Escaping the Treadmill
Beyond the uncertainty, some physicians are leery of direct primary care because they fear that charging subscription fees will price out some patients or spark a negative reaction among their patients.
“Physicians are a conservative bunch,” says Stephen Schimpff, MD, a retired internist who is author of Fixing the Primary Care Crisis.“They have to be pretty convinced that by making this type of change, they are not going to get themselves into a financial pickle or an emotional pickle with their patients.”
But with companies of 50 to 99 employees required to start providing healthcare this year under the Affordable Care Act, direct primary care is getting a boost, with employers increasingly interested in providing it to their employees as a way of reducing healthcare costs. Typically, most employers will match this with an insurance product, says Reiner, whose firm has been focusing primarily on partnering with employers.
Meanwhile, some physicians, frustrated by what they see as the paperwork and regulatory burdens that come with practicing medicine today, see direct primary care as their only attractive career option. Chris Larson, DO, says it’s the only way to provide “affordable care, accessible care, and care both patients and doctors are happy with.”
Larson began his practice, Austin Osteopathic Family Medicine, about two years ago and now has about 200 patients. Direct primary care appealed to him because he saw it as a way to know his patients by name and truly feel he is helping them.
“If I don’t stick with this, I am not going to be in medicine,” Larson says. “I’ll go buy and sell real estate. I refuse to be a fee-for-service provider.”
One of the biggest benefits of direct primary care, physicians say, is the ability it provides to control their schedule. When family physician Brian Forrest, MD, decided to try direct primary care 15 years ago, it was after doing his residency and some locum tenens work and realizing he didn’t want to work in a fee-for-service practice. He was distressed by how little time physicians had with patients.
In his residency, he says, “The expectation was to see a patient every 15 minutes,” he says. When he did locum tenens work in medical clinics, the pace was even quicker. At one clinic in Cary, North Carolina, he saw 63 patients in one day.
“In some cases, they double booked us every 15 minutes,” he says. “It was a pace of productivity required to pay for the increasing overhead. The overhead seemed to be greatly in part due to all of the bureaucracy associated with the insurance.”