Why Direct Primary Care?
There were at least six Last Straws. A girl doesn’t leave a job she loves and was planning to retire from, and decide to take a chance on starting her own medical practice, because of one bad day. But if I had to put my finger on the moment I started down the road to Direct Primary Care, it would be this one.
I was seeing a patient I knew well. I’ll call him Ambrose, mainly because I’ve never had a patient called Ambrose and it feels like a safe choice for an alias. Ambrose was in good health and the visit had been straightforward. As we were wrapping up, he confided in me that he was worried about his partner’s struggles with depression. His partner was undocumented and uninsured, and on a months-long wait list for primary care at one of the few clinics in the area that sees uninsured patients. Ambrose knew his partner needed help, but he didn’t know where to turn.
Nothing about this story was surprising. There are over 50,000 uninsured patients in Milwaukee and only a handful of clinics that will see them for primary care. That’s one out of every ten people in our city, and more than one in three young people ages 18 to 24, with no choice but to postpone care until they’re so sick they have to go to the emergency room, then pay an impossible medical bill for months or years afterwards. I knew this story all too well, but hearing about it from my patient that day rankled in a special way.
I’m a family doctor; I take care of families. So what I wanted to say to Ambrose was, “Why don’t you have your partner schedule an appointment with me and I’ll take care of him?” But of course, being employed by a mainstream, insurance-driven organization at the time, I didn’t have the power to make that happen. If I saw Ambrose’s partner, even if I somehow tried to game the system, they’d be charged hundreds of dollars for every visit. I’m a good doctor, but I don’t have such a high opinion of myself that I expect patients to bankrupt themselves to see me. Bankruptcy is bad for your health.
It didn’t happen that day or that week or that month, but something inside me knew I was going to have to make a change.
Direct Primary Care (DPC) is a business model, but it’s also a movement. Physicians all around the US are leaving corporate medicine to start their own independent practices. The “direct” part means that we cut out insurance company middle men; we’re about the patient and the doctor. Getting back to basics has so many benefits, including:
When you cut out those middle men you can keep costs way lower than at a traditional practice, and make care affordable for patients who might not have had access to primary care at all otherwise. Costs are completely transparent and you don’t need pentagon-level decryption software to understand your bill. Not all DPC clinics charge on a sliding scale, but we do at Presence Primary Care, because we believe our patients want to pitch in what they can to support each other and grow this new community.
I can take time with my patients. At an insurance-driven practice, doctors are always being pressured to go faster and do less, because each patient visit nets more insurance money for the organization. In a DPC model, care is membership-based, meaning patients pay a monthly fee rather than copays for each visit or procedure. That means I can address more concerns and take time to make sure you understand the plan, without treating every minute as a loss on the company’s balance sheet. We can answer questions and address problems in whatever way makes the most sense; in person, by phone, by video, or by text, because those encounters are not monetized.
We can offer same or next-business-day appointments most of the time. Most of us just aren’t so good at planning that we can schedule our pneumonia ahead of time. And when you’re sick, you want to see your own doctor. Although unpredicted situations do arise, we don’t have the same scheduling challenges as at a mainstream office. That’s because we’re not cramming as many patients as possible on to the calendar for fear of missing an opportunity to charge a copay.
We can keep our patient panel much smaller than at a traditional practice. So much of what disconnects patients from their doctor stems from doctors having more patients than they can realistically care for. So they need a huge team of people doing various parts of the job that the doctor would really rather do themselves. For example, let’s think about urgent after-hours calls. Emergencies happen in the evening and weekends; we all know this. When a primary doctor has thousands of patients, she can’t be available to them after hours to help them figure out if they need to go to the emergency room or she’d never have time to see her kids or like, eat a salad. She needs a team of operators and nurses to answer those calls, equipped with an expensive and elaborate set of protocols designed to minimize the number of patients they kill with bad advice. At Presence I can be available to my patients (whom I’m trusting not to abuse that availability!) for emergencies because emergency calls don’t come up that often when you have an appropriate number of patients.
We can do things that make sense. I don’t answer to executives, and I don’t answer to insurance companies. I work for and with my patients.
I can see patients regardless of their insurance status. No more turning away patients like Ambrose’s partner because of a business model that excludes them.
This is just the beginning of what I’ve been able to do with the freedom to design a practice that aligns with my values. Direct Primary Care isn’t going to solve all of our health care problems, but I think it offers a chance to do better. I can’t wait to see where we go from here together.
If you’d like to hear more about the Direct Primary Care model, or learn if Presence Primary Care is right for you, schedule a free discovery call with Dr. Mirer.
