DPC physicians love the DPC model. The fervor in which they sing its glowing praise often makes others think they believe DPC is the end all be all, the panacea to our healthcare woes. But more realistically, as DPC doctors can attest, the model is more like a medicine with a primary action, implementing direct payment for medical services, with associated side effects. Like amiodarone, DPC has many side effects, but, like sildenafil, the side effects are generally positive.
Promotes Independence
Around 2,000 DPC practices exist across the country; almost all of them independently physician owned. Compare that to the rest of the healthcare system where 74% of physicians are owned by hospitals or large corporations. With the supportive community and all the resources that have been put out over the years (find some at the bottom of this article), DPC allows primary care physicians to easily buck the trend by starting their own clinics. This relates directly to the next side effect.
Reduces Burnout
As employment increases, so has burnout. Some of this burnout ties directly to feeling powerless either at the mercy of insurance companies or large systems. Transitioning to DPC actually makes physicians feel less burnout and more fulfillment in their careers. The energy at DPC gatherings greatly outshines any other gathering of primary care physicians anywhere. While people in the system wax poetic about solving burnout and administrators organize poorly received mandatory wellness sessions and pizza parties, DPC actively reduces burnout and inspires a sense of purpose. No pizza required.
Broadens Scope of Care
Hospital owned physicians get pushed to see higher volumes of patients. Ultimately, this turns PCPs into nothing more than referral mills. DPC is concurrently a patient-centered and consumer-focused practice model. If a DPC doc referred for everything, the patient would not find the membership of value and quickly leave the practice. The model pushes for greater scope of care and allows for it. With fewer patients, and more time for patients, doctors get to review more literature and follow disease progression more closely. Without insurance interference, DPC practices have also been quick to pick up new technologies including text-based care, handheld ultrasound, and econsults which has allowed more care to go from the hands of specialists to the fingertips of PCPs.
On a larger scale, the side effects of DPC have also caused systemic change.
Payment Reform
The AAFP has been yelling into the wind for years about increasing payment for PCPs with little to show for it. DPC does it by simply existing. DPC fees, which are generally higher than any annual insurance reimbursement, prove that even if insurers don’t value primary care, patients do. Individuals pay out of pocket for their membership fees, often on top of a health insurance product. They recognize the importance and appreciate the service an uninhibited primary care practice provides. Employers have also fueled the movement, finding great success by partnering with DPC practices. At the 10,000 ft level view, DPC falls under the “value-based care” umbrella; but by being uniquely different in not depending on insurer payments, DPC will continue to stand out and affect payment reform conversations in important ways.
Price Transparency
When President Trump signed his price transparency executive order in 2019, a DPC doctor stood behind him in a white coat. Regardless of politics, having DPC in the limelight during a major price transparency push makes total sense. From providing in-house dispensing at cost to hunting down cash price imaging around town, no other group in the healthcare system has fiercely advocated and pushed for price transparency more than DPC physicians. DPC practices were posting prices long before it was cool (and now legally mandated) to do so. There was no formalized movement for everyone to do it, nor did the practice of finding best prices come as a prerequisite to opening a DPC. Doctors who wanted to do right by themselves and their patients naturally followed this course of action and helped affect change across the system.
Underserved
People often confuse DPC and concierge, meaning they think the model is out of reach for “the underserved,” an academically homogenized group. In reality, DPC has helped plenty of underserved populations where the traditional system can’t or won’t. Plenty of DPC docs have powerful stories of affecting real change in the lives of their underserved patients. The family whose only access to care was the emergency department. The patient who got tossed around multiple specialists without a coherent plan of care or place to call his medical home. The fully bilingual practice which built out a pharmacy to help non-native English speakers navigate a confusing pharmacy experience that previously led to missed or mixed-up medications. More formal studies and publications need to come out about the impact of DPC in underserved communities because the stories are there, and more are played out every day.
DPC may not cure all of the complicated and numerous issues for physicians and the healthcare system, but it certainly has moved many needles in the right direction. The magic of DPC comes from how many positive and widespread effects it has by simply existing. Even at an individual level, the DPC physician may not set out to reform healthcare, but in the act of starting their practice, they are providing another healing dose of DPC, with all its side effects, to our ailing healthcare system.
(This originally appeared on DPC News on 3/6/23. We are putting up our five best DPC News posts while we are on vacation. Enjoy.)