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Direct Primary Care is Healthcare Without the Hassle

Mary Delila Tipton MD shares how she became a traffic cop in her crowded exam room instead of a primary care physician... and how she's opting out.

February 13, 2024

I usually spend my winter break planning out vacations and schedules for the year. But this year I spent my winter break planning out a whole new life. A whole new direction for my medical practice, my patients, and my family.

I was 22 years old starting medical school as a freshly minted chemical engineer, my chosen undergraduate degree. Four years of medical school and five years of residency later I joined a primary care practice in Utah. It is now 18 years and I am still working at the same insurance based practice. When I joined this practice, my oldest and only child was two.  Now he’s almost twenty and I have four children. 

In almost three decades since I started medical school and dedicated my heart and soul to the practice of medicine, a lot has changed… but some things stayed exactly the same:

I love solving problems. 

I love helping people.

I love learning new things.

I love seeing patients. 

I count them as part of my extended family. I relish the fact that I can be present for some of the most joyful, terrifying and tragic parts of my patients’ lives. 

 

Who are all these middlemen crowding me in my sacred “safe space”? 

 

I see my job as a privilege, a calling to which I have dedicated a huge part of my life, my passions, and even my health. Despite the sacrifices made I do not regret my choice. I love watching infants grow bigger, the old folks grow older and the fact that when I go to the office I feel like each visit is time to catch up with an old friend. 

Of course when I started, I thought the only two people in the exam room would be me and the patient.  Silly me. 

The exam room is crowded with a bunch of people.  My attention is split between these intruders and the patient in my current insurance based practice.

Who are all these middlemen crowding me in my sacred “safe space”? 

We’ve got an insurance company whose goal is to get in the way of spending some of those astronomical premiums on actual care that benefits the patient. 

We have the pharmacy benefit manager, who uses opaque pricing and other schemes to pretend that they’re actually saving the patient money on their medications…. All the while collecting legalized kickbacks and funneling billions to their now vertically integrated insurance companies.

 

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There’s the employer of the patient who picked this insurance company. Not that they had much choice … having to constantly renegotiate plans for employees. Every year less benefits cost more and more dollars, dollars that come right out of my patient’s salary.

There’s the government. The Center for Medicare services bureaucracy creates mountains of paperwork and check boxes and even dictate specific visits that I have to have with my patient every year.  Visits with no added clinical value.

There’s the computer. The electronic medical record demands my attention as I struggle to add up to twenty codes per visit, type in carefully worded narratives and check a million boxes. It’s basically a cash register and data collection device for all of these above mentioned exam room intruders. Built to help them … not me or the patient.

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Even the state gets involved, because they control Medicaid. Both Medicaid and Medicare have reimbursements that are so low the only way to keep an insurance based practice viable is to maintain a very high volume usually with a non physician, i.e. short appointments with a nurse limited to one or two problems at the most.

We’ve got the pharmaceutical companies wedged in there too. They have created amazing medications for my patients but the price tag is astronomical.  The best treatments for diabetes cancer and heart failure can cost over $10,000 a month.

All these third parties drive up the cost and complexity of the system, and provide astonishingly little benefit to my patients considering the average insurance premium is over $1500 per family per month.

It’s getting really crowded in this exam room. I feel like I can hardly see the patient that I’m trying to help.  In the insurance model I’m not even a doctor…. I’m a traffic cop on crowd control duty. 15 minutes at a time. All. Day. Long.

 

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About a year ago after a series of punishing eighteen hour workdays I made my final decision that I could not continue like this. I will get off this train careening towards the land of substandard healthcare. 

What is the price of admission for this high speed train? Non consensual compromises for my patients and for me.

I love my patients, I want to provide them with the highest quality personalized attention that I can offer, but I am unable to do that in an insurance based practice. 

In 2024 I will open a new practice called Blossom Health. It is a membership based model for patients called direct primary care. I believe this model takes all of the good and eliminates much of the bad in the insurance system. 

It is called direct because I will contract directly with the patient and only with the patient. There will be no insurance companies in the way of my ability to care for my extended family for the last eighteen years.

It is called primary because healthcare is of primary importance and I provide the most important, basic head to toe cradle to grave care for patients. It is estimated that a good primary care physician can take care of almost 90% of one’s healthcare needs. In my new practice model I will be doing just that. 

The word care is included because I care enough to want to provide the type of care I can only provide with extended appointments times, direct timely access to me and the ability to meet patients where they are at using text, phone call, or video.  I can do this because I don’t have an insurance company to tell me I cannot.

 

 

Direct primary care, also known as DPC, is a membership based practice. The members of my practice called Blossom Health will pay an affordable monthly fee similar to the cost of a mobile phone bill. No copays, no surprise bills, just an exam room with only two people in it. 

Imagine having personalized expert care from your physician when and where you need it. 

Imagine feeling confident that your physician will partner with you on health related decisions for you and your loved ones. Imagine if your physician worked for you, not the insurance company.

Join the direct primary care movement and say goodbye to crowded waiting rooms, answering machines and all the runaround. 

It’s healthcare; without the hassle.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.

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17 Responses

  1. Sure there’s the deductible with Health Insurance, then there’s the co-pays even before the deductible is met… but, with Direct Health now does that factor into medicine prescriptions and MRI/CD or ultrasound scans- those are also at a high price. It seems everyone needs some sort of insurance anyway.

    1. When you cut out insurance and negotiated rates/facilities, you find that none of those things actually cost that much money. I can get a cash pay brain MRI for ~$250 near me, 1/2 that for a CT. Labs done by the same companies you use now, like Labcorp, are $5-20 per lab, nothing crazy.

  2. You articulated very clearly what many PCP’s juggle on a daily basis! Best of luck in your new endeavor!

  3. Dr. Tipton,

    I enjoyed your essay. I was a family doc in Ft. Collins, CO, for 18 years in a small FP group setting (2 to 6 docs), from 1978 to 1996 (pre-internet of course). Three of those years I was also a residency director. The next 20 years were in Occupational Medicine–also a rewarding primary care field–just as many rules but equally satisfying and better hours.

    Were I practicing today (I retired at age 68) I’d go the concierge route as you are doing. Hope it works out well for you.

  4. Welcome to the fabulous world of DPC Mary! After living what sounds like your life for 23 years (but just with 2 kids) I started my own DPC practice nearly 5 years ago. I absolutely love this practice model and could never, ever, go back to the craziness of insurance based so-called medical care again. My patients are thrilled with the change as well, and I love being able to provide the care and support they need without an insurance company intervening. In my opinion a person’s health should not be a business, rather a human right, but DPC allows us to make a good living while also providing the fabulous care of patients that we trained for so many years to do. Congrats and best wishes for your new life!

  5. This sounds great but it feeds the problem of massage shortage of primary care. If I left my 2,500 patients and went down to 500, that leaves 2,000 patients high and dry.
    I’ve done primary care for 22 years and the patient still comes first.

    1. This is a tough problem.
      Many docs choosing DPC are doing so as an alternative to leaving Medicine altogether so in that way 500 is more than zero.
      Many DPC docs are also working hard to teach other docs how the model works and bring more students into primary care by showing them a better way.
      I know my thousands of patients are not getting A+ care in the current model. I plan to keep working hard to advocate for change but in order to do that I need to opt out of insurance.

  6. Well written and on point. Especially the EHR; what a disaster for us physicians! Sure doesn’t save us any time.

  7. Today, DPC sounds like a non-system of privileged physicians caring for privileged patients. Medicare and Medicaid, with all their intrusive flaws, are a lifeline for the patients I care for. “Pay to play” is not an option for these patients, so it’s not for me. Please comment on more equitable ways to practice DPC that have escaped my attention!

    1. It is all a matter of perspective, although I appreciate your concerns. I have many Medicare patients who will be paying to see me because their access is so poor, i.e. there are no doctors taking Medicare patients. As Medicaid and Medicare expand there are more people with an insurance card and no doctor to see them. That is not equitable either.
      Many physicians who change to DPC are doing that instead of leaving medicine altogether which would leave even fewer patients with care. It is my opinion that a small portion of the money funneled to entitlement programs would be well spent by allowing enrollees to choose a DPC doc to care for them. i.e a Medicaid card, like a WICC card that can pay for a monthly membership, giving that Medicaid patient a choice and excellent care. Those in the DPC world are working on setting up pilot projects in various states to do just this.

    2. My thoughts exactly. My Medicare and Medicaid patients can’t afford the out of pocket costs for imaging studies, etc. I would still have the state and federal government and insurance company “in the exam room” as I try to mitigate the out of pocket costs for the patient. The reality is while DPC will be great for some, it is not likely feasible for folks with minimal insurance they purchased on the exchange. They are not in the tax bracket to be able to afford concierge medicine models.

  8. Absolutely correct. Superbly written.

    Started one of the first DPC practices in my suburban area and had a mix of patients, including quite a few Medicare-eligible folks. What many don’t realize is that when you are free to negotiate on behalf of your patients for reasonable (non-inflated) prices, you can save them a tremendous amount of money. Many of them find that their “free” Medicare health care is anything but free, and ultimately they can see a DPC physician at no net increase in their out-of-pocket cost, but with vastly better service.

    DPC may not be the complete solution to our country’s healthcare problem, but I am absolutely convinced it is an enormous part of that solution.

    God bless you in your work,

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