Tuesday, October 28, 2014

Teaching Direct Primary Care: Here We Go!

Direct Primary Care is all the rage.  It's been anointed in the "Health is Primary" initiative as a key business model for success by the AAFP (American Academy of Family Physicians).  The initiative was launched by the AAFP last week in Washington, DC.

A keynote presentation by Erika Bliss, MD CEO of Qliance at the Family Medicine Education Consortium (FMEC) in Arlington, VA two days after the AAFP announcement wowed the students, residents and even some faculty at the FMEC meeting. One big question from the students and residents:  Where can I get DPC training?  One big question from the faculty types:  How do you teach it?

Personal reflection as a DPC innovator, DPC Hybrid private practice owner and Family Medicine educator: Direct Primary Care is the only element in all of medicine that is moving ahead on the offensive.  The rest of medicine is otherwise on the defensive, hunkered down waiting for the next mis-directed initiative.  The AAFP is willing to take the risk of helping Family Physicians and their patients by going against the status quo and endorsing the DPC business model.  The "Health is Primary" Initiative allows Family Physicians to get some reassurance about the Future of Family Medicine.

How do we teach DPC along the entire Family Medicine workforce pipeline?
1.  Define our Dream (and help each individual to define theirs)
2.  Have a burning desire to achieve it (and cheer for each other as we get "fired up")
3.  Believe we can do it (and validate/reaffirm the belief of each other)

Dialog will be one of our powerful resources for spreading the word about DPC.  We are good at it.

The DPC pioneers have paved the way for the model to be accepted, proven and recommended.
The "Health is Primary"  initiative will add energy, deliver AAFP introductory workshops during the next year, and facilitate the DPC Member Interest Group which will help interested members to learn more.

Departments of Family Medicine can be pivotal in promoting DPC by updating faculty on the Health is Primary Initiative and the DPC elements in it.  DPC oriented faculty and clinical faculty and preceptors should be asked to orient faculty and departmental staff to DPC.  A Champion for DPC should be identified by interested Departments.

State Chapters of AAFP should be contacted for information or assistance with DPC resources and contacts.  The state chapter web site should connect with the AAFP "Health is Primary" initiative and its DPC elements.

Family Medicine Interest Groups (FMIG's) should get DPC speakers to introduce DPC elements to the student members at FMIG meetings.  FMIG advisors should find the online DPC info which is plentiful.  Pre-doctoral directors in Departments of Family Medicine should identify their DPC resources such as preceptors, clinical faculty and full time faculty, and social media resources for medical student use.

Students could introduce the DPC business model to preceptors for discussion during their clinical rotations. A list of online resources explaining DPC and its variations should be available on FM Department and FM Residency web sites.  Medical students could refer preceptors who are naive to DPC to these sites.

Residencies that identify how they will teach DPC should quickly add a DPC section to their web site and promotional materials.  Similar to the sports medicine, geriatric, perinatal, genomic initiatives across the last couple decades, the DPC aspect of practice management could be in place within two months for aggressive programs.

A champion for DPC should be identified for each section of the "Family Medicine Pipeline" and connected via social media.

Objectives for practice management training should be quickly modified to add a DPC component.  One key aspect of DPC in practice management is the learners attitude about business, money, commerce, ethics (business and medical), and the patient-physician relationship.

The Family Practice Model Units should explore a DPC track for patients and employers, which is doable (FYI-I was Medical Director of a University and a Community FM training practice- multiple payment models fit nicely.  None of them are inherently evil, but some faculty wondered if something they were unfamiliar with was dishonest--like capitation or fee for service.)

Residencies:  Students are hungry for this model.

All of us:  We're part of the problem as a citizen of the Medical-Industrial Complex.  Let's re-direct the ship around the iceberg with "Heallth is Primary", including DPC and what we learn as a result of having to teach about it.  How will it fit with "The Dream".

What do you think?


  1. Could not agree more. ~Michael Tetreault, Editor, The DPC Journal (www.DirectPrimaryCare.com)

  2. Amen! Great ideas, but still many roadblocks that need to be removed. I reference them on the "About" page on the following website - Tom Valenti (www.ForthrightHealth.com)

  3. Good constructive thoughts!
    Yet...there is a glaring vacuum of leadership ... needing to come from the AAFP/ACP/AAP rather than just from the pioneers on the DPC stage with apparent franchise-like organizations that will not serve independence on an exponential, grass-roots level...but instead transplant a new umbilical cord.
    Real solutions need to come from a larger source to truly, radically transform the health delivery marketplace and "right-size" insurance marketplace where Congress/status-quo will not...
    ---one Dr's voice educating himself re: DPC options...skeptical, but looking/listening. Who will rise for this promising occasion? Primary care may suddenly experience a refreshing revival of interest from current Drs/students and patients needing unfettered care