Seeing Family Medicine In A New Light

Convinced that there was no viable way to practice family medicine in the current model -- the discipline he was most passionate about -- this medical student was elated to learn about an innovative model of care that could make it all possible.

By Brian Gans

When I first entered medical school, I was very attracted to family medicine as a discipline, but I wasn’t attracted to practicing in a model that limited me to less than 15 minutes of face time per patient but required 45 minutes of paperwork to get reimbursed and left no room or time for innovation.  It was disappointing that I couldn’t go into the field that was most attractive to me, but I just wasn’t willing to enter that environment.  A year later, only in my second year of medical school, I can’t imagine doing anything else.

We all know that our health care system is broken; that it’s a hamster wheel where doctors and patients are rushed through appointments while the cost of health care skyrockets out of control. I didn’t think there was a viable way for doctors to practice primary care in this system until I learned about direct primary care (DPC). DPC is an emerging model for practicing primary care medicine that has made me incredibly excited to pursue a career in family medicine.

I first heard about DPC when my roommate, also a second-year medical student at Penn State, showed me a forum post he saw on the Student Doctor Network by Dr. Umbehr from Atlas MD, a direct primary care practice. When I read his post and researched more into DPC, I felt like I had won the lottery. Everything I wanted in a career and hoped to achieve as a physician was already being done!

I watched several webinars, which I also found through the Student Doctor Network forums, featuring presentations by physicians at Atlas MD and Qliance, and I was shocked to find out how much overhead is needed for billing and coding. I couldn’t believe my ears when I heard how DPC practices eliminated most of the overhead by cutting out insurance.
Direct primary care can be most simply described as a direct financial relationship between the patient and the physician. Patients pay the physician a monthly fee, which typically averages about $50, and in return they usually get unlimited 24/7 access to their physician. This model is different from concierge medicine because the goal is to make this type of health care accessible and affordable to almost everyone. DPC physicians strive to offer patients as much value as possible for their monthly fees. For example, most practices have eliminated the need for a waiting room, and patients are able to see their doctor within 24 hours.

DPC addresses a lot of the problems that plague traditional primary care, including the malignantly high number of patients that primary care physicians have to manage in order to stay solvent in their practice. Because of the current reimbursement rates for primary care, patient panels must be large and appointments short. It’s good business, but it’s bad medicine, and insurance is the problem. Good primary care is not expensive, and several prominent clinics, such as Atlas MD, Qliance, and Paladina Health, are providing this type of medicine and they are thriving. These clinics have patient panels of about 400-600 per physician, while the average primary care physician has a patient panel of about 2500. The shocking thing is that these physicians are working fewer hours and getting paid better than their fee-for-service colleagues.
 
I’m excited about the innovations in patient care that DPC is pushing forward. “Technology visits,” as Dr. Umbehr of Atlas MD calls them, allow patients to text, call, email, or Skype him whenever they need him, and it’s included in their monthly fee. Many in-office procedures are also wrapped into the monthly fee. Atlas MD also purchases all routine labs and most medications wholesale, and they offer them to their patients with very little markup, often considerably beating prices at even Wal-Mart and Costco. Clinics are typically very transparent about their pricing scheme and what the membership includes. As a physician, these innovations will give me much more free time and energy to improve patient care and innovate the way medicine is practiced without any red tape. That’s why I went into medicine.

DPC takes away all the barriers to my considering family medicine after medical school. I want to innovate to make health care better and more affordable for patients through my own health care start-up. I have a strong entrepreneurial spirit and the desire to own my own business, and direct primary care will allow me to do this successfully. A new age is coming when patients are going to get amazing medical care, and their doctors are going to have the infrastructure and economic support to do it well.  

Brian Gans is a 2nd-year medical student at Penn State College of Medicine and holds a B.S. in kinesiology from the University of Southern California. He spent two years as a clinical research coordinator at University of Pennsylvania’s Perelman School of Medicine working on clinical and translational research into the genetics of cardiovascular and metabolic diseases. Interested in technology and innovation, Brian plans to start his own business once he is a physician.

Read other posts about direct primary care 

Posted by Sonya Collins on Dec 12, 2013 9:19 AM US/Eastern
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