As burnout and job dissatisfaction rises among U.S. physicians, many have investigated switching to a Direct Primary Care (DPC) model as a form of relief. The alternative to traditional fee-for-service billing is seen by many as a way to refresh careers and return more of an office visit’s focus to the patient.
In 2015, the average monthly fee for DPC was $77.38, this compares to $182.76 for concierge medical practices, according to The Journal of the American Board of Family Medicine. This typically covers unrestricted next day or same day appointments, prolonged visits, direct communication via text, email, phone, virtual visits, and access to greatly discounted ancillaries such as in-house generic medications, labs, and imaging.
Recent reports published by Forbes indicate that DPC increases access and comprehensive medical care, and reduces overall cost when compared to a consumer-driven health plan and traditional insurance plans.
The model certainly provides hope for an improved patient experience, however any formal evaluation of a DPC practitioner’s experience within this model is limited.
In the U.S., clinician burnout and poor job satisfaction has become endemic. Enough so that a fourth aim of healthcare has taken hold—clinician and staff satisfaction; first discussed in a 2014 volume of The Annals of Family Medicine.
The “professional morale, practice patterns, career plans, and perspectives” of U.S. physicians were recently examined by The Physicians Foundation with help from Merritt-Hawkins in the 2016 Survey of American Physicians. The survey reported that amongst primary care physicians, 49.5 percent rate their morale and view on the current state of the medical profession as somewhat or very negative, 47.5 percent often or always experience feelings of burn-out, and 46 percent said they would not recommend medicine as a career to their children or other young people.
Looking deeper into the survey, possible explanations for these responses arise: 78.9 percent of primary care physicians identified patient relationships as a top source of job satisfaction but only 11.1 percent reported having the time needed with patients to provide the highest standards of care. Meanwhile, 51.4 percent reported time with patients as “always” or “often” limited. The top three factors identified as “least satisfying” about medical practice were erosion of clinical autonomy, regulatory/paperwork burdens, and inefficient EHR design.
In a recent article published in Medical Economics, a physician stated the multiple issues with EHRs is “magnify(ing) a shortage of primary care doctors….across the country.”
DPC vs. PCP attitudes
DPC has been touted as a healthcare delivery model that provides physicians with greater clinical autonomy, more time with patients, relief from the paperwork burdens associated with insurance-based practices, and headaches associated with billing-focused EHR systems.
The 2016 Survey of American Physicians did not examine DPC physicians as an aggregate. Therefore, the Moral and Practice Patterns of DPC Providers consisting of an online survey sent out to practicing DPC physicians in September 2017, was to see how these physicians’ responses compared to the responses of primary care physicians in the 2016 survey.
The Moral and Practice Patterns of DPC Providers is a first-look attempt to highlight the attitudes and outlooks of DPC physicians. Survey responses (n=72) were based on self-reported data and responses were not limited to one as that would have required a longer sign-in process respondents were not crosschecked to ensure that they were practicing DPC physicians. Data was not protected from researchers by a third party.
Doctors responded from 39 states; 76.4 percent reported themselves as family physicians, 13.9 percent as general internal medicine; and 72.2 percent were female, 27.8 percent were male. The average age was 43.5.
Notably, 9.7 percent reported often experiencing feelings of burnout and no respondents reported always experiencing feelings of burnout. This is down from 30.6 percent (often) and 16.9 percent (always) of primary care physicians in the 2016 Survey of American Physicians.
Nearly 14 percent said in the DPC survey that the negatives outweigh the positives and they would not choose to do medicine over again, compared to 27.4 percent from the 2016 survey. Nearly 67 percent report that they “would recommend medicine to their children and other young people” compared to 54 percent in the 2016 survey.
Perhaps as an explanation for these differences is that only 26.4 percent of DPC clinicians reported spending greater than 10 hours per week on “non-clinical (paperwork) duties” versus 48 percent of primary care providers in the 2016 survey. Nearly 46 percent of this survey’s respondents report working zero to five hours per week on these duties versus 21.3 percent of the 2016 survey respondents.