Hundreds of physicians from around the country gathered in Orlando, Florida, last week to strategize successful withdrawal from the nation’s collapsing health care system and how to improve health care using a new model: direct primary care.
Direct primary care practices displace higher-cost “concierge” medicine model with monthly subscription fees often ranging from $50-$125. Independent physicians build moderate bases of 400-600 members with flat fee costs and limited overhead. Direct primary care works independently of insurance, remaining autonomous in a progressively nationalized health industry. Thousands of physicians have adopted the model.
“The one-size-fits-all approach of government to Covid demonstrates the need of personalized care that fits the needs of the community,” said Dr. Lee Gross, president of Docs 4 Patient Care Foundation, a nonprofit organization that promotes direct primary care. “Practices need to be nimble and free of huge regulatory burden so that they can rapidly meet the changing needs of their community. It also shows that the financial influence of third-party payers controls how physicians are able to care for their patients.”
Gross, emcee of the conference, said his organization works on regulation, patient education to grow demand, and finding more physicians to follow the direct primary care model.
“This is a great free market medical conference truly offering alternatives to our broken system,” said Dr. Chad Savage, YourChoice Direct Care founder and health care policy expert. “It is one of the best ways to address it and stem the exodus of doctors.”
Health care policy expert and bestselling author Dr. Marty Makary was among the speakers.
Conflict of Interest
DPC Frontier founder and family medicine physician Philip Eskew discussed the conflicts of interest that physicians face within both the traditional fee-for-service system and other care systems including direct primary care. He emphasized that the failure to identify and navigate conflicts of interest is the most common reason for physician burnout.
“Often these conflicts of interest are so problematic and numerous in the fee-for-service system that avoiding burnout is impossible,” he said. “In direct primary care burnout is avoidable if conflicts are identified and either explained to the patient or avoided entirely. One of the most common ways to identify and describe potential conflicts is by carefully defining the scope of practice in the patient membership agreement and conversation as the patient joins the practice.”
Abandoning a Broken Model
Mary Tipton, a doctor of internal medicine and pediatrics, is leaving private practice after 18 years and opening her direct primary care practice, Blossom Health, in Utah this June. She already has an email list of 700 interested clients.
“Insurance and the government systems just control everything, they are basically practicing medicine without a license,” Tipton said. “They are doing these prior authorizations that are just excessive. There is such onerous bureaucracy over every transaction. The costs are essentially 10 times [what they should be] with overhead and complexity.”
When she sold ownership of her practice in 2023, Tipton was managing the care of about 5,000 patients. Her practice employed four doctors and 16 advanced practice providers and had more than 100,000 active patients. New adult patients were on a two-year waiting list to see her.
“We have more patients than we can handle,” Tipton said. “With the fixed and declining payments from insurers and entitlement programs, we have no way to pass on our rising costs to patients. The only possible way to stay out of the red is to increase volume and decrease quality. It’s not good for patients. It’s not good for doctors, and I’m done. I didn’t sign up for this.”
Happier Doctors
Tipton learned about the direct primary care model in 2015 when she spent time in the national health care reform arena with Gross and others. She continued to convince herself the option wasn’t feasible for her — until she attended her first direct primary care conference last summer.
“I’ve never seen a group of happier doctors,” Tipton said. “We’re smart enough, we’re determined and we’re in the right. In [traditional health care] the system does not incentivize the right things. Doctors lose autonomy and are unable to put patients first. This leads to moral injury.”
Every year the practice of medicine is worsening, she said, especially since the rollout of Obamacare in 2010.
“Everyone had insurance, but everyone forgot health insurance doesn’t equal health care,” Tipton said. “The way it ‘works’ is to conscribe doctors and compromise on quality of care. I’ve done it beyond the extent I feel is morally acceptable. We can’t hire doctors because there are zero people who want to do my job. Every doctor we’ve hired in the last five to six years has left in the past year; these are just unsustainable trends and things you can’t compete with in private practice. The corners being cut are significant.”
Eskew has seen a continuing trend of 200 to 250 new direct primary care practices opening annually and expects to see the same trend at the end of 2024.
“My biggest takeaway for would-be DPC physicians is: Do not move into a DPC practice because you think your life will be easier,” Eskew said. “This is not easier, this is better. You get to provide better care. You get to spend the time to become smarter to broaden your clinical scope and add value. This is not a place to rest on your laurels.”
