I just read this article by Halle Tecco called Direct Primary Care: Concierge Medicine for the Masses? and it was pretty good. She did a really great summary of DPC and the movement. She even quotes Garrison Bliss, who we are proud to say writes for DPC News. Halle details how DPC works, how it helps patients and doctors, the movement in general, and the math behind the finances. All good stuff. You know, I even like the title of the piece. My practice even used the saying “Concierge Care at an Affordable Price.” So, I am on board with that.
The author mentions the term DINOs but, alas. doesn’t give DPC News credit for creating it. At least the term is sticking. Hit this link for all the posts we wrote about DINOs. Halle kind of blows this issue off but shouldn’t. They are one of the biggest risk factors for killing the DPC movement as they hijack the name and make us look bad.
Now, here is where the author got things wrong:
Exacerbating the PCP shortage
A major concern to me is that America already faces a desperate shortage of primary care physicians. If DPC becomes more mainstream, it could siphon doctors away from existing practices, further limiting access to care for the most vulnerable populations who cannot afford membership fees. Remember, DPC doctors see half the number of patients as other PCPs. While some physicians may avoid burnout by moving to a DPC model instead of leaving medicine altogether, it likely would not make up for the decreased utilization.
Do you know what is really exacerbating the PCP shortage? The job of being a PCP in the system where they grind you down and burn you out. DPC is the only hope of getting more medical students interested in primary care. When more medical students get interested in the thought of freeing themselves from the shackles of employers then more of them will go into family medicine residencies. The answer, as the author states, is not the company Forward!!!! That’s just another middleman! And they are going through VC money like crazy. Only the small DPC docs are profitable. That should have been mentioned.
Perverse incentives
Lastly, a 2018 JAMA commentary highlighted the potential for perverse incentives, suggesting that DPC could incentivize doctors to focus on attracting healthy patients who require minimal care. This approach could leave those who need care the most with fewer options. And as stated before, patients must still carry insurance to cover specialist care, hospital stays, and other needs, creating a double cost on top of the monthly membership fee.
Increased regulation and transparency in DPC can help solve this. We can set clear ethics guidelines around patient selection, which can help mitigate this risk. Additionally, some DPC models offer sliding scale fees or partner with community organizations to address accessibility concerns.
Yeah, let’s use a commentary from the most perverse organization (AMA) that helped to create the most perverse healthcare system we have now to judge DPC and ask for increased regulation in order to kill the whole movement. No. DPC docs do NOT cherry-pick. I went over this detail in my book so won’t rehash it here. If you actually speak with DPC docs you would be amazed at the most challenging patients they have to care for. Most DPC docs also give away about 10% of their care for free. That’s an oversight from the author.
Lastly, she again mentions all the start-ups in DPC we should know. Great. I would say to ignore over 90% of that list as they will be gone in 5 years. What should say is that there is an overall a 90% success rate for doctors who start their own DPC practice and the reasons why the 10% fail. That is the future. But, alas, she decided not to contact me.
No problem. Halle, come to the DPC Summit in June and listen to my talk there.