling like they agree with that. They just want to be able to take care of their patients, not have to worry about all of the administrative burdens and hassles and be able to go at a pace that makes sense both for them and their sanity and also for the patients and the quality of care.

Q: What do you think makes you stand out above others who have tackled DPC over the years?

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Forrest: Well, I think specifically the fact that we were the first tackling it. There weren’t any roadmaps when we started it. And for me, it’s been an experiment since the start.  It was created sort of, I wasn’t copying what somebody else had done. I didn’t read about DPC in a journal article.  I didn’t have anybody to be a mentor. And so, I was having to put it together from scratch and I think there’s good about that because what I was able to do is find a lot of the things that didn’t work. It was trial and error. 

Every year around the last week of December, first week of January, I sit down and sort of adjust the model. and I’ve done that every year. We’ve changed the amount of the monthly memberships. We’ve changed the amount that people pay when they come in. We’ve changed our policies about enrollment fees -all kinds of other things over the years to really fine tune it based on what we found worked and what we found didn’t. It’s been an ongoing experiment. 

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I think if you look at most people now who are doing DPC, probably 90% of those people are going based on the guidance of somebody else that has opened a DPC practice. And that has given them some sort of milestones, a roadmap and shown them sort of the blueprints for how to do this. I think that’s the key difference.

Q: What has driven you all these years to be so innovative and make such a difference in healthcare?

Forrest: I’ve always been somebody who’s felt very purpose driven in my life and I want to fulfill that as my main goal.  If I see an idea or a creative way to do things that can improve things for the better, I don’t let fear of failure or negativity get in the way. I often will say that being afraid to fail is the best way to fail. So, it’s important to really feel like you can innovate, be creative, improve things and not be so concerned about the barriers that might get in the way. If I’d listened to all of those naysayers, then DPC would not have turned into what it is. It would have never become a prominent model.