A direct primary care physician's answers to top concerns about model [Q&A]

Despite physicians' growing interest in contracting directly with patients, such alternative practice models continue to face some harsh criticism.

For a direct primary care (DPC) physician's take on some key points of controversy, FiercePracticeManagement spoke with Jeffrey S. Gold, M.D., (pictured left) founder of one of the first DPC practices in Massachusetts.

FiercePracticeManagement: What is your response to the argument that by reducing their patient panels, often from a few thousand patients to a few hundred--that DPC physicians contribute to the growing physician shortage and access crisis in primary care?

Jeff Gold: I ask critics how well we're resolving the access problem now. I recently had one of my former patients join my practice, which I opened almost a year ago, because he had to reschedule his physical at my old office and they couldn't get him in for nine months. We saw him last week.

Long term, the way you fix the access problem is by having a model of primary care that students want to do. Right now they don't want to do it. Who wants to see 30 patients a day, write 30 notes that are three pages long and enter insurance codes? You can get away with it if you're in a high-paying specialty, but for a PCP coming out of residency with about $200,000 in debt, why would you want to go into not just a low-paying field, but one that beats you up so badly from an administrative standpoint?

As the DPC model evolves and expands, there will be a transition period, and that's going to be tough. I certainly can foresee midlevels having a role in DPC for a couple of years to ease the crunch.

FPM: What about the question of cost? How can DPC be scaled to include lower-income populations and those on Medicare?

JG: We get government officials to sit at the table and let us show them---like Washington state is doing with Qliance--the downstream savings to every taxpayer when people get better care.

As for my practice, we have people from all different walks. We have rich people who look at this as the benefit of having the service and the access. We have people with high-deductible health plans that know they're going to pay out-of-pocket at hospital prices with lack of transparency every time they engage the system. We have some people with no insurance even though we advise against that. We also have people on MassHealth and Medicare. The ability to have that variety is exactly why I wanted to do this model versus a true concierge model.

FPM: Has going into an alternative model caused you to lose any collegiality from other physicians?

JG: I think there's sometimes misunderstanding that DPC is different from high-priced concierge (our members pay an average of $70 per month, with e-visits and other services included). But the only negative emotion I've gotten from other doctors is that they're sometimes jealous.

I also have more time now to invest in professional relationships. I go to grand rounds at the North Shore Medical Center in Salem almost every Friday morning. I visit my patients when they're in the hospital, which no typical practice does anymore, and see some of the specialists there.

I have the time now that if I do need to send somebody somewhere, I pick up the phone and call and tell them what I've done, what's going on and why I want them to see the patient. If anything, this move has enhanced my rapport with other doctors. I'm biased, but I truthfully feel this is medicine the way it's supposed to be. - Deb (@PracticeMgt)

Editor's note: This interview has been edited for length and clarity.