From PCP to DPC

By: David Ostrowsky

Among the many issues that Americans—both patients and practitioners—have with their country’s healthcare system are that a.) the administrative hassles for insurance matters can be burdensome and b.) the patient-doctor relationship is increasingly void of good old face time. While there may not be a one-size-fits-all golden solution for these systemic problems, the emerging popularity of concierge and direct primary care (DPC) practices presents an enticing alternative to the more traditional system by which primary care physicians (PCPs) for generations have rendered care. And recent well-documented trends suggest that such alternative models may be here to stay.

As we were soaking up the holiday season last month, the findings from a new study conducted by researchers at Harvard Medical School’s Blavatnik Institute, Oregon Health & Science University, and Johns Hopkins University revealed fascinating insight into how the accelerated expansion of concierge and direct primary care (DPC) practices is profoundly altering the market for primary care in the US. Specifically, from 2018 to 2023, the number of concierge and DPC practices mushroomed by 83 percent while the number of clinicians in said practices skyrocketed by 78 percent. The concierge model involves providers accepting fewer patients and charging a yearly membership fee while still getting reimbursed from insurance; the DPC model, which also requires a subscription fee, completely eschews insurance as patients pay for medical services and prescription drugs out of pocket.

For physicians, the DPC and concierge methods by which patients receive more personalized care, often at same-day or next-day appointments and/or via around-the-clock phone and email consultations, have many appealing features. Firstly, these cutting-edge methods often trigger the old “quality over quantity” axiom. Many physicians feel that DPC, in particular, ensures they have a smaller patient caseload with less paperwork, meaning that there is more time to actually sit down and talk with their respective patients. Physician burnout has long been a pressing issue in the medical field and has garnered significant attention this decade. The back-and-forth communication with insurance carriers can be exhausting, time-consuming, and downright aggravating. Understandably, a model in which insurance is bypassed altogether (i.e., DPC) is inviting for many aspiring physicians. For good measure, some also gravitate towards these newer models because they present opportunities for establishing more autonomous practices.

For patients, many of whom are paying ever-increasing insurance premiums and out-of-pocket costs for medical care, not being able to receive robust, timely, and unrushed services can be maddening. Hence, the growing demand for a system in which one pays a set membership fee in exchange for longer appointments that can either be on an in-person or remote basis (i.e., telehealth). Meanwhile, the DPC model means that patients don’t have to fret over their own insurance paperwork, which can be a tremendous stressor for many.

The report’s findings, which were published in the December issue of Health Affairs, did acknowledge that because many physicians are in fact transitioning from more traditional healthcare practices to these alternative models, there are concerns about what a growing dearth of primary care physicians means for the overall population. Simply put, many patients still prefer to visit their PCPs, perhaps because of familiarity and longstanding relationships, and a growing primary care workforce shortage looms as a problem.

“It’s important to understand this growing segment of medicine, which many doctors and patients enjoy because of more face time together and faster, personalized access to care,” noted study senior author Zirui Song, a primary care doctor and Harvard Medical School associate professor of medicine at Massachusetts General Hospital. “It’s also important to consider what this expanding free market will mean for those physicians and patients who remain in traditional primary care practices, which increasingly face more patients needing new primary care doctors but fewer doctors to meet that need.”

Though concierge medicine and DPC practices still only constitute a relatively small segment of the primary care physician market—by most estimates, their representation hovers between 10-20 percent, though it can be difficult to calculate precisely because membership fees and direct payments to practitioners don’t factor into health insurance claims data analysis—there is an undisputed groundswell of interest among patients, doctors, and healthcare policymakers.

Evidently, for good reason.