Some people are not going to like what they read here but it has to be said. The DPC movement is awesome and frees the doctor to be able to see patients with more time and without the bureaucratic drag that has killed the healthcare system. So, let’s start with that. The bureaucratic drag comes from many sources. It is the insurance companies that take most of the money and do all they can to control the patients and the doctors. They withhold care (think prior authorizations) and tell the doctor what he or she can do. The government does the same thing with Medicaid and Medicare. Let’s add administrators to this drag. They may be in the form of multiple layers of bosses at a hospital that employs the family doctor. They have multiplied faster than tribbles (for you Star Trek fans) and hence I have given the name Administribbles. All this has caused massive burnout for physicians and has led to suicide, substance abuse issues, and doctors quitting or retiring.
If you are doing direct primary care then your goal is to remove or unass these coefficients of bureaucratic drag. Does having a hybrid DPC practice do that? No. That does not mean some hybrids don’t work but it is rare. Exceedingly rare. This is not a judgment on your decision to do a hybrid. Heck, maybe you are moving toward DPC but if your goal is to stay with two separate patient panels (one DPC and one insurance-based) then you are most likely a DINO.
This brings me to the true DINOs. I have been around this game a long time and have seen it all. The allure of DPC is the personal care the patient gets from their physician. You can call, email or text her because her panel of patients is low (approximately 600). She does 100% DPC and the patients love her because she knows them, the office is small and comfortable, there is no wait, the staff is personal, and the patient can truly get in probably that day if needed. These qualities (amongst others I won’t fully list here) are what makes DPC so special. Patients love it. Businesses love it. And that is why some will try to fake it.
Let’s start small and work our way up. I have seen a family practice office say they do DPC because it is a fad. They still did EVERYTHING else. Do they bill insurance on some patients? Sure. Sportsmedicine consults? Sure? Direct Primary Care? Sure? Concierge Care (yes, they even separate this out on their website menu as another option)? Yup. It reminds me of a restaurant that serves Italian food, Chinese food, and Mexican food. Do they cook any of them well? Would you want to eat there? Listen, just because you slap the name DPC on the menu doesn’t mean you are doing it. And you are giving the rest of the DPC doctors a bad name when you f%ck it up.
Let’s go bigger. I have seen a major family practice group with over 50 “providers” decide they now do DPC. Really? Go back above to where I mention what the allure of DPC was. This big group just wants businesses to pay them a per member per month amount in order to fill their coffers. None of their docs have a small panel. None of these patients will have direct and easy contact with their doctors. Sure, they can go to their walk-in care clinics for that monthly fee but that is NOT DPC. All the doctors who work for this group still grind in the insurance based model. Nothing has changed about their office. And the patient will notice nothing different about the visit. This is a DPC pretender.
Lastly, I have seen a massive urgent care company decide they like the term Direct Primary Care as well and so they slap that tag on their website. What? They don’t even do primary care! They meet no criteria I mentioned above. It doesn’t matter. They see a gold mine and they want in. Sorry, but you are a DINO.
I am sure there are more examples. You may not think it is important to worry about DINOs but you should. For one, they will compete with you and will do it unfairly. They will cut their prices very low to draw off your patients and then raise them later on. I saw this with the first example I listed above. But you are better than that and patients will realize it? Maybe, but it still sucks when there is a bait-and-switch being pulled on your patients and there is nothing you can do about it. More importantly, DINOs confuse patients and that is not good for the movement. Add to this that DINOs don’t really do the things we do in DPC and you get a bad reputation for the movement.
Who was this article written for? Well, for the doctors who are thinking about doing a hybrid practice. I would be very careful. Think about keeping it simple. Commit to real DPC. You’ll be much happier.
It is also written for the DINOs who think they can hijack the DPC movement. You can try but we are going to push back. This blog is the start.
And this was written for businesses who are thinking about DPC for their employees and the brokers who are trying to facilitate this. If you are NOT dealing with a real DPC doctor then you don’t know what DPC is all about. Since you want to get a large number of patients into a DPC practice then you probably have been dealing with DINOs. Maybe that works for you. I have seen it fail, however, over and over again because the patient never truly received the DPC experience. Why? Because you have been dealing with “the great pretender” of DPC. All medical students and doctors know syphilis is the “great pretender” of sickness because it looks like many other diseases. In the Direct Primary Care universe, DINOs are our syphilis and it is time we start getting rid of it.