Why Direct Primary Care?

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I’m going to take a break from talking about COVID 19 to actually talk about why Direct Primary Care (DPC) is a great answer for your personal and family healthcare.  Direct Primary Care is actually a large, nationwide movement of doctors who want to return their practices to what they envisioned when they first decided to go to medical school.

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What is direct primary care? Direct primary care is, in some ways, an old-fashioned idea.  In DPC, doctors get paid by their patients or by their patients’ employers. The money never passes through a third party, never gets siphoned off to take care of administrative costs or shareholder profit. This means that practices can be small. DPC practices are, in general between 400 and a thousand patients per clinician. This allows the DPC doctor to have half-hour appointments, 60 to 90 minutes for new patients, and to do procedures and extensive examinations that insurance-based doctors have to defer off to specialists. Because DPC doctors actually have the time to truly listen to and examine their patients, they don’t have to order as many studies, or to send the patient into the emergency department or defer to urgent care because they can’t fit the patient in for an appointment. This allows for the kind of interpersonal, gentle, care that most people think of when they think of an “old-fashioned country doctor”.

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Since the 1960s, medicine has been moving away from interpersonal care and into a mechanized, factory-like, system. This is a system that treats patients as a “widget”, and doctors as factory machines that just spit those widgets out as fast as possible. But! Patients are not widgets and doctors are not machines. Patients and doctors are both human beings. Good medicine requires that we treat each other as deep, complicated and meaningful people. This creates a trusting and healing environment. DPC is a return to that ideal.

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One of the things we have learned in this pandemic is that it is even more difficult to get care when we can’t even see our doctor. Insurance-based care has been slow to respond to the change in circumstances. Practices have been unable to adapt to telemedicine and texting, because that is not how they get paid. With DPC we don’t have to worry about that. We can adapt our care to whatever our patients need, instantly.  While other doctors have had to scramble to figure out how they’re going to see their patients (and get paid) under these challenging circumstances, DPC simply adapts.  Much of my practice was already conducted by text and phone. In fact, the only thing that changed is that instead of seeing patients in office I have been seeing most patients via telemedicine—which I already had set up.  

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Often one of the major questions I get from callers is, “Do you take my insurance?” When I explain that is not how my practice works, they ask me “What is my insurance for, then?”  My answer back is always a question, “I don’t know. What is it for? Can you get into see your doctor? Can you get the tests you need? If you go to the emergency department will they pay for it? I can tell you that often they will not. So, tell me. What are you getting from your insurance? “

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Insurance companies are not in the business of actually getting you care. Insurance companies are in the business of making money. The less you utilize medical services, the more money they make. They only pay doctors when you are sick.  They pay specialists and procedure-based doctors more. Under those circumstances, do you think patients end up going to more specialists and getting more procedures done? If you do, you would be right.  

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And what is your experience when you go into the office? Let’s say you wait that month to get an appointment, then what? Are you left waiting in the waiting room for 45 minutes or an hour? Is your care impersonal? Do they make you get mostly naked and sit on a paper cover on a cold table? Do you feel like you get treated like an individual person in the 7 ½ to 10 minutes your doctor can actually spend with you?

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None of this is to malign my colleagues in traditional primary care. They are doing the best they can within a very difficult system. In order for them to make enough money to support the people they need to bill the insurance they have to see more and more patients. From the insurance companies’ perspective, that works just fine.  You are paying your insurance to see a doctor. The more patients an insurance company can cram onto one doctor, the more of your money they get to keep instead of spending it on your health.

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So how is Direct Primary Care different? The answer is simple, you actually get to see and talk to your doctor when you need to see and talk to your doctor. When people call me for an appointment, I almost always have appointments either that day or the next day. I can certainly call or text them within minutes or hours, not days or weeks. When was the last time you were able to see your doctor that day or the next day? More often than not, questions and problems can be handled via text or telephone call. When was the last time your doctor texted with you?

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My patients rarely have to leave the comfort of their own home or office to come see me. I don’t spend my time writing notes to satisfy some insurance executive’s idea of what it is they need to see for me to get paid. I spend my time actually taking care of my patients. I can have a relatively small patient panel and still make a decent living, which is really all I want. I don’t need to pay huge staff to bill out insurance, to make sure I check all their boxes and put all the “right” words in my chart to make sure I get paid. My relationship is just with my patient, there’s nobody else in the room besides us.

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Medicine, an interaction between a doctor and a patient, it is a very intimate experience. Patients have to become quite vulnerable to their doctors. They are often getting, literally, naked in front of their doctors. Their doctors are looking at parts of them nobody else gets to see. They’re telling the doctor things they don’t even tell their spouses or other loved ones. Why should an insurance company be involved in any part of that? Why should it be privy to that information?  

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I have patients who have joined my practice from over an hour away, and Chula Vista, and Norco, and even one who is staying in my practice while she is out of state for the foreseeable future. Telemedicine makes this a much more viable form of practice. It allows me to extend the interpersonal nature of true healing care around my region. When they drive in to see me, they pass hundreds of other doctors. Why are they doing that? It is because this kind of care is impossible to get in a traditional insurance-based practice.

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I’m happy to say that there are constantly new physicians moving into Direct Primary Care. To find a DPC physician near you, see the DPC mapper at https://mapper.dpcfrontier.com/. There are even more doctors joining us in the San Diego area. One that I have had the pleasure of mentoring in DPC is Deepti Mundkur at My Happy Doctor (https://www.myhappydoctor.com/) in Miramar. Please feel free to call or write, any time. We LOVE talking about DPC!