The primary care doc fix is in 

Matthew Mintz, MD recently shared how primary care doctors are set to lose more than half of their salary. It’s well documented how primary care has faced a number of challenges with half of primary care physicians saying they’d leave medicine if they could as was mentioned in an earlier piece. There’s talk of a “doc fix” as physicians believe the debt ceiling deal is going to lead to a horrific outcome. Fortunately, it’s not all doom and gloom. Many primary care docs have found their own “doc fix.”

At the same time as traditional fee-for-service primary care docs are getting squeezed, there’s an exploding trend around the Direct Primary Care (DPC) model. Having written extensively on Direct Primary Care (click here for DPC-related articles on KevinMD, Reuters, Forbes, Huffington Post, etc.), I’ve hear about an extraordinary number of DPC practices or enablers (e.g., providing software or back office capabilities) popping up all over the country. Like anti-lock breaks and airbags that were once only available to the well-heeled but now are available to everyone, the same is happening with retainer-based primary care. Generally speaking, these low cost (freed from insurance bureaucracy, typical monthly fees are $50-80) DPC models have one-third of their patients who are uninsured. MedLion’s next clinic to open is in Salinas, CA. They are catering to the immigrant, farm worker population. Josh Umbehr, MD of AtlasMD shared how one of his patients lives in a storage unit and his fees are less than the co-pays at the local public health center.

MedLion, AtlasMD and many others bust the myth that retainer-based medicine is exclusionary. A little reported on facet of the health reform was the inclusion of Direct Primary Care Medical Homes in the insurance exchanges that will serve to rapidly grow this new segment. Showing this isn’t something solely popular with Democrats, one of the most vocal opponents of the PPACA (Rep Bill Cassidy (R) Louisiana – also an MD) has proposed a bill to pay for Medicare primary care this way.

Rather than dealing with the risk of the aforementioned halving of primary care salaries, DPC MDs are consistently taking home 50-100% more than their insurance-dependent brethren. They are doing this while reducing malpractice premiums 50%, enjoying 30 minute appointments and some running with no administrative burden at all. Not long ago, DPC pioneers had to custom develop their own solutions spending hundreds of thousands of dollars. Today, there are software companies providing solutions at a tiny fraction of that investment, there’s service bureau companies setting up to enable these practices and there’s an industry association establishing certification to help scale these models.

I predict in under two years that the primary care physician who doesn’t have at least 10% of their patients paying this way will be the exception to the rule. The economics and results are simply too compelling to ignore. Consider that the byproduct has been the following:

  • Combining a DPC model with a high deductible wrap-around policy saves 20-50% off of a typical health premium for a higher level service
  • DPC physicians are taking home 50-100% more income (or scaling back hours)
  • Patient satisfaction rates exceed Google and Apple
  • Downstream costs for the most expensive facets of healthcare (surgical, specialist & ED visits) are reduced 40-80%

Gradually, more and more employers are understanding what IBM found when they studied the results around the globe on their $2B of healthcare spent. The formula is remarkably simple: more primary care access led to healthier populations which led to less money spent. Not sure where to start? An earlier piece addressed overcoming barriers to building a direct primary care practice.

Dave Chase is CEO of, a Patient Relationship Management software company, previously founded Microsoft’s Health business and was a consultant with Accenture’s Healthcare Practice.  He can be found on Twitter @chasedave.

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