Communities and organizations grow over time in the same way a dense forest can transform into a sprawling metropolis. While on a day to day basis the change can be subtle and continuous, most changes occur in stages, each with unique characteristics. The direct primary care movement as a whole follows this pattern, having gone through several iterations and continuing to evolve today.
Gen 0: Bushwhackers
Dr. Garrison Bliss is largely credited with starting the DPC movement in 1997 and coining the term direct primary care. During this time period, other doctors also independently arrived at the idea to do insurance-free, member-based primary care. Dr. Bliss and these other innovators cut a path where no path existed. No education existed to tell them how to build a member based practice and they only had available clunky, insurance-focused technology to use in their new streamlined direct care office. They also led many of the early legislative efforts to remove hurdles, allowing DPC to exist as a care model; and in doing so created the name “direct primary care.” This generation turned an idea into reality and laid a path for the next generation to tread.
Gen 1: Pioneers
This generation established many of the core principles and brought to life the main philosophies of DPC. Generally composed of docs who were so fed up with the established system, they decided that opening their own practice with a new, largely unheard of model was the only path forward. Naturally, this group has strong anti-establishment feelings and tendencies. Just like early pioneers manifesting destiny in the 19th century who built their own self-sustaining habitats, Gen 1 DPC docs followed their calling to DPC, bootstrapping all parts of their practice themselves. Most of the DPC education easily accessible nowadays via the Alliance, AAFP, DPC frontier, and other sources, come from the hard earned wisdom of Gen 1 docs building clinics out of sheer force of will. This generation created the playbook of how to do DPC and created some of the early rudimentary infrastructure (ie technology) to aid the growth of the next generation. Where Gen 0 cut a trail, Gen 1 drew the map and wrote the handbook.
Gen 2: Settlers
Today’s DPC docs are part of the Settler generation. With handbook in hand, Gen 2 is following Gen 1 to settle on a rapidly developing area. Most regulatory challenges have been addressed, and resources, both in writing and via communities, abound. Infrastructure, in the form of DPC specific technology, exists and the number of companies with DPC specific offerings continues to grow. This generation is helping to develop the infrastructure around the community and trying new approaches to innovate within the model. Since many in this generation do not carry as many battle scars from working in a fee for service environment, they have less of an anti-establishment streak and accept more collaboration from “outsiders” than their Gen 1 counterparts. Gen 2 docs include those who are opening their own practices like the Gen 1 docs did as well as those joining established DPC practices which did not really exist for Gen 1.
Gen 3: City Builders
How does a town become a city? More people arrive, leading to more specialization and bigger projects. Systems become sophisticated and the variety of services and opportunities increase. The DPC community springs from those escaping today’s dystopian health system. As the community grows and evolves, as all movements throughout time have, systems and innovations will emerge. If the DPC movement continues to grow at the current rate (and likely projected even faster than current), city building will happen one way or another. Building a utopian city will take the innovation and inspiration of Gen 2 tempered by the warnings and wisdom of Gen 1. Gen 0 docs probably would have never imagined today’s landscape, and who knows what the DPC community will look like 10 years from now. Regardless, all DPC docs today, whether actively or passively, are part of shaping the foundation on which tomorrow stands.
Excellent analysis and perspective. Thank you!
[…] colleague and friend Dr. Kenneth Qiu recently wrote a brilliant article on “DPC Generations” for DPC News. In his analysis, Dr. Q describes the 4 generations of DPC […]
[…] interest, I recently read Dr. Kenneth Qiu’s excellent article “DPC Generations”. Ask anybody who knows me and they’ll tell you about my affinity for analogies. Dr. Qiu’s […]
[…] model, most physicians feel the independent, small practice embodies the true spirit of DPC. As the DPC model grows and changes, these physicians believe new entrants, especially corporate and Virtual Primary Care, do not […]
[…] to understand the intricacies and needs of the employer benefits world. The DPC model itself was started by a physician and as physicians in the model continue to run their practices, they will gain financial and […]