We have witnessed dramatic changes in our health care system over the last fifty years. Advances in medical science have extended and improved the quality of our lives. However, there are aspects of medical care that have suffered. Despite providers’ best intentions, crowded waiting rooms, physician delays and short rushed visits for an appointment that was scheduled weeks ago are now a common occurrence.
Direct primary care medicine, or concierge medicine, stands in stark contrast to today’s hectic medical office. Direct care practices are a throwback to a bygone era in medicine, when physician and patients developed long-term, trusting relationships, medical care was not rushed or fragmented and the family doctor competently managed most routine and urgent matters with a personal touch. Modern day direct primary care practices place a high emphasis on these attributes, while simultaneously incorporating the latest advances in medicine and technology.
The typical direct primary care practice charges anywhere from a monthly to annual fee, which covers all services provided. This fee is clearly published, and there are typically no co-pays or additional charges. There is little government or insurance interference, as care, which is not considered traditional insurance, bypasses these entities. Services are comprehensive and generally cover approximately 90% of an individual’s medical needs. Care typically includes wellness visits, urgent care needs, mental health and social services, simple surgical procedures and office tests and supplies. Substantial discounts on labs, imaging tests and medications are also frequently offered.
Today, there are about 6,000 direct primary care practices in the United States, and most of them are limited to no more than 600 members, allowing for longer visits and same day appointments. This smaller size is in stark contrast to the average family medicine office that carries 2,000 to 3,000 patients per practitioner. Care is generally provided at the physician’s office, but can include home and workplace visits as well as assisted living/nursing home rounds. Patients have direct access to their personal physician by phone, text and email after hours and on weekends for urgent medical needs. This frequently saves time and expense which otherwise would be spent visiting an emergency room or urgent care.
While most people would benefit from being a direct primary care member, seven groups of individuals find these practices especially appealing:
1)People with lower cost, larger deductible insurance policies, as these products do not usually pay for outpatient visits.
2)People who value maintaining health, as these practices devote a large amount of time to preventative care.
3)People with complex medical histories typically requiring frequent medical visits and needing more time with their provider.
4)People who want to take charge of their own health care, without government or insurance interference.
5)People who make too much or, ironically, too little income to qualify for Affordable Care Act subsidies.
6)People who are self-employed, or those who receive little or no insurance from their employer.
7)People who are between jobs and have no insurance coverage, or those whose insurance has been cancelled.
Direct primary care practices offer a refreshing alternative to the typical medical experience. Many people have discovered that these small “boutique” practices offer excellent care, while at the same time being personal, convenient and surprisingly affordable.
Richard R. Samuel, MD, ABFP
North Idaho Direct Primary Care