One day, a primary care physician located about two hours away called my office in a desperate attempt to find a rheumatologist. His lovely 64-year-old patient, very healthy otherwise, recently developed a severe and disabling inflammatory arthritis. After conservative treatments failed, he tried to refer the patient to the traditional medical system. However, they could not get a sooner than six months appointment. This is a symptom of a broken health care system.
A specialist is supposed to be there for patients when medical care becomes more complicated than a primary care physician can handle. Unfortunately, nowadays, unless patients get admitted to the hospital, the access to a specialist like me in rheumatology will be postponed to the extent that the patient’s health is in jeopardy.
But is it possible to see patients when they need help?
Often, we hear that the U.S. health care system is broken. Physicians are blamed for the lack of patient access, increased costs, copayments, and surprise bills. However, as a physician previously employed in the traditional system, I can testify that there is minimal control of our schedule and definitely no involvement in any of the costs related to the care we provide (consultations, copayments, laboratory, imaging, or medication). There are not enough specialists, and there are not even enough fellowship spots available to close the gap. Additionally, insurance companies limit the number of specialists in their preferred provider panels. And, if that wasn’t enough – because of the pressures on everyone’s schedules, patients are often sent to us too early, creating a bottleneck in the schedule.
On a typical day, most appointments with the patient last, on average seven minutes. Physicians are trapped in productivity models, being incentivized to see more patients, instead of offering a higher quality of care.
This is a symptom of our broken system that needs to be addressed, and fortunately, a few trailblazers have shown that change is possible, and we are now starting to see the market begin changing.
Getting back to this lovely 64-year-old patient and their doctor trying desperately to help – the market came to her support. Fortunately, her physician took the time and researched her options. He called my practice in a desperate effort to help the patient. After a short peer-to-peer consultation, I called and scheduled the patient for a visit the next day. The patient was surprised I did not start greeting her by asking for an insurance card. After our first visit, together with the patient, I planned for further laboratory and medication. All the costs involved in her care from consultations, laboratory tests, imaging were made available upfront to the patient. This time her medical care was reduced from estimated thousands to clear-cut hundreds of dollars. No copayments, no surprise bills in addition to what was disclosed and agreed by the patient. The patient was astonished, and she chose to continue care in my practice.
This is direct specialty care – we even have our own association now: the Direct Specialty Care Alliance.
The idea of being an independent physician seems so frightening these days. Starting a practice that will offer care directly to the patient, without the interference of “middlemen” seems something rather utopic these days for a specialist. Most times, we see referrals from other specialists or primary care physicians. How are we supposed to survive? How do we educate the patients that you are there for them? How can we justify the fact that we are not billing their insurance? How should we set a fair market price?
I am here to testify that it is possible, and I am not alone in this specialist direct care market. There are other specialists’ practices like mine, hidden gems for patient care. During my journey, I learned specialists are thriving to remove the “middlemen” and reconnect with patients. Patients are eager to shop for their health, discover transparent pricing and excellent quality. Patients and physicians desire mutual accountability. Since the direct primary care movement started approximately ten years ago, many patients that signed up to this model quickly realized the benefit of having access, affordability, and price transparency.
Specialists in direct care now exist across the country. In the last two years, I have been in contact with many thriving physicians providing a direct care model. However, it was so hard to find and connect. Our hope – and our patients’ need – is that connecting patients with direct care specialists gets easier. We are working on that now – we are working to change the system because our patients need it – and practicing good health care depends on it.
This is just the beginning of a new era in medicine, where patients and physicians reunite.
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