Why Direct Primary Care?

I can remember wanting to be a doctor since I was around ten years old.  I am a very goal-oriented person, so I worked hard to keep my grades up and made sure to do all the leadership activities, extracurricular activities, and the other necessary things to get into medical school after college.  Medical school and residency were pretty uneventful (except for the addition of four children).  I dug in, put my nose to the grindstone, and made it happen. As a kid, I really enjoyed watching Dr. Quinn, Medicine Woman. I know that somewhat dates me, but I really loved how Dr. Quinn was with her patients. I imagined having personal relationships with my patients, caring for them over a continuum, sharing happy moments as well as sad times, doing house calls or whatever it took to ensure good care, and having a relationship of mutual respect and care. Of course, life isn’t really like a TV show.

When I was a new doctor almost 18 years ago, I was eager to establish relationships with my patients and get into the medical world.  I enjoyed seeing patients, but there were so many obstacles.  I would see patients at the store who complained that they had called to be seen but couldn’t get in.  Most often, I never knew they needed in, and the patient was told there were no appointments. I wanted to run on time, but there was so much paperwork to do that I either spent hours charting at night and on the weekends, or I ran behind.  Insurance companies and Medicare continued to institute new “rules” that were supposed to make patient care better. They didn’t. They gave me more work to do and took away from the time I had to spend with patients taking care of what they ACTUALLY needed.  There were not enough hours in a day to do all the work that needed to be done. Patient visits had to get shorter to allow time for prior authorizations for studies like MRIs that were needed, and to fill out more paperwork to get medications covered for patients.

I became weary. More of my time was spent checking boxes and doing paperwork than seeing patients. I was frustrated because I felt like I couldn’t do the job that I felt I wanted to do.  I felt like I was rushing through visits so that I didn’t get behind. I was forced to do lots of phone medicine because I couldn’t get to everything in a day. I worried that this was not the best I could do and that something important would get missed. Patients were frustrated too. They would come with a list of problems, and I would have to tell them that we didn’t have time to address all the concerns and we would have to book another appointment. That meant another copay for them, which made me feel guilty too, but if I didn’t move on to the next patient, everyone would be waiting on me for the rest of the day.  The days were constant rushing from the moment I arrived at the office until I left, usually feeling guilty (that good ole Catholic guilt) that I was missing family time AND had still work left to do at the office.  Something HAD to change, or I had to walk away. I loved the patients but everything else I had to do to maintain the status quo overshadowed that.

Fast forward to the present.  I am transitioning out of that traditional fee-for-service world where doctors get paid by how many patients they see and into the direct primary care world.  It is like a breath of fresh air! Direct primary care is a new type of medical delivery model that is challenging the status quo. Instead of paying for each visit, patients pay a monthly fee to be a member. Insurance is not billed. This gives them unprecedented access to me via my cell phone. They can call, text, or email. They have unlimited visits each month. Visits are longer. Because there is greater access, I am only accepting a few hundred patients into my practice instead of a few thousand. This means I have time to be like Dr. Quinn. I can take the time I need. I can know every single patient.  If we have to have the patient follow up to take care of everything, I don’t feel guilty because they don’t have to pay an extra fee.  If a prior authorization needs to be done, I have time to do it.

I am lucky to be able to build great relationships with people and meet them where they need it. I have time to talk. I can do a house call if a patient istoo sick to come to the office.  I can offer a video visit if needed because I don’t have to meet any insurance requirements.  I have time to provide stellar care. I can call specialists to seek help. I can read up on the latest information.  I see great changes for the patients too. We develop relationships of trust. We get to know each other. I have time to call or text a patient just to check in to see how they are. I’m not stuck looking at my computer the whole visit checking boxes so I actually get to listen to the patient.  I get great feedback from patients who are happy because they are able to save money and get the care they need and more.  This keeps me excited and fueled with passion.  Making a change like this was just what my heart needed. THIS is the kind of doctor I was meant to be. THIS is the life I was meant to lead.