“Few things are harder to put up with than the annoyance of a good example.”

                                                                                                                          – Mark Twain 

My colleague and friend Dr. Kenneth Qiu recently wrote a brilliant article on “DPC Generations” for DPC News. In his analysis, Dr. Q describes the 4 generations of DPC physicians: Bushwhackers, Pioneers, Settlers, and City Builders. This is very well-written. I encourage all my DPC friends to read it. Well-done, Dr. Q. 

This notion of building DPC cities excites me, as I am sure it does you. We in the DPC community believe that if more and more of our colleagues convert to DPC, and if more and more residency graduates choose a DPC practice, the result would be a win for physicians, patients, and all of healthcare. 

Occasionally I hear someone at a DPC gathering shout out something about DPC taking over the world. Sometimes it occurs on a stage. Sometimes some post meeting libations are involved. Hopefully, not both at the same time. We all cheer, clap, raise a fist, and feel energized. 

And we should. There are few moments more motivating than hearing a Jeff Gold or a Vance Lassey share a battle cry on the stage in front of hundreds. (By the way, had Jeff painted his face that day of his tattoo reveal, he would forever be referred to as the “Braveheart of DPC.”)

But is it realistic to think we can do more than just build our own DPC cities? Can we build a huge DPC nation? Can we really take over primary care? The health care system? The World? 

Maybe. I hope so. But realistically, probably not. 

Disagree if you wish. But remember, there are many obstacles. Many would lose if we win. Many will fight very hard and reach far into their deep pockets to maintain the status quo. We might take over the world one day. But it will not happen without a huge fight. 

When I opened my DPC practice in 2015, I spent many hours trying to calculate mathematically how every primary care physician in the country could convert to DPC, reduce their panels to 400-600, and still offer for care all patients, regardless of their income or employment. Even if we recruited huge numbers of Advanced Practitioners to join us, and if primary care residencies expanded their slots dramatically and all graduates chose a DPC path, the proposition just seemed too daunting. I finally gave up. Dreaming about taking over the world gave way to focusing on my practice and DPC on a smaller scale. 

Recently I had a conversation with a very insightful and experienced leader in Family Medicine who, by the way, very much likes and supports DPC. When I asked what he/she predicted for the future of DPC, I was given an answer I was not prepared for. The reply was that DPC will continue to grow to more than a niche, but likely not much bigger. But it was their opinion that another very positive result of the DPC movement could be that the rest of health care becomes more “DPC-like.” Not exactly what I wanted to hear. But it got me thinking.

I personally feel that DPC can and will grow much bigger than a small niche. So many physicians and patients are very unhappy and want change. But maybe we should have a parallel goal – an even more realistic goal – that as we continue to grow DPC into cities, that we work to push and pull the rest of the system to look more like us. Smaller patient panels. Fewer administrative hassles. Less overhead. Straightforward payment. Cost savings. Greater autonomy. Fewer people in the exam room.

Maybe our colleagues cannot or choose not to completely escape the stranglehold of third-party payors and hospital employers. But they can take our lead, and with their own Braveheart leaders, demand to work in a world more like ours, and change their own work environment.  In other words, we become the model everyone else tries to emulate. 

Make no mistake. I will always have trouble trusting hospital systems and insurance companies and most elected officials. But I do trust that the vast majority of our colleagues have the same values as us, and yearn to practice in a better model. And I know patients want better. 

Here’s my point. I think we need another category identified, and added to Dr. Q’s excellent analysis. A category that already exists, but needs recognition, its own marching orders, its own goals, and its own self-awareness. 

And that category is “Influencers.” 

We are all familiar with the term now as it relates to social media, fashion, music, and style. 

It exists in health care too. Think Gawande. Kevin Pho. Peter Attia. But it seems to me there are also a number of Influencers within the DPC community today. DPC physicians who are being noticed, whose voices are being heard, who are setting examples. Getting noticed. Stirring up trouble. Inviting envy. Sometimes annoying. Provoking change. 

I can think of many DPC Influencers. Farrago. Umbehr. Gunther. Purcell. Leonard. Gross. Dr. Q. Too many to name them all. They have an audience. Their feet are in many doors. They have an impact. And they can have even more, hopefully. 

DPC Influencers are not just limited to physicians. A good example is Christy Gupton with Custom Benefits Solutions, who is making inroads daily with employers, helping to grow DPC practices, and helping to build our DPC cities. 

Back to Twain’s quote above, these Influencers are not annoying to me, you understand. But they may be to others. No one likes to be shown what they are doing, or what is being done to them, is wrong or wasteful, or simply stupid. What might at first be an annoyance can lead to an awakening, an enlightening, a realization that there is a better way. The DPC way. 

Thanks to Bushwackers, Pioneers, Settlers, City Builders, and Influencers, we have come far, but we have a long way to go. We may fall short of the ideal. We may not take over the world. But let’s not lose sight of the influence we can have. 

There is a corollary to all this. Many of my DPC colleagues will disagree with me (yes, you Doug!), but I believe that in order to have influence, we need at least some, if not many, of our own Influencers engaged in such entities as the AAFP,  state academies, and other organized bodies. It is critical that we spread our message both within and outside “the system.” 

Let’s ALL strive to be Influencers. From whatever vantage point we occupy. Let’s ALL set an example. Let’s “annoy” the system. In a positive way. In a manner that provokes change. Let’s grow our own cities, and also work to make health care more DPC-like. In our communities and in our professional circles. If we do that, we have done well. 

Thank you Kenneth for your article, and all my DPC friends for your dedication and feedback.