A recent study was published in Cureus which piqued my attention, and not only because I’ve long been interested in the direct care model. The study describes the characteristics of pediatricians practicing direct primary care, a subscription-based alternative to traditional insurance-based medical practice where a family or individual pays a single monthly fee for care rather than using insurance. By cutting out the middleman of insurance, DPC physicians can provide more personalized care to their patient panels, and often offer services like house calls, discounts on labs or common generic medications, and same and next-day appointments. Their patient panels tend to be smaller to allow for this personalized level of service, usually not exceeding more than a few hundred patients.
In terms of provider satisfaction with this care model, I’ll let this graph speak for itself:
In nearly every measure, the DPC docs surveyed were happier than at their old job. The lone exception not meeting statistical significance was compensation – and the researchers looked at this, too:
It’s fascinating to me that the docs surveyed, even with taking a salary cut in the first year, still were much happier on average than under their old arrangements.
So what can organizations still taking insurance learn from a study like this on DPC? I think there are several potential takeaways. First and most obviously, there is clearly more to the practice of medicine than the financial reward. The docs in the study didn’t make more in the first year, but were substantially happier. These happiness gains were made despite the fact that the docs were no more likely (at least statistically) to feel appropriately compensated than they were at their previous jobs. Employers and traditional practice owners should take note that there are other factors – the erosion of physician autonomy, the need for time off, and reducing administrative burden, for example – that can’t be solved by throwing more money at the problem. If the job is unsustainable, the job is unsustainable whether you make $5 or $500,000.
Secondly, I think it’s worth reflecting on why the care model is attractive to patients in the first place. DPC is the ultimate alternative to the legacy healthcare system. It is intensely relational in a way most modern practices are not. DPC docs text their patients, make house calls, and generally provide an extremely high level of service that focuses, for lack of a better term, on the customer experience. They do this by limiting panel size, and streamlining payment to providers – something systems can’t easily emulate. While systems might not have to compete for patients, they may need in the near future to compete for doctors – and if they don’t deliver on physician happiness the way DPC does, they may find themselves with plenty of patients, but no one to take care of them.
There’s always going to be a subset of docs who can’t hack it in a DPC model, whether due to poor business skills, poor relational skills, or both. If systems don’t want to be left with just those doctors, however, they need to get serious about addressing administrative burden and physician autonomy in primary care. The growing popularity of DPC, and the empirical success in improving physician happiness that this article demonstrates, should prompt anyone who works in a legacy health system to ask themselves whether they’re doing enough to promote autonomy in physician practice and reduce administrative burden. If they aren’t, they may find themselves managing an increasingly unhappy physician workforce – and eventually, unable to meet the needs of their patients on even a basic level.