Is There a New Species of DINO Evolving in Direct Primary Care?

Author: Lara Kenney, MD

The Direct Care world has been buzzing about “DINOs” (Direct Primary Care in Name Only) for some time. This term is often used with disdain to describe corporations and private equity ventures masquerading as Direct Primary Care (DPC) practices, aiming to capitalize on the momentum and reputation of DPC while focusing on profit before the physician-patient relationship. This inevitably erodes the quality of medical care.

In the developing ecosystem of Direct Care, DPC practices are the anchor species, nurturing the physician-patient relationship and fostering quality medical care. But what happens when a new species evolves, an invasive species capable of disrupting this delicate system?

Recently, while covering an outside heme-onc practice, I was consulted on a patient who had a mildly abnormal CBC. While reviewing the consult paperwork, I recognized the logo of the referring office—a DPC practice! Ah, a breath of fresh air to my afternoon schedule. I was instantly relaxed and smiling as I walked into the exam room.

DPC patient consultations are like a warm hug, reminding me of the quaint consultations of my early career; the PCP detects something, does a reasonable workup, needs an expert opinion, and then is able to take that opinion and advice and manage the condition more or less independently, carrying the primary responsibility for their primary care patients. I don’t have to worry about inconsistent follow-up or a nonexistent physician-patient relationship.

With my shoulders relaxed, jaw unclenched, and an easy smile, I walked into that exam room. There sat a very tense, worried-looking patient. This was unexpected. I approached, sat down the outside labs papers, and said, “So, here is the blood work that caused the concern….” Before I could even finish my sentence, they grabbed the papers for a better view. “I have been wanting to see these numbers.” Wait, this DPC patient hadn’t seen their labs? Their PCP hadn’t discussed these labs with them already? The muscles of my jaw twitched; the smile faded. “So, here is the blood work, and you can see that your results have been slightly abnormal each time.” I couldn’t help but notice their eyes were getting rounder, their body language more tense. “And, generally, this is not a big deal,” I said, as they interrupted, “I don’t have cancer?!?!?! Google suggested that I might need a bone marrow transplant, and I haven’t slept in two weeks because I have been so worried about this appointment.” Now, I could feel my shoulders begin to tense, that tightness in the neck muscles, the locked jaw. What was this? A DPC patient that hadn’t seen the labs, hadn’t discussed the results, and had spent two weeks in a panic when they could have simply reached out to their DPC doc and asked? Was this some new DPC practice I was unaware of, a new species I had not yet encountered?

“I’m sorry, I saw your referral papers and couldn’t help but notice you belong to a DPC. I had assumed you had discussed this with your primary care doctor?”

“Oh, I haven’t ever seen the doctor. I go to one of their smaller offices in the next town over. I have only seen their NP for my Botox, weight loss injections, and hormone pellets. They drew these labs and then just told me I needed to see a blood doctor.”

Well, that did it. Bring on the tension headache and enjoy my unmistakable, very transparent, facial expressions. I will be damned, a new DINO species!

“I’ve never had an appointment with Dr. DINO.”

Alas, this was not a DPC patient at all. This patient had been preyed upon by a small, invasive, new DINO.

DINOs, whether large or small, prioritize the business of medicine and revenue streams over the delivery of genuine medical care. Services like cosmetic Botox, boutique IV infusions, injectable weight loss programs, and hormone pellets can be beneficial, but what happens when they overshadow the core values of DPC?

DPC is still a young and emerging ecosystem. Even small DINOs can disrupt this ecosystem, causing an imbalance that will affect all DPCs. DINOs benefit from the goodwill and reputation of DPC but may divert patients away from the DPC practices that are providing core primary care services. Patients could find themselves receiving more spa and boutique treatments rather than necessary primary care, further eroding the public’s respect and trust of Primary Care physicians and leading to criticism of the entire DPC movement.

The allure of quick, profitable services may tempt additional DPC practices to adopt similar models, further spreading this new, invasive species. This could undermine the very foundation of DPC, which is built on physician-led care, the physician-patient relationship, and quality medical care.

So, should these new, smaller DINOs be formally classified as another invasive species in our Direct Care ecosystem? We must ensure that the Direct Care ecosystem remains balanced, with quality medical care at its center.