Tell Me I Can’t

Posted on by

So, I unintentionally sparked another DPC vs DINO debate on Facebook the other day. Here we go again. 

A large DPC-adjacent management operation (i.e. not a DPC) was recruiting on the Alliance’s website. I had beef with that because it’s meant for private member physicians to find help and save docs morally injured from the system, not enrich non-DPC entities hiring injured docs with a bait and switch “DPC” lure.

The outfit in question claims lots of docs and midlevels. However, on closer inspection, many of them are just “affiliates.” So they are another DPC-adjacent middleman. Their website features, count ‘em…nineteen (!!) administrators. 

Looking at their website, this outfit, whatever it is, is not a DPC clinic, it’s some kind of networkey, conglomeratey, employer-financey…thing. They sell employers insurance options with DPC (or at least stuff they hope is DPCish, you have to assume, since they don’t operate many (if any?) of the clinics they farm the work out to (before undoubtedly keeping a generous cut of those employees well-earned money for themselves). Companies like this are springing up like weeds, and for good reason: DPC is awesome. But not all DPC’s are awesome, and even more sad is that not all “DPCs” are DPC at all. I referenced this entire situation in my April ‘24 article with the fake Rolex watch analogy.

Pushback on my criticism of these companies is always the same “that’s-just-the-way-it-is,” defeatist argument along the lines of (if I might summarize) “if we want to make a difference, we have to take money from employers and their middlemen and grow DPC into large corporations, and force DPC to grow faster and inorganically.” In Dec ‘22 I refuted this argument as gorgeously demonstrated by a nationwide legion of “beauty operators.”

Fierce disagreements have arisen about the role of various “management” companies associated with employers wanting to offer DPC. These organizations have been termed Primary Care Management Organizations (PCMO), Management Service Organizations (MSO), DPC In Name Only (DINO), and other acronyms. Regardless, the argument of some who support the need for an alphabet soup to grow DPC practices have taken their mindset/argument in an ugly direction these days. 

Having failed to actually make a rational argument for the need for these middlemen, in these debates you can now see the average independent DPC doctor and their clinic referred to almost derogatorily. We are called some version of “mom and pop practices”, “rugged individuals”, etc. And the implication is clear: Independent DPC doctors–doctors who left lucrative practices of moral injury where they were abused and their patients treated as human ATMs- doctors who worked their butts off and risked it all to serve their patients above all– are small. Simple. Insignificant. Rare. Not reproducible. They lack the power (at least cumulatively) to really make a difference. They may be “DPC 1.0 pioneers” who had a good idea, but lack vision and are now old and in the way of all the new progressive “DPC 3.0” ideas. And possibly the most patronizing idea of them all is that “Most docs can’t do what they did, and they need these huge organizations to be successful in DPC.” I’m not one of them, but boy if I was, that would infuriate me. Nobody tells me what I can’t achieve, or that I must have their help to achieve my dream. Makes me think of the motivational Michael Jordan poster pictured above that hangs in my friend’s basement.

This condescending mindset is insulting and reeks of corruption and control. I hear: “Bigger is better. You and your cute little patient panels need to get out of our way and let the adults work.” Those “adults” are forming huge corporate administration-heavy organizations ready to commandeer and then redefine DPC for their own enrichment. And to clear their runway, those who would dare stand up for patients and new DPC docs through friendly debate are gaslit via accusations of stirring up “infighting” in DPC.

If administrators (barely/formerly practicing docs though they may be) are going to start administration-heavy management organizations (i.e. not medical practices) and call them DPC, and in the attempt, return our patient-centered cause right back to the complicated, top-heavy, abusive, utterly broken and corrupt gutter we escaped…then damn right I’m going to fight, and I won’t be alone.

So, all you management entrepreneurs: If you want me and my fellow deplorable independent DPC docs to stay off your runway, do the right thing: Start whatever business you want to. Call it PMO, PCMO, HMO 2.0, I really don’t care. Just don’t call it DPC.

Get our awesome newsletter by signing up here. It’s FREE!!! And we don’t share your email with anyone.

14

About Vance Lassey, MD

Dr. Lassey earned his medical degree from the University of Kansas School of Medicine and completed his residency at the Smoky Hill Family Medicine Program, where he served as the chief resident. He went on to practice rural inpatient, outpatient, emergency room, and obstetric care, in Holton, Kansas. He found the calling he loved to have been hijacked by middlemen. Stuck in a broken system, mired in bureaucracy, clicking boxes, coding, not seeing his family, and hearing patients complain bitterly about medical costs he had no ability to control, Direct Primary Care (DPC) became the solution for him, his family, and his patients. He is passionate about restoring the physician-patient relationship, bringing transparency and sanity to medical costs, and advises physicians around the country on how to get out of the FFS system. He serves as an Assistant Clinical Professor at the University of Kansas School of Medicine, is the recipient of numerous clinical and teaching awards, and is a founding member and the past President of the Direct Primary Care Alliance.