Monday, April 28, 2014

Transition to Hybrid Direct Primary Care: Challenges and Pitfalls

I've started four Family Medicine offices from scratch, starting in 1980 through 1999.  I've directed a campus health center, started and directed a Family Medicine training center for a community hospital and directed a University Family Medicine center.  Now, I've helped to start a weekly free clinic for the uninsured and underinsured in my community.  I've learned a lot and had a lot of fun.  Patients in all these setting were great.  The challenge of Direct Primary Care (DPC) is next. It's one of the solutions to the disastrous mess coming to health care (or already here).

Direct Primary Care, the business model, connects well with Direct Family Medicine, my practice model for applying DPC.  I have a fifteen year old, two physician family medicine office which takes "families only".  It's a niche practice now converting to a DPC hybrid, practicing traditional Family Medicine with Direct Family Medicine.  We started formally in July 2012.  See my blog posts about DPC in June, July and August of that year.

Challenges:  My office staff attitude about health care was pretty "normal", with a strong belief that insurance, funded by business or government, paid for health care.  "People need insurance", I had taught them.  With DPC, the challenge is to believe that some people don't need insurance for primary care. With a hybrid practice, all of us had to shift our belief to both- insurance is good for our existing patients and insurance isn't needed for our new Direct Family Medicine patients.

All new patients had to sign into our Direct Family Medicine "track".  How could we explain it to potential new patients calling during busy office hours?  Not Well.
What should we say?  Not much before the phone rang or another patient was signing in or checking out.
How many people were fired up about signing up after our phone explanations?  None
How many people liked the idea as I explained it at the end of their office visit, giving them a one page description of DFM?  About one a day.

The traditional patients with insurance had gradually increasing amounts of administrivia, detracting from our DFM track.  A couple who operate a Christian coffee house that I frequent had a sudden gap in their health care support.  I gave them a year of DFM to speed up the learning and practice curve for us. They helped me to better understand what we were doing.

More later.


  1. don't forget that there's lots of docs who are happy to help share what they've learned setting up their DPC practice like and

  2. Yes, Josh, it's one of the great things about the DPC community- very helpful people who value transparency.

  3. I've been DPC since 2008.
    I will never go back to dealing with 3rd parties.
    My practice is fun and fulfilling!