“For insurance to be affordable it needs to cover catastrophic events, not common ones.”
–Dr Landon Roussel, Host of the Direct Primary Care Podcast
The US healthcare system is failing us. Prices our increasing far beyond our ability to pay, yet health outcomes are far below those of other countries with developed healthcare systems. Many solutions have been posed, yet the one that is shown to be effective has yet to fully take hold: Direct Primary Care.
In this episode Dr Roussel discusses the current healthcare crisis, where we are and how we got there. Moreover, he explains why DPC is the answer to the crisis. Finally, he responds to certain criticisms of DPC that have been leveled by critics of the model, many of whom are financial stakeholders with a vested interest in maintaining the status quo.
[2:07] Purpose of the Direct Primary Care Podcast is to be a resource for those interested in Direct Primary Care—particularly those on the fringe, those who are interested in the model but don’t quite see how it would work in the mainstream.
[2:10] The podcast is not just for doctors but also those in the insurance industry, health administration, policy makers and economists.
[2:44] Our discussion will deal with Direct Primary Care only—not concierge, not other models for healthcare delivery
[3:00] What is Direct Primary Care?
- Full access primary care
- Generally monthly or annual fee
- No insurance
- Low cost (<$100/month)
[3:49]Direct Primary Care doesn’t cover insurance, not labs, meds, imaging or specialist visits.
[4:00] My interest in Direct Primary Care
I learned aboutDirect Primary Care as a medical student.
My motivation going into medical school was to practice straight up general medicine, making use of my training to help every day folks with every day problems.
[4:30] On the hospital wards and in clinic, I would witness residents and attendings having to see 15-20 or even 30 patients per day, many of them coming in with limited primary care access.
I did not think that I could practice primary care without burning out.
[4:45] Initially, thought of becoming a specialist, as 99% of my class does, or just staying out of clinical medicine, perhaps going into academia or industry.
[4:55] Towards the end of my third year of medical school, I learned about a new model being pioneered in Seattle by Dr Garrison Bliss.
It involved a low cost monthly fee in exchange for all-access primary care.
[5:02] Just being able to see a few patients per day—maybe up to five or six—while having the flexibility to help many more over the phone and email would allow me to be the doctor I went to medical school to be.
[05:22] So I decided to go into primary care, choosing to go into internal medicine residency with primary care track at a a Harvard Medical School affiliated program.
[05:30] There I had the opportunity along the way to spend time in Direct Primary Care clinics and be mentored by Dr Garrison Bliss, Dr Josh Umbehr, and Dr Jeff Gold. I also had the opportunity to meet many more Direct Primary Care doctors atDirect Primary Care Summits.
[06:10] My current Direct Primary Care practice is in Louisiana.
[06:34] Healthcare is now in a state of crisis.
[06:44] It’s riddled in debt.
[07:02] There is a huge shortage of primary care doctors.
[07:12] Physician burnout/satisfaction is rampant.
[07;22] The insurance model in healthcare is outdated.
[07:30] Healthcare services have expanded virtually exponentially in the past fifty years since health insurance was rolled out in the 1950’s and 1960’s.
[08:20] Health insurance has continued to cover virtually all of healthcare needs, even as healthcare services have come to include not only catastrophic events but also every day services—eg preventative care, regular management of chronic diseases.
[08:40] Rates have consequently increased dramatically to the point that premiums are on average not affordable, and the cost is only increasing.
[08:55] It’s as if car insurance expanded to cover all car repairs—oil change, tire change, battery replacement, etc—or homeowners insurance covered replacing a heater or an AC or a new paint job. Of course the cost of the premium would go up.
[09:19] For insurance to be affordable it needs to cover rare events, not common ones. Otherwise it’s not pooling risk, it’s just pooling money.
[09:22] Then insurance becomes not insurance but an financier, like one would pay a car dealership for unlimited repairs or apple for AppleCarePlan.
[09:33] And if we want to talk about financing models for healthcare, that’s well and good.
[09:43] But if we are going to talk about subscription type plans for healthcare, which I think is the way to go, then who better to provide the subscription service then the doctor. Why outsource financing when it’s not necessary?
[10:01] Direct Primary Care as the answer
[10:12] Direct Primary Care lowers overall cost of care by 30-40%.
- No third parties for most services
- Coordinated care
- Doctors available any time
- Continuity of care
- Less need for duplication
- Less legal risk because of patient rapport. Not just overall cost for the system less but also for the individual
[11:07] Direct Primary Care fee can be paired with HD health plan, which is much cheaper.
[12:04] Doctor patient relationship has been nearly third party free for 2,000 years. Only in the age of managed care has insurance come to be the responsible party for paying for medical expenses.
[12:27] Hospital growth is a modern trend due to third party payment
[12:40] Unfounded criticisms against Direct Primary Care
[12:53] 1. Unfounded Criticism #1.It will reduce the number of primary care doctors
Actually, the reason so few enter the field is because of the stress of burnout, low pay, etc
Can encourage new med students, residents to enter the field, and can keep other doctors from retiring
[13:33] We have the physician staffing right now to provide Direct Primary Care to everyone.
[14:30] 2. Unfounded Criticism #2. It’s going to harm patient care because doctor’s aren’t regulated/connected/integrated, etc.
Data doesn’t support this and it’s empirically untrue.
[15:19] 3. Unfounded Criticism #3. It’s financially unfeasible for the underserved.
This happens to be empirically untrue: Ryan Neuhofel, Josh Umbehr, many others
There’s nothing against helping people pay their fee.
[16:00] Direct Primary Care doesn’t solve the need for insurance, but it reduces the cost of it and what the plan needd to cover.
Dr Landon Roussel is a Direct Primary Care doctor who lives in Baton Rouge, Louisiana. He founded the Direct Primary Care podcast in 2016 as a way to support the Direct Primary Care movement as it continues to resolve the healthcare crisis from a grassroots level, one doctor-patient relationship at a time.