DPC Simplicity
Elon Musk has a famous algorithm that requires questioning every requirement and, most crucially, deleting nonsensical ones, before automating anything. Similarly, Steve Jobs built many of Apple’s revolutionary products on a principle called “the simple stick,” relentlessly pursuing elegant simplicity by removing everything unnecessary until only the essential remains. In a healthcare system where complexity reigns, DPC is the simple stick that is transforming the system.
Everyone in healthcare agrees we need seismic change. The system is broken, costs are spiraling, and both patients and physicians are increasingly frustrated. Yet most so-called innovations in healthcare merely build upon existing structures rather than questioning their fundamental necessity. Electronic health records digitize paper chaos without eliminating the chaos itself; quality metrics measure everything except actual care. Payment models add new bureaucratic layers on top of already Byzantine systems. Too many people continue building more floors on top of a sinking building.
When trying to create solutions while accepting the limitations of the current system, you don’t actually create new solutions because you’re trying to solve problems with the same thinking that created them. The healthcare establishment has convinced itself that certain complexities are unavoidable. Prior authorizations? Necessary evil. Dozens of insurance plans with different payment schemes? Just how things work. Rising costs and complexity? The price of modern medicine.
DPC proves that much of healthcare’s complexity is artificial. By eliminating the middleman of insurance for primary care, DPC physicians demonstrate that healthcare can be both simpler and better. Longer appointment times, direct communication with patients, transparent pricing, and actual doctoring. These mainstay features of the model are all possible when subtracting rather than adding. The magic of the DPC model lies precisely in its simplicity. It’s healthcare stripped down to its essential elements: doctor, patient, and healing relationship.
Frequently, voices from outside our community will insist that things “have to be a certain way” or “can’t be done differently.” They’ll argue that the model can’t scale, can’t serve complex patients, can’t integrate with “real” healthcare systems. Simply by existing and growing to this day has proven them wrong. Every successful DPC practice is a living counter-argument to the mythology of necessary complexity.
Maintaining simplicity is actually harder than developing complexity. It requires discipline, wisdom, and often courage. It’s easier to add a new process than to eliminate three existing ones. It’s simpler to create a new protocol than to question whether the protocol serves any real purpose. As the saying goes, “If I had more time, this letter would have been shorter.” Creating something simple requires more thought, more editing, more restraint than creating something complicated. In healthcare, if everyone was more conscientious about what truly serves healing, our systems would naturally become simpler.
As the DPC movement matures, there must be vigilance to maintain the commitment to elegant simplicity; otherwise, it can also accumulate the barnacles of bureaucracy that weigh down traditional medicine. Every policy, every “improvement,” every new layer of process we think about introducing should pass through a crucial filter: “Does this truly serve the doctor-patient relationship?” The future of healthcare doesn’t need more complexity. It needs the courage to subtract, to simplify, to focus on what actually matters. DPC physicians have already proven that better healthcare through subtraction isn’t just possible, it’s transformative. The simple stick isn’t just a design principle; for DPC, it’s our gift to the future of medicine.
I agree 1,000%. And add every time state or federal GOVT agencies (bureaucrats) attempt to jump into the DPC arena, simplicity is lost (or rather its hijacked). We see this same problem with hospital systems’ attempt DPC. More rules, more oversight, more data collection, more administrators, system controls… all destroy the DPC simple way. Physicians should think about that as outsiders bring dreams of DPC with their “system.” Don’t give up your soul again.
Well written! I have been trying to explain the benefits of DPC to a new medical student whose dad is the CEO of our largest healthcare system. Clearly she has heard things a certain way her whole life. I truly like the description of simplifying things rather than making them more complex and the important test of every idea or change, “does this benefit the doctor-patient relationship?”