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The Direct Primary Care Way

Direct Primary Care is a relatively new concept for most patients. It’s essentially the old-school patient-doctor relationship we’ve all wanted but lost because of the corporate practice of medicine.

In a Direct Primary Care model, the patient gets concierge-style care, and the doctor gets to practice the medicine they went to medical school for. The patient goes through their chosen primary care doctor while having the occasional specialist involved as a consultant in their care.

The Direct Primary Care Model

In DPC, the doctor often opts out of health insurance to avoid financial and administrative constraints. The patient pays the doctor an ongoing monthly fee to retain that doctor as their PCP.

The patient, in return, can contact the doctor anytime they feel they have a health issue or need health-related advice. The goal is for the 2 people to get to know each other well enough that should an eventual health issue pop up, it’s easy for them to communicate well enough to manage that condition.

The payment is often monthly and helps retain the doctor. The doctor benefits because they’ll have a steady income, and the patient benefits because the doctor won’t take on new patients.

Most DPC doctors aim to maintain that patient-doctor relationship with each patient for several decades. Here at Digital Nomad Health, I hope to be my patient’s PCP no matter where they move.

DPC is Not Health Insurance

Most patients who choose to become a member of a DPC practice choose to have a high-deductible health plan or no health insurance at all. They will, instead, arrange to pay for servies in cash either out of pocket or through a cost-sharing plan, like Sedera or Crowdhealth.

When a patient needs an MRI or blood tests then that will be arranged with the imaging and lab center directly. Often, paying cash means you’ll get an extensive discount.

As a DPC physician, I have also chosen to opt out of health insurance for my own medical care; that’s how much I believe in it. A recent MRI I needed set me back $450, which is well worth it. Imagine if I had been paying $400 a month for a decade just for this one time when I needed an MRI. Not to mention, my copay for that MRI would have likely been $1,500 through the insurance.

Longer Appointments

Let’s do the math; the average primary care doctor will see 3.5 patients per hour, 8 hours per day, 5 days a week, 50 weeks a year. And each patient will need an average of 3 visits a year. That comes out to a panel size of 2,300.

The Direct Primary Care doctor will have 45-60 minute appointments which means their panel size will be much smaller, well shy of 500 patients.

Longer appointments allow for more meaningful discussions which are necessary because healthcare is complex and there is a large gap between what the doctor understands and what the patient knows.

Longterm Patient-Doctor Relationships

When I’ve built a 10-year relationship with my patient not only do I know what their normal is but I also know what their wishes are. I can read their mind and I can advocate for them when they can’t.

The average primary care patient-doctor relationship is less than 18 months because patients change their insurance, lose their jobs, the doctor quits their medical practice, or because the patient gets too sick for a primary care doctor to be willing to see them.

In the Direct Primary Care practice, the goal is for that patient to never have to look for a new PCP; I’ll be their doctor until one of us dies.

No Bias From Health Insurance Companies

When I work in a traditional healthcare model it’s the health insurance company that dictates what I can and can’t do. Just because I think the patient needs an MRI or a specific blood pressure drug doesn’t mean the insurance company will allow it.

On the flip side, if I think a patient can be managed in the outpatient setting but the standard of care is to admit the patient for inpatient care, once again, I can’t go against that medical grain.

In the cash-pay, DPC model, I am the doctor who has built the bond with my patient; we decide together what the best option is and figure out how to pay for things accordingly.

Sharing Community Resources

The DPC doctor is not just a solid clinician but they are incredibly resourceful. They communicate well and know where to send the patient for the next best steps.

I’m a wealth of knowledge when it comes to disease prevention; that’s my schtick. But I’m also really knowledgeable when my patient has Chronic Pelvic Pain disease and they need the right expert to help them through it.

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