The rise of direct primary care
Internist ben fisher, MD, made a dramatic move recently: he opened his own direct primary care practice. Fischer treated patients for eight years as part of a 30-physician group practice in Raleigh, North Carolina. He had no disagreements with his group, but he was tired of the fee-for-service model. It forced him to spend time on cost containment for insurance companies that would be better invested in caring for patients.
“I felt a very clear sense that the work I was doing was not the work of my calling,” says Fischer, who completed his residency in 2003. “It was the work of the insurers.”
Fischer continues to work at his original practice while opening the new one, and with his wife Liz, an MBA, helping him navigate the details of setting up a practice, he feels off to a good start. “This is very much a leap of faith,” he says
Fischer is among a growing number of physicians nationwide to transition from fee-for-service medicine, or open a new practice based on what was once considered an “alternative” practice model. In direct primary care, physicians don’t take insurance but instead charge patients a flat monthly fee—usually in the range of about $25 to $80 a month—that covers primary care services.
One reason for the mounting interest in direct primary care among physicians is the growing complexity of managing a practice. Many physicians say keeping up with the paperwork involved in value-based care, meaningful use of electronic health records, and other initiatives tied to the Affordable Care Act leaves little time to actually practice medicine.
“What is motivating physicians to convert is primarily a desire to be able to spend more time with patients,” says Mason Reiner, cofounder and CEO of R-Health, a network of more than 50 direct primary care practices in the Philadelphia area. “In the traditional hamster wheel of fee-for-service medicine, it’s all about volume and not about relationships. Almost every primary care physician I’ve ever met went into primary care because of the desire to build meaningful relationships with their patients. If you don’t build relationships you can’t deliver great care. That takes time.”