The University of Houston College of Medicine is Actually Opening a DPC Clinic. Is It A DINO?
This is some surprising and bold news. A new medical school is trying a new approach to one of their teaching clinics. I definitely appreciate the effort but I have some thoughts about it as well.
The University of Houston College of Medicine only opened in 2019 and they are throwing their hat in the ring for DPC. Here’s the info that just came out:
With a $1 million gift from The Cullen Trust for Health Care, the University of Houston College of Medicine (UHCOM) will open a low-cost direct primary care clinic on the campus of Memorial Herman Southwest Hospital, the first in a planned network of clinics aimed at increasing access to care for those without health insurance.
A couple of quotes from the piece:
- While there is a growing number of DPC providers in Texas and around the country, few specifically target low income patients who don’t have access to health insurance coverage.
- The clinic will be strategically located in Southwest Houston where nearly one in three people live below the federal poverty level. The uninsured rate in the Southwest area (45%) is five times higher than the nation (9%). It will be staffed by UHCOM faculty physicians and will also serve as a training site for UHhealth professions students. UHCOM hopes to establish a network of DPC practices in other communities of Greater Houston that have significant health disparities.
Okay, here are my thoughts. This is an opinion piece so I will give my opinions.
- Medical students getting exposed to DPC is awesome but…..
- Is this really direct primary care? Maybe. If they are not billing insurers then that puts them in the ballpark. What’s the difference between this and a sliding scale charity clinic or even a free clinic though? I guess it depends on if this clinic actually makes patients pay monthly. If patients aren’t really paying and no one is enforcing this then you just have a charity or free clinic. If I had to put money on it then this is where I bet this thing ends up.
- Skin in the game is important. Patients have to have skin in the game and pay regularly (see #2). The faculty need skin in the game but they don’t own this DPC clinic. That’s never good. The bureaucracy kind of does and that means layers of committees involved in any changes. That is nothing like the small DPC clinics that are self-owned by primary care docs around the country. They are all personally on the hook if the business fails and therefore make decisions quickly and proactively so that doesn’t happen.
- Will the faculty have a panel they are fully responsible for 24/7? That seems doubtful but I have no info on that. If not then these patients aren’t getting the full DPC experience of texting, emailing, and personalized care.
- The concept is built with the idea that losing money is okay because they were gifted $1 million. It’s subsidized. That’s never a good precedent. How often will they go back to this well? Yearly?
- No one I know has been contacted by U of H to consult with them. You would think they would love to hear some good advice from DPC docs who have done this business before.
I want to be clear that I am not against anything that gives care for the uninsured who are low income and still can’t get or afford health insurance. However, I still want to also protect the concept of direct primary care. It seems to be the cool new fad and EVERYONE wants to hijack the term. See my DINO article.
My questions to you, as readers and fellow DPC docs, are:
- Do you think it is a DINO?
- Do think this U of H clinic will make it or go extinct (see what I did there)?
- Will it morph into something else at some point?
- Lastly, has anyone been contacted by U of H for their expertise in helping them do this clinic?
PLEASE LEAVE SOME COMMENTS HERE WITH YOUR THOUGHTS!!
Your skepticism is certainly understandable. However, your concern seems to be that this is just a new medical school using the DPC moniker to attract interest, when in fact it is just going to be a free clinic, and thus a DINO. However, while the article doesn’t give many details, it does use the terms “low cost” and “reduced prices.” This suggests that even poor, uninsured patients will have at least some “skin in the game.” A broader question would be is a partially subsidized DPC that serves the under served (i.e. low monthly rate is kept low due to subsidization) still be a DPC or is that also a DINO? Prior to my departure from my academic institution, I had a few high level talks (that went nowhere) about doing exactly this at my institution. The idea was to use the University’s employees (my institution is the second largest employer in our major metropolitan area) as a test group to show the University that DPC could provide better quality at a lower cost (save them money), while simultaneously teaching or medical and allied health professional students about interdisciplinary care.
I am always concerned when these clinics use DPC in their name because I fear they will not be truly DPC for all of the reasons stated in the article. I do not want the DPC moniker to be tarnished by DINOs. As a small, relatively new DPC clinic (opted out, no insurance, monthly subscriptions, etc.) I am able to offer the patients whom I know to be financially strapped a lower rate for my monthly fee, but it is at my discretion. Every patient pays. I do this because I want them to not feel that it is charity care, but rather that they are just as important a part of my practice “family” as the next person is. I also want them to feel that they have the same privileges that my “non-scholarship” patients have, meaning that they will receive the same attention and care that everyone else gets. If I didn’t require them to pay, I think they would feel that they could only use my services as a bare minimum, and they would miss out on the fantastic peace of mind that DPC patients have when they know the doctor is listening.
Agreed!!