The Healthcare Wall: A DPC Doctor’s View from the Outside

Direct Primary Care is designed to simplify things for both my patients and me. And in many ways, it has. I no longer have to rush through visits, stay up late battling the EHR, or fielding hundreds of daily inbox messages. But when it comes to coordinating care with our local hospital systems, I’ve run headfirst into a wall.

Repeatedly.

In Grand Rapids, we have three major players: Corewell Health (formerly Spectrum), Trinity Health, and University of Michigan Health-West (formerly Metro Health). I regularly interact with two of the three. While I never expected smooth sailing, I also didn’t anticipate that inefficiency, incompetence, and bureaucracy—rather than outright hostility—would be the most significant barriers. From the outside, these systems appear connected, relatively effective, and collaborative. But from the DPC side? It feels like shouting through a brick wall—one lined with fax machines, login portals, and dead ends.

Labs and Imaging: When Orders Don’t Order Anything

Even something as routine as ordering labs or imaging has become a mess of confusion and duplication. It took over a year to get access to Epic CareLink from one system, and I assumed that would finally streamline the process. It hasn’t.

I place orders directly in CareLink, yet patients still report being told there’s “no order on file.” We fax the same order—still nothing. Even when we confirm the order is visible in CareLink, the lab insists they don’t see it. And if they do run the test? I don’t get the results. There’s no auto-fax, no integration, no courtesy copy. We I have to log into a separate system and manually track them down.

Imaging referrals are no better. I send instructions, refer patients, and then… silence. Nothing scheduled. No confirmation. Sometimes, the referral was never processed. Unless my assistant chases it down screen by screen, I’m left guessing.

And don’t even get me started on tracking down consult notes from specialists. Unless we access the hospital portal and retrieve the report ourselves, I may never even know that the consultation took place. (Okay, I admit I’m being a little dramatic—but only a little.)

Referrals and Communication Breakdowns

Referrals routinely fall through the cracks. Even basic contact information gets ignored—I’m still getting faxes sent to my old office, despite repeatedly updating it on referral forms and portals. I’ve used every method—fax, CareLink, phone calls—and sometimes none of it makes it to the right place.

Even when I build strong relationships—such as with a hospital-based infusion center where one of my patients attends weekly—those connections collapse the moment the staff rotates. Institutional memory? Gone. We’re back to square one.

Bureaucracy by Design

To be fair, the individuals inside these systems are generally polite and even eager to help. But their hands are tied. They often can’t fix the issues, even when they want to. The systems they operate within are built on cumbersome workflows, complete with unnecessary layers, and deeply resistant to change.

 The result? Delays in care, wasted time, and a lot of unnecessary back-and-forth for everyone involved.

So I Adapt—And So Do My Patients

This dysfunction has forced me to refine our workflows frequently —not because I want to, but because I have to.

I’ve also trained my patients to play an active role. Need a new medication? Check your insurance coverage if it’s brand-name or non-generic. Have you not heard from the specialist we discussed? Here’s the number—give them a call, then update us. Recently, I have typically provided this information at the time of referral, unless I call ahead myself.  Script not filled? Ask the pharmacy why. Sometimes, it’s just a coverage issue, even when the patient is willing to pay cash.

I don’t just care for my patients’ health—I help them become savvy healthcare navigators. I want them to be informed, empowered, and just a little dangerous. Don’t accept “no” or “I don’t know” without asking why. That’s what I’d do. Beat me to it, and we’re both better off.

A Word on Prior Authorizations

One silver lining: my approval rate for prior authorizations has dramatically improved. Why? Because I’m directly involved in the process. I’ve trained my assistant to understand how to jump through the hoops. We no longer rely on a random staff member in a queue who has no relationship with the patient or any clue why I ordered what I did.

Breaking Down the Wall

This isn’t a rant for rant’s sake. It’s an honest look at the daily barriers that DPC doctors like me face—barriers that shouldn’t exist. I’m not asking for miracles. Just working phone numbers, orders that go through, results that come back, and systems that recognize me as part of the patient’s care team.
Until then, I’ll keep adapting. I’ll keep faxing, logging in, double-checking—and yes, training my patients to be their own fiercest advocates. But I’ll also keep calling this out. Because the only thing worse than a broken system insists it’s working fine.

If you’re a fellow DPC doc dealing with the same wall—or if you’ve figured out how to punch a hole through it—I’d love to hear from you because this cannot be how it’s supposed to work.
(And yes, I know I sound a little dramatic. But when it’s your third fax and they still claim they don’t have the lab order… the drama starts to feel justified.)

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