As Direct Primary Care (DPC) continues to grow, more and more companies have set up shop with the name ‘DPC.’ While most DPC practices consist of solo doctors who said goodbye to insurance and started charging a monthly fee, larger companies have now joined the space of ‘DPC.’ Companies offering up-front telemedicine with a back-up (fee-for-service) doctor or management groups offering to manage multiple locations and run a clinic via a franchise model are some of the many examples of new models branding themselves as ‘DPC.’ These models are quite different from the solo doc who hung out a shingle and charges a monthly fee. In this Q&A, Dr Roussel discusses the question: What is Direct Primary Care? Is there a strict definition? If so, what is it? If not, how can one tell a ‘true’ DPC practice from a lookalike?
[1:00] Over the past months as DPC has continued to grow in support and popularity, we’ve witnessed a number of organizations provide clinical care with the name “DPC” that have led many in the DPC community to question what being a DPC practice means?
[1:50] These models are all quite different from the DPC practices like mine and others who run small, independent or maybe 2-3 partner groups. Our practices have more of a homey environment, small-town doc sort of feel to them.
[2:03] While there’s nothing inherently wrong with having a larger group run a DPC practice, if the ‘Direct Primary Care’ as a model gets lost amidst a fray of corporate, government or bureaucratic interests, the entire meaning of the word is lost. This makes it hard for the public to sort out the wheat from the weeds.
[2:30] But where is the line? At what point is corporate or government involvement “too much” for DPC?
[2:36] To answer these, we really need to answer the more fundamental question, what is Direct Primary Care?
[2:42] To start, Dr Phil Eskew on his site DPC Frontier has a post “DPC Defined” in which he posits that for a practice to be a ‘pure DPC” practice, it must:
- Charge a periodic fee.
- Not bill any third party.
- The per visit charge must be less than the monthly charge.
This is certainly a reasonable definition.
[3:05] Some doctors, however, including myself, may find such a definition of DPC to be too rigid to account for the variations in practices out there.
[3:13] What about the ones that take occasional one-time visits? What about the ones that have employer contracts with small businesses? If you examine closely few practices are probably 100% pure according to this definition. Most can agree, however, that some things simply aren’t DPC.
[3:29] A large insurance company contracting with a doctor, for instance, to pay a capitated fee is unlikely to be considered DPC. On the other hand a small employer, say a group of plumbers, who pays the monthly fee for DPC employees, that’s probably not uncommon for DPC practices.
[3:47] Where is the line?
[3:50] My personal feelings about where the line are much like Supreme Court Justice Potter Stewart’s feelings when it comes to hard core pornography: “I know it when I see it…”
[3:57] There are simply some forms of care that simply aren’t DPC by virtue of the adulteration of the doctor patient relationship
[4:04] That’s where I think the core of DPC lies, in the minimization of third party involvement in the doctor patient relationship. What this means in terms of particulars is certainly up for discussion. I would love to hear your thoughts on what is direct primary care.
Nonetheless, this is a discussion we need to have, both amongst DPC doctors, and with the public.