In late 2017, I was standing in the hallway between two different departments in a hospital where I was rounding on a particularly busy day. As a hospitalist, I was very familiar with this facility and where to go in order to find a moment of peace away from the hustle and bustle of my workday.
As I held the stack of rounding sheets in my hand, I had a fleeting thought: “I now understand why so many doctors kill themselves.” And it scared me.
Preceding this moment were the typical stresses of being a physician: a stacked work schedule, colleagues in bitter disagreements with each other, and pleas for staffing help to administration that fell on deaf ears.
Thankfully, instead of following through on my thoughts, I started researching ways to redirect my career before burnout pushed me completely out of medicine.
What is direct primary care?
As a primary care physician, I revisited my desires of why I became a pediatrician. My hope was to one day be known as a child’s pediatrician and experience the joy of caring for that child throughout their younger years.
While researching my next steps, I came across a forum of physicians on Facebook practicing under the direct primary care model.
Direct primary care, or DPC for short, is a retainer-based membership model that allows the doctor to have a predictable income while affording the patient direct access to their doctor. Or in my case, their child’s doctor.
A direct primary care (DPC) membership is akin to a gym membership, where you are charged a monthly fee and use it when needed. I am not only a DPC doctor but a patient as well.
The best part for me is that it forgoes the long-standing insurance-based fee-for-service model. We all know that the current health care system has become a source of stress for both patients and doctors alike.
Benefits of DPC for this pediatrician
As I continued down the path of research, I found that this model worked well for family medicine physicians as they are able to see a wider age group of patients. This type of care appeals to not only families but also self-insured employers.
But would it work for a pediatrician?
Countless colleagues, friends, and family tried to convince me it would not. Nevertheless, I held firm to my decision to follow this path. After much blood, sweat, and tears, I have a thriving pediatric direct primary care practice. In fact, next month my patients and I will be celebrating the 5-year anniversary of the practice.
Starting a direct primary care practice is not the easier path, but my overall stress has greatly reduced. Taking great care of patients in a more personalized manner fits my personality better than answering to insurance companies. Providing high-quality care to a smaller patient load reduces my stress as well. When I lay my head on my pillow at night, I can rest easy knowing that I gave my patients the medical care they deserve.
Improved balance between work and life
While true life/work balance is a fallacy, life as a direct primary care pediatrician has felt more in balance for my priorities. While sometimes work gets more of my attention than family and vice versa, I am better able to be present for the person in front of me at the moment. Since I am in control of my schedule, I am able to block time for important family events or see a patient in a way that is convenient for them.
Increased job satisfaction
Nothing beats the job satisfaction of being a direct primary care pediatrician. Whether it is saving a kid from a trip to the ER by stitching up her chin on her living room couch or receiving videos of kids pretending to be Dr. Wadley, I love my job. Since my patient panel size is not thousands of patients, I really get to know kids and families well. Providing personalized service and spending time with patients also contributes greatly to my job satisfaction.
Benefits of direct primary care for patients
About a year ago, I was diagnosed with a chronic illness that has greatly changed my outlook on the medical system. While I try to navigate through referrals and med refill drama, I can always count on my DPC family doctor to fill in the gaps that my busy specialist’s office just cannot.
More personalized care
My family and I have been a direct primary care practice member for the last five years. Frequently, when discussing plans and budgets with my husband, he reminds me that having a DPC doctor for our family is non-negotiable. “Please don’t make me go back to the regular way of medicine,” he says with some frequency. Our doctor knows us well, and there aren’t many layers between her and us. We are grateful for this type of continuity of care and personal relationship.
Shorter wait times
With smaller panel sizes, DPC doctors are able to get patients seen and taken care of quickly. I will often get a same-day or next-day appointment with my primary care physician. As a direct primary care pediatrician, I can also give parents an almost immediate answer if they text me a picture of a rash or something else that is worrying them about their child. This type of comprehensive care with short wait times is very difficult in our health insurance-based primary care practice model.
Greater access to the doctor
While greater access may be off-putting to some physicians, it really is the cornerstone of the DPC relationship, and medicine in general. Patient experience is improved in this service model due to the ability to text your primary care doctor a simple question or discuss a concern easily over the phone. As a part of the primary care membership, patients can obtain routine care, find answers to their questions, and overall have an improved doctor-patient relationship.
How DPC can save your career and your life
While there are many critics of the direct primary care model, more and more doctors are choosing this way of practicing medicine. Without the administrative demands of the third-party billing model, doctors are able to jump off the hamster wheel and find the joy of practicing medicine again. Direct primary care may not save all of the health care system, but it sure saved me. If you are ready to jump in the water and give it a try, there is a community of happy DPC doctors ready to take you by the hand and help you find your new path.
Andrea Wadley is a pediatrician.