Your voice: Direct pay practices benefit the few, not the many

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I see more and more articles about direct patient care (DPC) practices and how wonderful they are, including a recent article by Rob Lamberts, MD (The Last Word, December 10, 2018 issue). These articles all sing the praises of converting to DPC, how it eliminates burnout for the physicians and allows them to spend much more time with the patients.

But there is a dark side to the conversion that nobody in the DPC camp ever seems to talk about. While the new practice model might be great for the select group of patients who agree to stay on and pay their monthly fees, what about everyone else? Dr. Lamberts wrote that he averages 8 to 11 patients per day. I wonder how many he was seeing before he made the switch. In my practice, I was routinely seeing 25 to 30 patients per day. Had I jumped on the DPC bandwagon, that would have meant that about 20 patients per day would have been displaced and forced to find a new family doctor.

We all know that there is a primary care shortage. Every time a traditional practice converts to a DPC model, the gap grows wider. It benefits the few at the expense of the many. There aren’t nearly enough other family practices to absorb all of those patients. So while the switch might be great for the provider who does it, what burden is it putting on the healthcare system overall? How many more unnecessary emergency department visits are there as a result of decreased access? How many patients with chronic conditions like diabetes and hypertension become uncontrolled because they aren’t able to find a new doctor in the area? Other area physicians are often forced to close to new patients any time another local doctor retires or otherwise leaves the neighborhood. That happened a couple of times in my practice. I can only imagine that the same thing happens when a practice converts to DPC and cuts loose a couple thousand patients who suddenly need to find a new doctor.

None of this is to suggest that doctors shouldn’t do what’s best for themselves and their practices. I myself left private Family Practice and moved to Urgent Care. I just can’t help but wonder where the thousands of patients who get displaced are supposed to go for care once their family doctors can no longer see them. Urgent Care picks up a lot of the slack for acute care needs (I still see 25 to 30 patients per day) but they don’t handle chronic conditions. Especially as the population ages, there is an ever-growing need for better primary care access. It seems to me that a growing DPC movement will make the access situation even worse.

I certainly don’t have the answer but it’s definitely a problem that needs attention.

Steven Gitler, DO

Cherry Hill, N.J.

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