Surge in Direct Primary Care Growth and How to Stop It
Let’s review the new analysis from Harvard Medical School’s Blavatnik Institute, Oregon Health & Science University, and Johns Hopkins University.
The researchers found that in just five years, from 2018 to 2023, the number of concierge and DPC practices grew by 83 percent and the number of clinicians in those practices increased by 78 percent.
Wow, that’s great!
The share of clinicians in concierge and direct primary care practices who were physicians declined from 67.3 percent to 59.7 percent, whereas the proportion of advanced practice clinicians increased.
Yeah, that’s not so good. Doctors and “advanced practice clinicians” are not the same (training and education are much, much less).
Independent ownership decreased from 84.0 percent to 59.7 percent, whereas corporate-affiliated practices grew by 576 percent during this period.
Umm, this is bad. As predicted here on this blog, one of the biggest risks to the allure of Direct Primary Care is the VC/PE sharks waiting to pounce. And they are a pouncing.
I have a few other things to mention. I cannot read the full article and don’t care to spend the money to. I really wish they separated concierge practices from Direct Primary Care. They are two different animals. Second, I also question their ability to truly attain the real number of DPC practices out there as this has been difficult for even Phil Eskew.
From this study comes this article: FEE-BASED PRIMARY CARE IS RAPIDLY RISING IN U.S., HASTENING DOCTOR SHORTAGES FOR PUBLIC
Really?
- The number of individual clinicians working in these practices expanded from 3,935 clinicians in 2018 to 7,021 clinicians in 2023.
- The widespread adoption of these membership-based models targeting higher-income patients creates concerns about a growing general primary care shortage.
7,021 clinicians are hastening the doctor shortage for the public? Not burnout, suicide, doctors quitting, or doctors retiring early?
They use the term clinicians because they added midlevels involved in concierge care or DPC. So the number of doctors leaving the system is way off. Add to that, they are not giving DPC numbers, which are probably around 2500 or 3000.
And that is hastening the shortage? There are 300,000 primary care doctors in the US. So, 1% are leaving and yet this is a travesty in need of a triggering headline. Or this quote from the piece:
“The growth of these models may benefit participating patients and clinicians, but it’s important everyone understands the potential impact these practices have on the health care system at large,” says Dan Polsky, co-author of the study and a Bloomberg Distinguished Professor with joint appointments at the Carey Business School and the Bloomberg School. “We have to consider how the growth of these models may affect access to primary care for the vast majority who can only afford the care covered by their insurance plan.”
Dan, yes, we really need to consider the health care system at large, or what I would call the COLLECTIVE. Maybe some laws should be passed to stop this crime? No more rugged individualism by doctors. That is evil.
“Our research draws attention to the rapid expansion of these models,” Polsky adds. “It’s our hope that by increasing awareness of the rise in fee-based practices, that we’re raising the necessary questions for policymakers to ensure that high-quality primary care remains available for all Americans.”
Yes, Dan, go to the policymakers. These doctors cannot be allowed independence. They must be indentured servants to the system that has been killing them.
“Four legs good, two legs bad.”
Counter argument, aimed at the lawyers who ultimately behind this, whether it is through policy making or funding this “analysis”: Where is the outcry for more public defenders, low-cost attorneys, and so forth? Can’t the same argument be made that if attorneys all flock to higher pay, less overtime hours situations then every other profession should enjoy the same? Below is an AI ripoff from Gemini:
“While exact, current figures vary, there are likely thousands, potentially over 9,000, public defenders nationwide, but this number represents a significant shortfall, with studies showing many jurisdictions need hundreds more to handle caseloads adequately, leading to major staffing and funding crises. The US Courts system manages over 3,700 lawyers in federal defender offices, with more in state/local roles, but caseloads often demand far more attorneys than available.
Key Figures & Context:
Federal Defenders: Over 3,700 lawyers work in federal defender organizations, alongside private panel attorneys.
State & Local: A 2007 census found 957 public defender offices (state/county funded) handling millions of cases, but staffing issues persist.
Shortages: Reports from states like Pennsylvania (where 850 public defenders were needed vs. 30% fewer available) and Oregon (where attorneys worked over 26 hours daily) highlight severe understaffing.
Why the Numbers Are Hard to Pinpoint:
Varying Definitions: Some figures count federal defenders, others state/county, and some might include private attorneys taking public defender work.
Dynamic Nature: Staffing levels change due to funding, hiring, and workload demands.
In essence, there are many thousands of public defenders, but their numbers are insufficient to meet the constitutional right to counsel for indigent defendants, creating a persistent crisis. ”
Clearly, there are few lawyers making a full career out of public defending, and likely few who are affordable to even middle class citizens much less the working class or those just above indigent level. So it’s ok for the legal profession to look away from the constitutional rights for indigent defendents, and instead pursue the highest paying gig they can find. But if a doctor demands to improve his practice by vastly improving the out-of-pocket cost of primary care, he’s the problem. Got it…
Oh, and by the way: we all did indigent care in our training. It’s called residency, and most of us did it for at least 3 years. I wonder how many lawyers work as public defenders, sliding-scale attorneys, selected pro-bono for at least 3 years of their careers?
I’m pretty sure I can guess the politics behind this “analysis.” It’s the same old, tired BS that has led to the current healthcare insurance crisis because both sides of the aisle are paid by the big insurance companies to keep the status quo. They can’t suppress medical freedom, just like they can’t suppress individual freedom without risking a revolution. DPC, in my opinion, is a grass-roots slow revolt to centralized third party payors and government interference. They don’t like it, so they have to denigrate it. If not, they don’t get the money and flashy TV and internet ads for their next campaign.
¡Viva la Revolución!
Love it! Great response!!