Let's take an honest look at some of the misconceptions and rumors about Direct Primary Care (DPC).
Misconceptions about DPC as a business model
It's essentially concierge medicine: it favors the wealthy and leaves the poor behind
DPC and Concierge medicine are close, but very different.
Concierge medicine typically charges a monthly access fee (sometimes in the high hundreds or thousands of dollars monthly), plus will bill insurance.
Direct Primary Care charges one flat monthly fee that includes all or most primary care services and does not bill insurance.
If DPC clinics stay below the IRS threshold, families can receive great care for $300/month or less.
It will only work in larger cities - not small, rural towns
This just isn't true. DPC clinics are thriving in nearly any sized town.
If a physician or provider wants to work full time at 4 days per week, a patient panel of around 250 is all that's needed to support a healthy lifestyle for the physician while keeping costs affordable for patients.
Starting a business is expensive, especially in medicine
If you're set on leasing out a space (or buying a space), purchasing all new equipment, hiring multiple staff right away, and paying top-dollar monthly costs for all of your software and vendors: yes. That can get expensive.
I've helped some DPC and Direct Care physicians start with less than $2,000 invested.
It's possible to start your business with $500 or less, as primary care services are often very cheap to offer with minimal supplies needed.
Also, medical supplies are far cheaper than you think. It's the specialized medical equipment that gets expensive - but there are often great alternatives.
For example - a cast removal tool can cost upwards of $700. But it's basically an oscillating multi-tool, which you can get for $45 or less at a home building supply (yes, I've done this).
DPC doesn't seem 'secure' enough of a model to consider as my full-time job
It's not the most popular model, but it's a very proven one. So long as you can get 250 paying members, you should be able to pay bills and make money with a modest budget.
I would argue that a recurring revenue model (people paying you monthly) for a service that is very important to them is more secure than the fee-for-service model that's based mostly off of the government and insurance company determining prices for each level of office visit, procedure, etc.
Take the COVID-19 shutdown, for example. Fee-for-service clinics struggled as they were left waiting to see whether insurance companies would reimburse for telehealth visits. Office visits also plummeted, along with revenue. DPC clinics thrived during that time. Monthly payments still flowed in, and clinics were able to switch to mostly telehealth visits without any issue.
Misconceptions about DPC's role in medicine
We have a primary care crisis - smaller patient panels won't fix this!
There are arguments for both sides here. Yes, physicians moving from seeing a panel of 2500 patients to 500 isn't helping. However, the goal of DPC is to create a model that keeps physicians in medicine without burnout.
Plus, I believe DPC has the chance to instill hope to medical students and residents for a job that is fulfilling and pays well - meaning we could eventually have more medical students choosing family practice as their specialty.
DPC isn't the only answer to this - but I think it has the potential to be a net positive rather than a net negative.
We can't have rogue physicians doing whatever they want - they need oversight or at least peers to help
We don't have any more rogue providers in DPC than the traditional system - they're just practicing a different model of medicine.
Yes, DPC physicians may start out without fellow attendings in the building to consult with, but it's very easy to call, text, or message friends or acquaintances with questions.
There are even services today that directly connect family physicians to specialists for curbside consults.
Misconceptions about practicing DPC as a physician
Insurance will go away completely
As a DPC practice billing membership, you won't have to bill insurance or deal with any of their policies for your services.
However, if you have patients that have insurance and you want to refer them, you'll have to deal with prior-authorizations and other complications when they want to use their insurance outside of your office.
There's no current easy answer to this issue. If you want to serve your patients well, you'll do all you can to help them use their insurance when you need to refer them to someone else. Every office deals with this differently - especially depending on your state laws.
For example, patients in most states that have an HMO plan will not be able to be referred to specialists in-network from you as their provider. However, in some states (Maine is one), state law requires that any insurance plan honor referrals from out-of-network providers.
Read more on dealing with insurance as a DPC physician here
If I offer 24/7 on-call services, I'll get slammed - I can't handle that!
In the first year of Assurance Healthcare & Counseling Center, we averaged about 400 members (opened with around 150, then grew to over 600 toward the end). Guess how many after-hours phone calls we received that first year?
Five.
Not five per week. Not five per month. Five the entire year!
Why? A couple reasons...
By promising same or next-day visits, people are calling and you're able to address needs quickly - either on the phone during the day, at a same-day visit, or reassuring them that waiting until tomorrow will be just fine.
People are generally respectful, especially now that they know you're doing this on your own. They'll only call if they really need you.
We highly encouraged people to call as soon as they felt they needed help rather than wait. Symptoms will typically worsen at night, so calling early is best.
I can't do everything my nurse / MA does - I need help
Unless you spend 6 months marketing and selling like crazy before you open your clinic, you likely won't start out with 600 patients on day one. And that's good.
In your early days you'll have time to learn and re-learn everything your office needs to run. If you are completely unsure - try hiring a nurse for a day or two to walk you through all the details - drawing injections, managing vaccine schedules, and anything you might need a refresher on.
It's going to be a good thing that you learn everything, because then you can teach and train others on how you want everything run - if you ever choose to hire others to help out.
Everybody loves the idea - I'll grow way too fast!
If you're sharing your idea of opening a DPC clinic with patients and friends - they probably all are extremely supportive and sound excited.
Unfortunately not everybody will join you. If you have a current patient panel, the typical numbers are 10% of that panel within the first 3-6 months.
Why so slow to commit? Health care is a big deal, and navigating their own insurance and understanding how their benefits all work together is a big decision, and often confusing.
In the end, not growing fast is a good thing - it helps you to learn and make smaller mistakes along the way before they turn into bigger ones.
Ready to make the jump?
Whether you're starting your own practice or considering applying for a position with a DPC clinic, I hope you make the move. It's a great way to practice medicine and such a great experience for patients.
Still have questions about DPC?
Join the Direct Care Tools community on Skool!