[Good morning friends!! Here’s an idea to consider if you’re frustrated with all the health insurance options out there! I’d never heard of direct primary care before, but a reader – and doctor – of the blog just emailed this over and thought it was worth re-sharing in case it’s a perfect fit for you. Just make sure to do some due diligence first as I’m sure there are some caveats in there :) You’ll find a map of DPCs you can search through to see if there’s any around you at the bottom of the post… Thanks for shedding light on this, Rachel! And glad you found your dream job!]
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J. Money!
I love your blog and devotedly update my net worth every month.
But you have complained about health insurance one too many times, my friend. You need to discover Direct Primary Care!
So I’m a family doctor, and we docs hate health insurance, too. Doctors end up working for the insurance company instead of for their patient – the insurance company mandates how much they can get paid per visit, and so docs have to see more and more patients per hour to make ends meet. Insurance makes up all these rules about coding the visits and diagnoses and procedures, and you only get paid so much for each of them, and you have to check off rather arbitrary requirements in each note that you write to get paid at different levels.
And then there’s all the paperwork you have to fill out and go back and forth on for prior-authorizations – basically the doctor has decided on a plan of treatment, but if the insurance company thinks it’s too expensive, the doc has to justify it to them. Because that is exactly how we love to spend our time, writing up paperwork to justify our plan of care to folks that have never been to med school!
I served in the Air Force for the past 8 years and didn’t have to deal with any of this (Tricare has different struggles, but at least I could get patients the care they needed without making them broke!). So when it was time for me to leave Active Duty, the last thing I wanted was to become suicidal over my next job (burnout rates for physicians are awful right now! Doctors hate their jobs!).
I love being a doctor and didn’t want to lose that passion, so I looked into my options. I specifically looked up the smartest doc I knew, who had retired from the Air Force, to see what he was doing now – and he was in a direct primary care practice. Solution!
Direct primary care takes health insurance out of the transaction for your basic day-to-day medical care. Rather like car insurance – you save your car insurance for expensive things, not for gas or oil changes that you expect. That helps keep car insurance at reasonable rates – we could do the same thing for health insurance.
You pay a monthly fee to have access to your doc, but then you get as much (or as little) care as you want/need. You still should have a high deductible health insurance in case of emergencies or accidents, but for most things, I can take care of you! I manage chronic conditions, treat skin problems, do biopsies, diagnose and treat sports injuries, inject joints, perform pap smears, help with pregnancy and breastfeeding problems, perform sports physicals and well child checks…
I do as much as I have ever been trained to do, and I love it!!!
I spend SO much more time seeing patients and reading up on how to care for them better, I write in my notes what I and my staff will find helpful for future reference (and DON’T have to stress about checking off the stupid little things that I have to in order to get a certain level of payment by health insurance).
We have cut out a TON of overhead because we don’t have so much paperwork to do for insurance. So we save money AND we save our patients money and we are all happier. Instead of having to have 2,000-3,000 patients to make ends meet, my goal is to have 600 (my boss/partner is already there, and has been doing this for the past decade, quite happily and successfully).
Can you imagine knowing 3,000 people and being in charge of their health?? That is just so many. 600 is a great number. And I can spend more time in every appointment (never less than 30 min), and always have open appointments for today or tomorrow if someone needs to get in fast.
Especially with all this covid madness, my patients are reaping the benefits! I’m keeping my patients at home as much as possible, doing a lot of visits over the phone or webcam, and we just called all our older patients individually to make sure they were doing OK. I just delivered some meds to a patient’s apartment yesterday to keep them home and safe. But my patients can call or email or text to reach me, 24/7, and I can talk them down from their worries and discuss how to best care for their families in this crazy time.
When it comes to $$: for young adults, my practice charges $60/month, older adults are $80/month. Which might sound pricey, but compare that with the cost of being seen for cash by an urgent care (where one of my many side hustles is for now) is $140 at MINIMUM – labs or xrays or medicines or anything extra will just keep jumping that number up and up!
We have a bunch of medications in our office that we buy wholesale and give to our patients at (almost) cost. We have deals with local imaging companies and labs for much less expensive cash prices. And there’s the convenience – instead of going to the doctor’s office (and waiting forever…), then pharmacy (and waiting), and lab (and waiting), we do all that in our office – the doc sees you, we get your meds for you, and draw your blood all in house.
So next time you’re mad at health insurance, just know there’s another way! I really hope that this is the healthcare of the future – it certainly makes sense to me. I love my job and my patients and practicing medicine so much, and this is a great way to do it.
If you want more info, a lot of articles have been published about DPC lately, plus there’s our own web site and my little YouTube channel, and a map of DPCs across our nation:
- Our website: PineridgeFamilyMedicine.com
- YouTube channel: Pine Ridge Family Medicine
- Good article: Direct care practices perfectly positioned to help patients during coronavirus outbreak
- Map of DPCs: DPC Frontier Mapper
Sorry for the long email! Hope it was helpful. Stay healthy!
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Thanks Rachel! It was helpful!!
Anyone here ever try this option before??! What did you like/didn’t like about it?
Thankfully we have decent insurance coverage now through my wife’s gov’t job, but there were a stretch of years there where we were paying upwards of $1,000/mo and getting CRAP in return for it! I told her something like this seems great for those who are self-employed, and she wrote back saying,
“We’ve definitely got a lot of self-employed folks as patients. AND small businesses that can’t afford full health insurance for their employees, but want to offer SOMEthing to take care of their people. Which I LOVE!”
So take from this what you will!
Here’s a couple more articles on DPCs I found while doing a quick search. It’s def. a “thing!”
- GoodRx: A Patient’s Guide to Direct Primary Care
- Consumer Reports: Pros and Cons of Concierge Medical Care
- American Academy of Family Physicians: Direct Primary Care
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I had a great doctor years ago and he went to this system exclusively and I was unable to see him anymore unless I signed up. It sounds like a good model, and I could see me using this one day.
Great post, thanks for the info!
This is probably a great model for people with chronic illnesses like diabetes that require a lot of management.
Frankly, paying them $60/month is $ 720 a year and for those of us who are relatively healthy it is probably not worth it.
I have an outstanding PCP who I see twice a year. My only condition is high cholesterol and we manage that well together.
I definitely see the value of this Direct Medicine! I loved the article and I agree with the author that the middleman (insurance company) is what is messed up with modern medicine. This has definitely given me something to ponder!
It was a fun thing for me to learn for sure :) Wanted to get it out there in case i wasn’t the only one! And from the emails I’ve been getting it seems there are many of us out of the loop!
So… you want me to pay you $60/month to not see you most of the year on top of the $125/month I pay for my HDHP. So I am still looking at $2,220 a year just to have coverage. Technically double coverage for my PCP. Like the commenter above, this might work for someone with a chronic condition or a hypochondriac, but I don’t see the value personally. I would rather take the money and put it in my HSA or a savings account.
I do like that there are people challenging the current system we have, but to me you are just making people pay extra money they may or may not have since they still have to have some sort of traditional insurance, and even with the HDHP they could be one major incident away from bankruptcy because they think you can do everything for them and they don’t put any extra money aside for that emergency you can’t help with. Just my thoughts. But keep on trying to fight the system and maybe someday it will bring about some much needed health care reform
I’ve found that a lot of folks come in more often to see their doc when they have unlimited visits – or even just emailing me with question if something is worrying them. It’s in these casual visits that we end up having important conversations about their weight, drinking habits, or the rash that keeps coming back – the sort of thing that is easily forgotten and not mentioned, but can change someone’s life if properly addressed. I am so glad you are in good health. A lot of my patients don’t have health insurance at all, which I really don’t recommend but also want to give them what healthcare I can. I think the frustration is properly aimed at HDHPs that cost so much while providing, for the most part, nothing. I’m at least accessible when you need me!
I think just the fact you EMAIL and talk to people directly is worlds better! Exactly why I’ve used an accountant for 10+ years now – I email her probably once a month with some random question and a few times she’s saved my a$$ – and MONEY! – in the long run. Unlimited access is def. a freeing feeling even if you don’t use it…
I was forced to switch docs when my insurance changed after my Cobra ran out a couple years ago. I tried get an appointment with a new PCP for a physical and it was a SEVEN month wait to see any of their doctors. Researching alternatives, I stumbled across a doc in my area that was starting a new Direct Primary Care practice. Absolutely love it – great doc, easy to contact and schedule, never feel rushed in appointments, able to see the same day if necessary. Well worth the cost and the docs like it better too – she had 5000 patients in the old system and described herself as a “pill dispensing robot.”
NICE!!!
Glad it’s working out for you! And that there was one *close by* too! That seems like one of the biggest problems from chatting to a few people so far who were interested in it but the closest ones were 50+ miles from them :(
I thought about doing concierge medicine when I was self employed. Ended up doing a health share. which was ok too but I worried if there was ever anything catastrophic they might not pay… I need a PCP, someone that would actually be worried about preventative medicine and making sure I’m getting the things I’m supposed to get at whatever defined interval I’m supposed to get them. Not just someone that is there when I get sick and can see me 2-3 weeks after I get better on my own… Would love to have blood work done, maybe figure out why someone who exercises every day and eats fairly well feels like garbage all the time at 38 years old…
Concierge medicine tends to be a bit more pricey than Direct Primary Care in my experience. But look into a DPC near you, it sounds like your goals align very closely with ours!
Interesting. I mean, you still need major medical though, for emergencies and major illnesses. I have never shopped for insurance myself, only reviewing the options my company offers, so I have no idea if that is affordable without routine care. I do have a high deductible plan, putting the difference in premium from a “platinum” plan with low copays, into a HSA.
My primary care doctor does not participate in insurance, for the reasons the author talks about. They will file with your insurance company but are not in network with any plan. People have asked me why I am okay paying $200+ for a visit, when I could be doing so for a copay. And it’s because I don’t go all that often, and he is able to spend a sufficient amount of time with me during visits compared to some practices I’ve been in. We have a chat in his office and then he does the exams, including all the things some physicians relegate to nurses or assistants, like taking blood pressure. It seems like a good value to me. I mean, people pay for facials, massages,Manicures, etc, so paying that for a medical professional doesn’t seem unreasonable. That being said, if he went to a subscription plan, I doubt I would be as on board.
Def. feels better dropping the money when put that way, haha…
I cut my forehead a few years ago. The doctor didn’t take my Obamacare
insurance. I asked if I could pay cash. He said sure. It was $250 for
a nasty cut. I thought it was very reasonable.
I’m unemployed now. We bought Obamcare insurance again. It’s reasonable
if you make a low salary, but if I get my job back, I have to repay the insurance
at $2,500/month for a high deductible plan.
WOW!
Left a comment on twitter and thought I’d post here too. I have a HDHP at work that costs me $0 and pay $50 a month for a DPC doctor who I frankly don’t use often. But it’s worth every penny, $600 a year is cheap to have someone that knows your name, spends 45 mins with you a visit, is available via text and email and who can see you same day for something serious. Had a skin biopsy done at no additional cost last year which probably paid for my whole year of DPC care.
Rock on!! Glad you’re finding it so helpful!
Sounds like an ideal situation! It’s outrageous how much insurance charges for biopsies when they are so easy.
My family and I went off my employer’s expensive PPO plan several years ago and joined a health care sharing network, which has been an awesome experience. We just moved and I’d be interested in a DPC doctor, but there are none in our area per the database.
Question for Dr. Rachel – do you think most docs are aware of the DPC model and are just scared to try it because it’s unconventional (like dropping employer coverage as a family and joining a HCSM), or are there practical hurdles that you see preventing more practices from making the switch? Just wondering if it’s worth talking to a few local PCPs we know to see if there would be any openness to the DPC model.
I don’t think most docs are aware of DPC. Most are much more medicine-minded than business-minded (which makes sense) and so would rather hand the reigns over to some business guru and just do what they are good at (medicine). Which has led us to where we are – the business gurus have been taking advantage of the altruism of doctors to the extent that health insurance CEOs make $$$$. Just like most people, docs are afraid of making a switch into the unknown of DPC, away from the status quo. But it’s worth it! Talk to your local PCPs and feel free to give them my email address. Or better yet, the name Dr. Josh Umbehr, out of Wichita, who is a leading expert on DPC and super nice to boot.
I live DPC ! I lost the health insurance I did have to a divorce And hope no options for care until I found out about this!! Affordable Heath Care is not that for me!! It would not cover any of my needs unless I paid hundred a month! DPC has allowed me to see my Dr and get the much needed care for the past two years and get on top of issues needed address! With out DPC I would not be in a good way. So grateful to have found this option and great Drs who care more about the patient !!!
So glad to hear that :)
What’s cool is that us doctors are just excited about DPC as you sound like you are :) We finally get to practice medicine the way we want to and care for folks properly!
What is the difference between concierge care and DPC?
Every physician can be different in how they practice, but my impression is that concierge tends to be more expensive, and that patients can expect to have truly 24/7 access to their doc – as in, call in the middle of the night asking about a non-emergency. DPC doesn’t cost as much, but there’s also a level of restricting access to your doctor until reasonable hours of the day and night, taking a few days for turnaround on documents to be filled out or refills of meds to be placed, if that makes sense.
This is fascinating! I work for a broker/TPA and we have a niche solution that involves high deductibles & semi self funding.
I would like to research this more but when Dr. Rachel says you should still have high deductible health insurance, do the DCP visits count towards the deductible? I am suspecting not. Either way, this is very intriguing. Thanks for sharing!!
You are right, the DPC monthly fees do not count towards your deductible, as it’s not ‘in network’ at all. Health insurances want your money to be going toward their providers, keeping it all in their system. There’s been discussion in legislation of at least being able to use your HSA accounts for your DPC membership fees – and some of my patients have been doing that for a while, anyway, semi-legally. Thanks for reading!
Someone else in my feedly of PF blogs mentioned this once and I loved the idea. My biggest fear about the RE side of FIRE is the health insurance so I’m hoping that by the time we get there, this is mainstream enough that I can find DPCs available wherever we end up locating. And I’m so glad of the map. It showed me there is actually an office where we live now. We might just have to check it out. My question though is what if you need specialists. If my DPC is a general practitioner and I need an orthopedist…what happens there?
Specialists depend on the area – we have an orthopedic surgeon who does house calls and works only for cash, and has very reasonable rates. Your DPC doc often knows of those kinds of referrals in the area. For non-urgent surgeries, my favorite option is the Surgery Center of Oklahoma – they do great work and post their prices right on their web site, https://surgerycenterok.com/