When Doug invited me to be a contributor, I was honored but a tad hesitant. As a founder of this movement, I have a perspective that has been shaped by decades of trial and error, accomplishments, and failures. When I opened my first monthly fee practice (Seattle Medical Associates), I had no way of predicting that it would succeed or that I would still be a doctor a year later. It was built on an idealized model of care that I wanted to practice, and I refused to compromise with the “let’s just try to improve with workarounds” crew. Fortunately for all of us, It was immensely and quickly successful, which is why I am still a doctor and this movement is growing steadily.
When I realized how joyful this model was, I decided to make it available to as many doctors as possible. This meant working with many others to create national organizations, helping over a thousand primary care physicians to take the leap – via conferences and an uncountable number of personal phone calls. It meant creating Qliance, as a laboratory to evolve new services that could improve care, like contractual relationships between doctor and patient, organized data driven referral networks based upon price and quality, cash pay opportunities for insured and uninsured alike in the reals of specialty care, imaging, colonoscopy, labs, etc, It also involved political outreach at both the State and Federal level, as well as an important rebranding of our movement as Direct Primary Care rather than the ridiculous and odious labeling as Concierge or Boutique. We also developed a language around this movement that allowed non-physicians to understand that this was not just a new name for capitated care. Our final contribution was to generate some of the initial data that DPC worked, not only for doctors but also for patients. Before Qliance completed its almost 10-year run, we had the earliest data that DPC also reduced overall healthcare costs by between 10 and 50%.
Some think of me as a DINO, a bit strange given that I and my co-conspirators in Washington State invented the term Direct Primary Care. Qliance is often discussed as proof that scaling is impossible, despite considerable recent evidence to the contrary.
Here is what I said to Doug after he thanked me for coming on board:
“Of course, I love DPC News! Everyone committed to saving Primary Care is a friend of mine, and you have the best conduit available for news from the grassroots and growth plates of this movement. I also greatly appreciate the work you do reading and evaluating articles about DPC. I generally try to stay quiet, but let me look at the possibility of sharing more of my thoughts with your readers. I still have a lot to say about DPC and I have a lot of pride in what DPC is accomplishing. I was particularly delighted with the Hint Conference I just attended. I heard from a wide array of people from all corners of this movement who are actively solving problems in Primary Care that the rest of America regards as insoluble. I heard 2 very different talks about incorporating empathy, humanity, and kindness into health care, a topic close to my heart. I also saw a room full of hope, innovation, and joy.
I look at this movement as I would see my own family, much dispute and discussion at the dinner table, but still family at the end of the day. There are now multiple generations of DPC docs who share a common vision of what high quality care looks like and how to provide that service to patients with integrity and consistency. We are succeeding by sharing our knowledge and support rather than tearing down our competitors…”
My next post will be a gentle rebuttal of Doug’s assessment of One Medical. Stay tuned.