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Does it seem like you could die before you can get an appointment to see your family doctor? And, when you think of the cost of insurance, your co-pay, and medications – do you wish you had died?
Let’s face it. The healthcare system in America is in crisis. The cost of insurance is going up. The cost of treatment is going up and the cost of prescription drugs is going up. The only thing decreasing is the time doctors spend with patients. That is due to the declining number of primary care doctors, increased paperwork, dealing with insurance companies and the incentives for churning through a high volume of patients.
Direct Primary Care
Enter direct primary care (DPC). This medical practice model takes health insurance companies out of patient care and reduces paperwork. The result, Gayle Brekke, Phd., FSA told SA is less pressure on providers and better treatment for patients. She is chief influencer at Primary Care Mindset.
“It’s a relationship,” Brekke said, that harkens back to the way family doctors operated in the first half of the last century.
“That’s what a lot of people and DPC physicians say,” according to Brekke. “It’s because they practice in a way that makes more sense to them instead of the way many large healthcare organizations do.”
Quicker Appointments Longer Exams
It takes 26 days to get an appointment with a family doctor, according to an AMN/Merritt Hawkins survey, for an examination that lasts 18 minutes on average, according to PubMed, a publication from the National Institute of Health.
In contrast, DPC patients can see their doctors in a manner of days, or sooner for emergencies, says Brekke. In addition, doctor visits in a DPC practice run longer – 30 to 60 minutes or more.
“It is important to know that DPC leads to doing other things downstream. DPC physicians have an incentive to do more than a traditional practice because they have more time,” says Brekke. “A DPC can get on top of a medical condition quicker because a patient can get in to see them quicker.”
Reduced Paperwork And Insurance Inefficiency
The most burdensome challenges of doctors and staff in conventional practices are high patient volume, keyboarding electronic health records, and fighting insurance companies.
By removing health insurance companies from the patient-doctor relationship, DPC physicians reduce the time they spend on administrative tasks. It also reduces the need for administrative staff, according to Brekke.
“It’s not unusual for a DPC to have one part-time administrator,” said Brekke. “There are an average of 2.5 administrative people for each physician in traditional medicine.”
Instead of insurance, patients pay a monthly, quarterly or annual fee for unlimited primary care. Fees vary by location, but can start as low as $80 per month. In addition to examinations and treatment, patient care may include consultations, care management and coordination as well as clinical and lab services.
As a result, doctors and staff have more time to focus on patient care, because they no longer have to spend time billing insurance companies for payment, seeking prior authorization and coding.
Reduced Patient Volume
In addition, DPC practices limit the number of patients they care for.
“DPC doctors take care of far fewer patients than traditional practices,” says Brekke. “A DPC doctor might have 400 patients. A traditional practice could have 1,200 or more. That means doctors have more time with their patients and their patients are better cared for in the DPC model.”
Patients also have greater access to their doctors through phone calls, text and email. In addition, many dpc practices dispense medications. Plus dpc doctors usually build relationships with labs and specialists that cut costs for patients. In fact, more specialists are adopting the dpc model, according to Brekke. They are designated direct care specialists (DCS).
Brekke cautions that while DPC eliminates the need for health insurance in primary care, patients still need coverage for major illnesses and injuries.
Two Buckets
“I think of DPC as having two buckets,” said Brekke. “You have one bucket for individuals and you have another for small companies.”
An employer with a handful of employees can offer DPC coverage for a fraction of the cost of a major medical plan. Of course, major medical insurance covers more than DPC. However, most small businesses with a limited workforce can not afford to offer the coverage.
Overburdened Doctors
In a 2023 Time Magazine Op-Ed, a Stanford University School of Medicine physician sounded an alarm about the demands doctors face that are not directly related to patient care.
“Doctors today spend two hours doing computer tasks for every one hour facing patients,” wrote Dr. Ilana Yurkiewicz. She is a primary care physician and oncologist at Stanford University School of Medicine.
That jives with previous research published in PubMed.
“During the office day, physicians spent 27 percent of their total time on direct clinical face time with patients and 49.2 percent of their time on EHR (Electronic Health Records) and desk work,” a 2016 study found.
“In an era where multibillion dollar software promises to ease data-sharing, the process for providers to input and find health data remains manual, labor intensive, and error prone,” wrote Dr. Yurkiewicz.
“Our current solution to these technologic glitches is leaning on people to serve the needs of the electronic charts. It was supposed to be the other way around. Support staff becomes crucial, yet patching logistical holes often falls to doctors. Recently I prescribed a medication that took 22 clicks, waiting on hold with an insurance company, tracking down a denial letter, writing an appeal, documenting all these phone calls, and keeping my patient apprised through messaging.”
Doctor’s Off Boarding
Most doctors did not pursue a career in medicine to shuffle electronic paperwork and arm wrestle with insurance companies. Yet that is a tedious, time-consuming part of modern medical practice. As a result, the number of doctors leaving medicine is steadily growing.
“The percentage of U.S. doctors in adult primary care has been declining for years and is now about 25% — a tipping point beyond which many Americans won’t be able to find a family doctor at all,” according to a KFF Report.
The number of primary care physicians per capita declined from 68.4 per 100,000 people in 2012 to 67.2 per 100,000 people in 2021. At the same time, Canada, which has national healthcare, had a ratio of 133 primary care physicians per 100,000 people.
By 2037, the National Center for Health Workforce Analysis (NWCA) projects there will be a shortage of 87,150 primary care physicians.
Currently, over 100 million Americans don’t have usual access to primary carea number that has nearly doubled since 2014.
The same month Dr.Yurkiewicz’s piece appeared, Dr. Jesse M. Ehrenfeld, then president of the American Medical Association, spotlighted physician burnout in an address to the National Press Club. He called the trend, “an insidious crisis going on in medicine today that is having a profound impact on our ability to care for patients.”
A Personal Toll On Doctors
Dr. Ehrenfeld emphasized that the problem is nationwide.
“The physician shortage that we have long feared—and warned was on the horizon—is already here. It’s an urgent crisis,” said Dr. Ehrenfeld, ” … hitting every corner of this country—urban and rural—with the most direct impact hitting families with high needs and limited means.”
Dr. Ehrenfeld cited several doctors he knew personally who quit their practice or suffered a breakdown. Perhaps the most poignant was a story he shared about a long-time friend:
“Two years ago, a dear friend of mine and medical school classmate, an emergency room physician in California who worked tirelessly on the frontlines throughout COVID, took his own life. He was an energetic and loving soul … a brilliant and caring doctor … who felt the weight of the pandemic on his shoulders. He struggled to get out from under it. I knew he struggled, but I didn’t know how to help him. And he didn’t know how to ask for help.
“I am still deeply troubled by his death, just as I am haunted knowing there are thousands of people in his community who can no longer receive his care.”
Whether you are a doctor wanting to learn more about direct patient care or a patient looking for a direct patient care practice near you, check the following link:
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