Cherry Picking DPC Patients
It amuses me when MBAs talk about Direct Primary Care practices “cherry picking” patients. I know that they consider “cherries” to be completely healthy patients who come in once a year for a brief physical exam or not at all. From a business standpoint, this is the dream: collect a monthly fee and deliver nothing in return (see: health insurance). Obviously, this is a rare occurrence in DPC. Patients usually seek out Direct Care practices because their needs are not being met by the insurance-based system. They typically have some combination of medical trauma and medical complexity requiring the additional time and improved communication offered by most DPC practices.
It’s unusual for healthy patients to join a DPC practice, pay the membership every month, and never utilize the services. These are NOT my ideal patients. I struggle with the ethics of charging patients a monthly membership and never seeing them. I have attempted to talk some of them out of continuing their DPC memberships, since I don’t see the value of paying for a service they aren’t using. However, they have assured me that the peace of mind is worth it to them, just knowing that they have access to a physician if needed. When these patients have medical conditions that they are neglecting, failing to get labs or other testing done or even to come in for appointments, I lose sleep worrying about them and spend a lot of time badgering them to follow-up.
I honestly do not believe that any DPC doctors want patients they never see. We all went into medicine to fulfill our intellectual curiosity while helping patients improve their quality of life. My ideal patients bring a combination of medical complexity, motivation and a sense of humor. They seek the same doctor-patient relationship that I do. A nice juicy cherry of a patient brings a medical puzzle to solve along with the joy of their company. The cherries I seek would not be fully appreciated in an insurance-based practice or in a corporate DPC practice.
Short but sweet, and addresses the false “cherry-picking” allegations perfectly. I completely agree! Thank you for this article, Emily.
I agree that we don’t want just the patients that pay us a fee and NEVER come in, your points are very valid. I think what we’re aiming for is a win-win for both the provider and patient. I feel like DPC is unique because the healthier our patients are, the less often they come in, and we have aligned goals because we are not depending on sick patients for our income. As Doug talked about a few months ago in his article “Do Hospitals Want Patients to Be Healthy?” traditional medicine models rely on illness, so what is their incentive for the patients to be as healthy as possible? I love that we are able to welcome patients to our practice at all levels of health, and they know that we’re there to take care of them whether they come in once a year or once a week! They know that we truly are there to improve their health because we’re not counting on them to be sick to be able to pay our bills. I’ve always felt that on a moral level I would hate to be hoping for people to get sick so I could put food on my table.
We all have our share of patients who almost never darken our door, but they are happy to be members because they know that we will be there when they need us. And we also are happy to work with the complex patients who know they can come in as frequently as necessary because they aren’t worried about copay after copay and know we will spend as much time with them as they need. It’s a happy time when those complex patients are able to move into more of an annual wellness visit status! Most doctors I know did not go into medicine to sit in an office and get paid by patients who never come in. They want to truly be able to help people, and the DPC model allows them to practice medicine as it should be done, with the time and attention it requires. I loved your conclusion – such a great rebuttal to the charge of “cherry picking!”
This is a beautiful article-thank you so much for your vulnerability.
When someone claims DPC is cherry picking, it exposes their lack of knowledge about the subject. You are absolutely correct: my patients are my patients because the fee-for-service insurance world systemically underperforms for them. It’s a low threshhold to outperform our fee-for-service colleages. All you have to do is listen to the patient, spend some time with them (new patients are scheduled for 1 hour, minimum) and communicate to them that you’ve heard them and not just push them out the door. 80% of my patients essentially say this, and my Google reviews reflect this as well. If an MBA says we’re cherry-picking, then we’re just picking the cherries that fell to the ground because the insurance “tree” let them fall.