I was interviewed a few weeks ago about DPC by a journalist and the article just came out. It’s called The Evolution of Direct Care and Concierge Medicine by Jennifer Nelson. This was her pitch to me:

So, the story for Medscape is looking at DC practices over the last few decades since their inception and seeing how they fared, what’s changed–for the worse or better.

Only physicians practicing in DC models who love it contacted me, so I’m looking for the drawbacks. Why are so few docs still going to this model? How hard is it to make it a go financially—or depending on specialty? Has anything changed for the worse over the years in direct care?

I think she did a good job with the piece. Here are the quotes from me that were used:

“It’s a big change. You go from a salary as an employed doctor to a DPC doctor where it may take 2 years to start making a good living,” says Douglas Farrago, MD, a DC family practice doctor who has written three books on direct care. His latest is Slowing the Churn in Direct Primary Care (While Also Keeping Your Sanity). “Very few [physicians] want to do that. They also worry about being a business person.”

Marketing and patient retention are crucial in this model. Because insurance doesn’t cover DPC fees, the value must be clear to potential patients. “You must work at it every day. You must grind. You must educate prospective and current patients about the benefits of DPC,” says Farrago.

Nonetheless, transitioning from a traditional model to direct care entails significant upfront costs and constantly advocating and educating patients accustomed to an insurance-based system. Farrago tells Medscape Medical News that he has interviewed about 60 of the 155 failed DCP practices that he found in his research.

The most common reasons for failure included poor or stagnant growth, personal health or family health issues, pricing, personality issues, or the physician’s heart wasn’t in it. However, “Everyone I interviewed was asked if they still would do DPC or recommend it for others, and they all said a resounding yes.”

I wish she had interviewed more DPC docs in the field but it is what it is. As far as the above, I have been interviewing doctors who have closed their practices and plan to expand my findings into a keynote talk at some point. More to come on that.

What do you think about the article?