I’ve started to see patients in a DPC setting and it’s been pretty enlightening. Even more, so is contrasting my DPC experience with my urgent care experience. I currently work at a local urgent care on the side to maintain an income while my practice builds. Having my feet in both settings provides a stark contrast between good patient care in DPC and churning through patients in urgent care.
My initial visits are 90 minutes long and the most surprising thing is that I’m actually running to the end of these sessions, even for the “young, otherwise healthy” patient. For context, I am an emergency med personality who found their way into family medicine. I tend to be pretty ADD and like to get things done quickly and succinctly. Yet, when put in a context where I can live out the philosophy of truly specializing in the patient, I enjoy taking the time to turn over every stone. And when given the chance, patients are more than willing to open up and share the concerns they otherwise wouldn’t have mentioned in the quick 5 min visit. As a medical community, we’ve gotten good at preventive care, but what good is preventive care if the patient doesn’t have the time or trust to tell you all the things they are doing or concerned about? Finally getting to practice medicine in a DPC context has been rewarding and fulfilling.
Take all the good things about DPC, invert them to make them bad (eg change getting to know a patient to trying to learn as little about a patient as possible), and you get urgent care. Forget moral injury, the sheer cognitive dissonance I have between taking care of my patients and treating urgent care patients is astounding. Yet, despite the objectively bad care urgent cares provide, they are incredibly profitable and it seems like just about anyone can open one and become instantly successful. Part of their success is the sad state of our primary care. If fee for service primary care is the rotting flesh of our decaying healthcare system, then urgent care is the gangrene. I talk to so many people who don’t have a primary care or who can’t get an appointment for months and their only option is urgent care (I must unironically mention, these are some of the same people who don’t understand the value of DPC).
When I explain DPC to certain people, I explain that at its core it’s a business model, but it’s also a movement because those of us who do DPC are driven by a vision for better care for our communities. We push uphill to justify our value to people who easily spend thousands of dollars on insurance companies who deny care. Instead of making loads of money exploiting patients who don’t know better, we sometimes even take significant pay cuts to build a world where patients receive better care without facing financial calamity. I got hooked on the idea of DPC when I attended my first summit as a 4th year med student in 2017, and now as a practicing DPC doc, I’m convinced this is the only way primary care can make a comeback.