One of the most common questions asked about our movement is “What is the difference between Direct Primary Care and Concierge Medicine?” The answer is…..not much. There are slight differences, however, and they are important.
Before I go on, I just want to note that others have given their opinion on this topic:
- Rebekah Bernard, MD also did a nice piece on it on the KevinMD blog site: Direct primary care physicians are not concierge doctors
Let’s build on these resources, start simple and work our way up.
There is a actually a definition of Concierge in Merriam-Webster online and it relates to healthcare. It states:
of, relating to, or being a health-care practice (as of primary care physicians) in which patients pay a membership fee for enhanced access and services
That sure does sound like Direct Primary Care, doesn’t it? Surely, they are not the same, are they?
Direct Primary Care doctors do NOT bill insurance. Many Concierge Medicine practices still do and this is double-dipping. If the doctor bills the insurance and still bills the patient a monthly or annual fee then he or she is NOT doing Direct Primary Care. That’s an easy one to separate the two.
The next issue to distinguish the two is price. If the doctor is charging an obviously HIGH price to have a patient as a member then he or she is not doing Direct Primary Care and is catering to the very wealthy. There are some caveats to this, however. If the office is in a major city then the prices may be higher, which can blur the lines a bit. Also, affordability is in the eye of the beholder. What is affordable to you may not be affordable to me. It’s almost the case of the “I know it when I see it” definition. No one has ever drawn the line in the sand of when a practice crosses over from Direct Primary Care to Concierge Medicine but you usually can tell by seeing that price. In other words, you’ll know it when you see it. Maybe it’s sticker shock? I am not sure but this brings us back to affordability. Concierge Medicine has the connotation of being inaccessible to the masses and catering to the rich. This is due to the past history of Concierge Medicine especially as portrayed in the news and on television shows featuring this product. It may not be fair, but that is the reputation.
Somewhere in there lies the answer of delineating Direct Primary Care from Concierge Medicine.
Let’s dig deeper.
Maybe the definition of concierge depends on whether it is a noun or adjective? As an adjective, it truly means an exceptional level of service. I think both DPC and Concierge Medicine do that. In other words, a Concierge Medicine practice and a Direct Primary Care practice both give incredible service, access, and a personal touch due to the small panel size.
When concierge is used as a noun by being attached to “Medicine” to form Concierge Medicine it becomes a historical term describing a type of practice, one that caters to the wealthy as described above.
So, if you use Concierge Medicine as a noun then the answer seems to be there is a difference between the two. It comes down to affordability for the masses and the history of pure Concierge Medicine practice proves this is not the case.
If you use the term Concierge Medicine as an adjective then Direct Primary and Concierge Medicine are the same as they both give that exceptional level of service expected with the term concierge.
Wait, there’s more.
I have to remove another sector that claims to be DPC and those are DINOs or Direct Primary Care in Name Only. I do NOT believe they do authentic Direct Primary Care. In fact, it is the reverse reasoning for this discussion. What DINOs offer may be affordable to the masses but they don’t give the exceptional level of service (access, no waits, personal doctor, etc.) like DPC and Concierge Medicine. They just slap on the Direct Primary Care moniker to their website and offer a monthly fee to be treated like everyone else in the broken insurance model.
Taking this all together, It looks like we have a spectrum. DINOs are affordable but aren’t Concierge Medicine. Concierge Medicine has great service but it may be unaffordable to many. It looks to me like Direct Primary Care is the Goldilocks of this whole movement as it is both affordable and has great service. It is in the middle and it is just right.
We are getting closer.
I keep coming back to the word affordable because it is critical in distinguishing Direct Primary Care from Concierge Medicine. I do not mean the word cheap. I have had other doctors tell me that they worry that the term Direct Primary Care gives off the feeling of being cheap or of low quality. That’s why the word cheap should never be used. It’s affordable.
Maybe DPC is just an affordable version of concierge medicine?
In fact, in my DPC office, we called ourselves “Concierge Care at an Affordable Price”. Why? Because we wanted to get across to patients the incredible things that we do for a low monthly fee. In fact, I do not think that the typical Concierge Medicine that caters to the ultra-wealthy had any more services than we had.
This brings me to the bigger picture.
Does Direct Primary Care or Concierge Medicine offer some solution to our broken healthcare system? Well, DPC does try to lower costs for their patients by getting them affordable labs, affordable medications, and finding affordable options for specialists and testing like radiology, etc. I do not think the typical Concierge Medicine practice does that. That may be because their clientele wouldn’t care as much about this. In fact, I guess if you had to truly figure out the difference between the two then would you ask the doctor two questions:
- Do you still bill the insurance company? If yes, it is NOT a Direct Primary Care clinic.
- Does it matter to the majority of your patients if you get them more affordable medications, labs, procedures, and diagnostic tests? If not, then you are probably in a Concierge Medicine office and not a Direct Primary Care clinic.
So how do we sum this up and answer the question “What is the difference between Direct Primary Care and Concierge Medicine?”
A Direct Primary Care practice does NOT bill insurance, has a small patient panel, advocates to get lower costs on medications, labs, and diagnostic tests, and gives incredible service (access, hours, etc) at a fee that is affordable for the MAJORITY of the population.
If you are still confused then take a breath and reread this. I do not pretend to know everything and this is NOT the official document that figures out the answer to this question. Hopefully, in time, the term Direct Primary Care, which is affordable to most, will take over the whole membership model space anyway.
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