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Why I'm changing to the direct primary care model

In my previous blog, I discussed direct primary care (DPC) and what it means to a patient who enrolls in our practice, Direct Primary Care of Eugene. DPC is primary care as it is meant to be. The doctor is available able to focus on getting you well and to take the time to work with you on an individualized and comprehensive wellness and prevention plan. You get the doctors direct phone number and there are no long waits for appointments. But let’s be honest, this model not only benefits the patient but also the doctor.

It was 19 years ago this week that I finished my training at the University of Iowa in Iowa City and moved to Newport, Oregon to begin my career as a doctor. I had chosen internal medicine as a specialty because it best allowed me to use my analytical mind. I wanted to take an interest and make a difference in the health of my patients using a systematic approach- come up with a plan for each diagnosis (or ‘problem’) on the list on any given day, and by guiding the patient to carry out these plans the whole person should get better. Blend in my natural compassion and a chance to get to know my patients’ interests and backgrounds, and you have my ‘practice style’ in a nutshell. A word about that last part: I’ve always said I remember a patient best not by the diagnoses or medication list, but rather by his or her story. Things like hometown, interests, what their children do. What plane did the person fly in the war? In essence, I enjoy that connection.

I have discovered these things about myself over the past 19 years while trying to exist in a healthcare system that demands I take time away from patients to focus on billing, insurance forms and government regulations. I became good at seeing 25 or more patients and filling out all the forms, but it has made it all but impossible to keep my ‘style.’ I think that is bad for patients. If a person doesn’t understand all his or her medical issues and have a coherent plan to deal with each one, how can he or she expect to get and stay well? The goal of primary care is to help patients feel better and live longer. When the patient-physician bond is being broken by the ever-increasing clerical demands being placed on the physician, it’s bad for all concerned.

I have been following the direct primary care movement for over a decade. It appeals to me because it suits my style of practice, for sure. However, there is also more and more evidence to show that it reduces healthcare costs overall compared to care via traditional systems of care, all while improving overall quality of care in measurable ways. Thus, DPC provides better care for less money. Personally, I believe there will be a continued trend to higher deductible insurance plans which will be used for expensive items like procedures and hospitalizations. This leaves an opportunity for physicians and patients to contract for affordable primary care services. A popular analogy is auto insurance- it’s there when you need it when something bad happens like an accident or a tornado, but it is never been used for oil changes or car maintenance. It’s how insurance is supposed to work.

But what if a patient can’t afford to join a direct primary care practice? Isn’t it just for wealthy people? This is a common misconception. The fees at Direct Primary Care of Eugene are set to be affordable to most- less than a trip to Starbucks daily and comparable to the cost of a cell phone each month. It is certainly less than a pack of cigarettes daily. In my opinion, there is no way around the fact that it is the best investment you could make in your health. Furthermore, as I discussed in the prior blog entry, there are ways to recover the costs of a DPC membership via reduced insurance, medication and laboratory fees.

So 19 years after arriving in Oregon as a physician still wet behind the ears, and after thousands of wonderful (but too rushed) visits with patients who have taught me so much, I am joining the grassroots movement of direct primary care by starting Direct Primary Care of Eugene. After reading this I hope you better understand my motivations and the value that I can bring to you in my redefined role as primary care physician and wellness coach. Come and experience the difference, because it is very different from anything you may have experienced before from your doctor.

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