Direct Primary Care, a Controversial Topic on Personal Statement?

[jeb26]

Hello,

I am a senior currently writing my personal statement for medical school (I will not be applying until next summer), and have read time and time again that you should not include controversial topics in your personal statement. I am curious if wanting to go into Direct Primary Care (Family Medicine) is considered controversial? I started talking about it in my personal statement because a year ago I received a truly outrageous medical bill for an urgent care visit that lasted ten minutes for something as minor as a UTI. It really changed what I wanted to do in terms of medicine and it had a profound impact on me by making me aware of some of the serious flaws in our healthcare system. I even volunteer in a mixed direct primary care/ free clinic setting and I think it is truly a solution to a huge failing of our healthcare system. I don't want to get too much into why DPC is or isn't a good model, but I do want to make sure that this isn't something that would turn off anyone reading my personal statement.

Thanks!

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[deleted480308]

Hello,

I am a senior currently writing my personal statement for medical school (I will not be applying until next summer), and have read time and time again that you should not include controversial topics in your personal statement. I am curious if wanting to go into Direct Primary Care (Family Medicine) is considered controversial? I started talking about it in my personal statement because a year ago I received a truly outrageous medical bill for an urgent care visit that lasted ten minutes for something as minor as a UTI. It really changed what I wanted to do in terms of medicine and it had a profound impact on me by making me aware of some of the serious flaws in our healthcare system. I even volunteer in a mixed direct primary care/ free clinic setting and I think it is truly a solution to a huge failing of our healthcare system. I don't want to get too much into why DPC is or isn't a good model, but I do want to make sure that this isn't something that would turn off anyone reading my personal statement.

Thanks!

what do you think is outrageous for a doctor's visit and a UTI workup?

 

[LizzyM]

Folks here won't be able to answer your question unless they understand what it is that you are asking about. "The direct primary care (DPC) model gives family physicians a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee (i.e., a retainer) that covers all or most primary care services including clinical, laboratory, and consultative services,"

How does this serve anyone except the wealthy who can afford to pay a flat fee whether or not they use your services in a given quarter? Patients still need to have health insurance to cover the cost of hospitalizations, diagnostic imaging, etc.

Why not just become a practicing primary care provider (physician) in a closed panel HMO where patients pay a flat fee, like an insurance premium, for all their care both primary care and specialty care?

Why does the manner in which patients pay you for your services matter to you as a practitioner?

 

[jeb26]

what do you think is outrageous for a doctor's visit and a UTI workup?

It was $700 for what was literally a ten minute visit, never even saw a doctor, I saw a PA. I have a high deductible insurance plan, so I had to pay for it completely out of pocket. This is where I think direct primary care could really be advantageous, for people with high deductible insurance (seems to be becoming the norm). If I had had a direct primary care physician I would have been able to call them rather than have to go to the urgent care center (this is what I have seen of most direct care physicians at least, with less patient load they are able to make themselves available on off hours for emergencies).

And to be clear I'm not talking about concierge medicine. I'm talking about the "radical" idea of having patients pay for the actual costs of healthcare rather than the ridiculous prices hospitals charge that in no way actually reflect what the actual cost of the service was. For example I was charged $100 for a urinalysis, which I know for a fact cost much less than $10.

 

[deleted480308]

It was $700 for what was literally a ten minute visit, never even saw a doctor, I saw a PA.

did you not ask them their fees before you went in? avg cost of a UTI workup in urgent care is less than half that...

 

[jeb26]

did you not ask them their fees before you went in? avg cost of a UTI workup in urgent care is less than half that...

I actually did and they said they couldn't possibly know until after I had been seen. I knew I had a UTI and I told them that, I told them I've had them before and they wouldn't even give me an estimate. Regardless, I was in a lot of pain and despite the fact that I live in a decently large city, it was the ONLY place open at that time that wasn't an emergency room.

This is off topic though. I'm simply wondering if this is or isn't a controversial topic for a medical school application, I am obviously not going to go into all this detail on an application.

 

[deleted480308]

I actually did and they said they couldn't possibly know until after I had been seen. I knew I had a UTI and I told them that, I told them I've had them before and they wouldn't even give me an estimate. Regardless, I was in a lot of pain and despite the fact that I live in a decently large city, it was the ONLY place open at that time that wasn't an emergency room.

This is off topic though. I'm simply wondering if this is or isn't a controversial topic for a medical school application, I am obviously not going to go into all this detail on an application.

The reason I ask (adcoms might too) is because when someone describes the cost of something as "unreasonable" I often get skeptical of their comprehension about business and how economics actually works. I don't know all the test they gave you or the detailed billing but you paid a premium for services because you wanted a very scarce product. Medical care at very weird hours is expensive because most docs want their weekends and evenings off. So the urgent care center only has to compete with EDs and they are much more expensive.

So direct primary care doesn't even kind of solve your problem. Direct primary care has business hours too in most cases. You went outside of business hours for a totally routine, non-emergent issue. It's basically a textbook example of how bad patient behaviors increase costs.

 

[jeb26]

Folks here won't be able to answer your question unless they understand what it is that you are asking about. "The direct primary care (DPC) model gives family physicians a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee (i.e., a retainer) that covers all or most primary care services including clinical, laboratory, and consultative services,"

How does this serve anyone except the wealthy who can afford to pay a flat fee whether or not they use your services in a given quarter? Patients still need to have health insurance to cover the cost of hospitalizations, diagnostic imaging, etc.

Why not just become a practicing primary care provider (physician) in a closed panel HMO where patients pay a flat fee, like an insurance premium, for all their care both primary care and specialty care?

Why does the manner in which patients pay you for your services matter to you as a practitioner?

This type of care is not concierge medicine and is not at all geared at the wealthy. Monthly fees at direct primary care practices are modest (~$50 a month), and are significantly less than most peoples monthly phone bill. It is certainly advantageous (in terms of quality healthcare and increased physician access) for those who are in the middle class, but I agree it seems unlikely that those who are poor would want to pay a monthly fee for healthcare. They would probably just risk not going in for minor problems, even if this means having to go to the ER later and more costs in the long run (I see this happen too often). That's why I've really been inspired by the current practice I volunteer at because I think it solves this problem by offering affordable, quality healthcare to those who are able to pay a monthly fee, and free healthcare to those who are unable to pay that fee, but it allows them to still have quality preventative primary care. It reduces overall costs by cutting out most of the administrative costs associated with insurance, and allows more time for each individual to spend with the physician which will likely in the long run lead to decreases in health costs for the individual.

 

[jeb26]

The reason I ask (adcoms might too) is because when someone describes the cost of something as "unreasonable" I often get skeptical of their comprehension about business and how economics actually works. I don't know all the test they gave you or the detailed billing but you paid a premium for services because you wanted a very scarce product. Medical care at very weird hours is expensive because most docs want their weekends and evenings off. So the urgent care center only has to compete with EDs and they are much more expensive.

So direct primary care doesn't even kind of solve your problem. Direct primary care has business hours too in most cases. You went outside of business hours for a totally routine, non-emergent issue. It's basically a textbook example of how bad patient behaviors increase costs.

Sorry but unless you have had a severe and incredibly painful UTI, you don't get to comment on the "emergency" of that particular situation. And most of the direct primary care practices I have looked in to (and certainly the one I would run) do allow patients to call them for emergencies. It is one of the benefits of having a reduced patient load. A doctor with 2,200 patients would not be able to do this. So I would argue that is does solve that problem.
And the issue with healthcare and healthcare costs is the fact that they are charging (somehow legally, it astounds me) prices for services and just basic medical equipment that is many many times the actual cost of those items. Have you ever seen some of the "chargemaster" costs at hospitals? They don't at all reflect the costs of those services/equipment.
THAT is why my bill was $700. Because I was charge $100 for a urinalysis, $100 for a pregnancy test (an unnecessary one at that), $120 for a bacterial culture, and then another $200 for two more lab tests that I don't recall anymore. And then $200 for the doctor's charge (regardless of the fact that I never saw a doctor and there wasn't even one at the urgent care center) and room fee. Those fees do not at all reflect the costs of those tests.
I want the autonomy to run my own practice, to charge people fair prices for health care, without going bankrupt and being overly burdened with insurance filing and administrative duties that cut into patient time and decrease the quality of their care at an increased cost.

 

[jeb26]

Folks here won't be able to answer your question unless they understand what it is that you are asking about. "The direct primary care (DPC) model gives family physicians a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee (i.e., a retainer) that covers all or most primary care services including clinical, laboratory, and consultative services,"

How does this serve anyone except the wealthy who can afford to pay a flat fee whether or not they use your services in a given quarter? Patients still need to have health insurance to cover the cost of hospitalizations, diagnostic imaging, etc.

Why not just become a practicing primary care provider (physician) in a closed panel HMO where patients pay a flat fee, like an insurance premium, for all their care both primary care and specialty care?

Why does the manner in which patients pay you for your services matter to you as a practitioner?

And to answer your other comment, yes I agree that direct primary care should be used in combination with insurance. But more and more insurance plans are becoming high deductible insurance plans, so the cost of primary care comes out of pocket and as a result makes people less likely to seek out primary care. This increases health care costs because people don't seek out help until the problem is exasperated and the problems because much more difficult to treat (if it can be treated at all at that point). The state of the United States primary care system currently is a disgrace

And I DO care how and what patients pay. I do not want to treat a patient and then turn the other cheek as a hospital tries to gauge them for every penny they can get. Morally, I can not and will not do that as a doctor. This is one of the reasons I would like to run my own practice, so I can charge fair prices for healthcare and offer quality care (not the 7 minutes per patient business most hospitals require of family medicine doctors). DPC offers a way to do this.

 

[deleted480308]

Sorry but unless you have had a severe and incredibly painful UTI, you don't get to comment on the "emergency" of that particular situation. And most of the direct primary care practices I have looked in to (and certainly the one I would run) do allow patients to call them for emergencies. It is one of the benefits of having a reduced patient load. A doctor with 2,200 patients would not be able to do this. So I would argue that is does solve that problem.
And the issue with healthcare and healthcare costs is the fact that they are charging (somehow legally, it astounds me) prices for services and just basic medical equipment that is many many times the actual cost of those items. Have you ever seen some of the "chargemaster" costs at hospitals? They don't at all reflect the costs of those services/equipment.
THAT is why my bill was $700. Because I was charge $100 for a urinalysis, $100 for a pregnancy test (an unnecessary one at that), $120 for a bacterial culture, and then another $200 for two more lab tests that I don't recall anymore. And then $200 for the doctor's charge (regardless of the fact that I never saw a doctor and there wasn't even one at the urgent care center) and room fee. Those fees do not at all reflect the costs of those tests.
I want the autonomy to run my own practice, to charge people fair prices for health care, without going bankrupt and being overly burdened with insurance filing and administrative duties that cut into patient time and decrease the quality of their care at an increased cost.

I'm a huge fan of direct primary care. You can't begin to understand how much I love the model. What I'm pointing out though is that your arguments are weak. Every female of childbearing age gets a pregnancy screen. It's to make sure you don't get something you shouldn't in case you are pregnant for liability reasons. It's marked up because that's what businesses do, mark things up. They do more lab tests than you understand because they have to rule out things you don't understand for liability and to make sure you get the appropriate meds, again marked up because that's how businesses work. The culture is again to check for what you have for proper treatment and liability, again marked up because....business. And all the markups are high because if the only other game in town is an ED because patients (yourself included) will consistently wait until after hours to decide that a non-emergency is now an emergency......then you can charge anything you want and it's still the cheapest game in town. The urgent care didn't screw you over....the urgent care saved you the cost difference you would have paid at an ED that night/weekend. You should be thanking the urgent care.

You want to corner the market? open a shop next door and do uti workups at 11pm on sunday for $600

 

[jeb26]

I'm a huge fan of direct primary care. You can't begin to understand how much I love the model. What I'm pointing out though is that your arguments are weak. Every female of childbearing age gets a pregnancy screen. It's to make sure you don't get something you shouldn't in case you are pregnant for liability reasons. It's marked up because that's what businesses do, mark things up. They do more lab tests than you understand because they have to rule out things you don't understand for liability and to make sure you get the appropriate meds, again marked up because that's how businesses work. The culture is again to check for what you have for proper treatment and liability, again marked up because....business. And all the markups are high because if the only other game in town is an ED because patients (yourself included) will consistently wait until after hours to decide that a non-emergency is now an emergency......then you can charge anything you want and it's still the cheapest game in town. The urgent care didn't screw you over....the urgent care saved you the cost difference you would have paid at an ED that night/weekend. You should be thanking the urgent care.

You want to corner the market? open a shop next door and do uti workups at 11pm on sunday for $600

I think we are very different people. I'm not interested in price gauging people. I'm interested in giving people quality and affordable healthcare. I don't need to "prove" DPC works as a viable business model because doctor's currently are already proving that is does. I was simply wondering if this is going to be controversial in a personal statement. Keeping in mind that a personal statement must be short and concise and I don't want to be making a long argument for whether DPC is beneficial to patients or not.

 

[deleted480308]

I think we are very different people. I'm not interested in price gauging people. I'm interested in giving people quality and affordable healthcare. I don't need to "prove" DPC works as a viable business model because doctor's currently are already proving that is does. I was simply wondering if this is going to be controversial in a personal statement. Keeping in mind that a personal statement must be short and concise and I don't want to be making a long argument for whether DPC is beneficial to patients or not.

you quite literally are not listening to me....I wish you well

 

[jeb26]

I'm a huge fan of direct primary care. You can't begin to understand how much I love the model. What I'm pointing out though is that your arguments are weak. Every female of childbearing age gets a pregnancy screen. It's to make sure you don't get something you shouldn't in case you are pregnant for liability reasons. It's marked up because that's what businesses do, mark things up. They do more lab tests than you understand because they have to rule out things you don't understand for liability and to make sure you get the appropriate meds, again marked up because that's how businesses work. The culture is again to check for what you have for proper treatment and liability, again marked up because....business. And all the markups are high because if the only other game in town is an ED because patients (yourself included) will consistently wait until after hours to decide that a non-emergency is now an emergency......then you can charge anything you want and it's still the cheapest game in town. The urgent care didn't screw you over....the urgent care saved you the cost difference you would have paid at an ED that night/weekend. You should be thanking the urgent care.

You want to corner the market? open a shop next door and do uti workups at 11pm on sunday for $600

you quite literally are not listening to me....I wish you well

No I hear you. They are doing it because they can and hospitals nowadays are first and foremost businesses. Thank you for the insight? I very much knew that already. I feel very confident that for that reason the type of DPC clinic I would run would be very successful. That is not my worry. My problem is I'm afraid that my personal statement is either A) going to be controversial or B) I'm going to have to spend too much time defending DPC as a business model that is beneficial to patients when I should be spending time discussing why it is I would make a good doctor and what made me want to become a doctor.

 

[Kissmyabjj]

I would be careful writing about this topic for the simple reason that many of the docs reading it will not be familiar with direct primary care and will not take kindly to an applicant discussing reinventing the wheel. It is annoying and depressing, but I experienced this personally when I was interviewing for residency. It is always better to let the interviewers feel like the experts.

 

[jeb26]

I would be careful writing about this topic for the simple reason that many of the docs reading it will not be familiar with direct primary care and will not take kindly to an applicant discussing reinventing the wheel. It is annoying and depressing, but I experienced this personally when I was interviewing for residency. It is always better to let the interviewers feel like the experts.

Thank you for directly addressing my question! I will definitely take this into consideration!

This is rather unfortunate for me because I am really very very passionate about it. But I am also very passionate about family medicine (not the type of family medicine where you only get to see patients for 7 minutes as it is now, but the type of family medicine I could do in a DPC practice). I think I could work my way around this though in my application and interviews.

 

[gyngyn]

Thank you for directly addressing my question! I will definitely take this into consideration!

This is rather unfortunate for me because I am really very very passionate about it. But I am also very passionate about family medicine (not the type of family medicine where you only get to see patients for 7 minutes as it is now, but the type of family medicine I could do in a DPC practice). I think I could work my way around this though in my application and interviews.

Tell us how it goes.

 

[Pusheen]

I would just suggest picking a different example if you were to talk about your experience.
Sorry if tmi, but I have also had a terrible uti. I went to the pharmacy and got those urinary tract numbing pills and waited till the next morning to see a pcp. I've been asked to take pregnancy tests in these situations and I've been able to convince the doc that I'm not pregnant.
You raise an interesting point, but I think you don't have the best example

 

[jeb26]

I would just suggest picking a different example if you were to talk about your experience.
Sorry if tmi, but I have also had a terrible uti. I went to the pharmacy and got those urinary tract numbing pills and waited till the next morning to see a pcp. I've been asked to take pregnancy tests in these situations and I've been able to convince the doc that I'm not pregnant.
You raise an interesting point, but I think you don't have the best example

I understand what you're saying. I only use it because this seemingly small event actually ended up having a surprisingly large impact on my career goals and career focus. A large part of the medical school personal statement is supposed to be about the "journey" of how you decided you wanted to become a doctor, and I consider this a huge part of that. That being said, with all these comments I am probably no longer going to mention DPC in my application.

 

[LizzyM]

You want to practice medicine. You want to diagnose and treat illnesses in adults and children and offer preventive services. You want to provide the best possible care in your community. That's all you really need to say. From what you have said, I believe that I am not putting words in your mouth. How your practice is structured and how you are compensated should not be part of your personal statement. Too many things are likely to change over the next 10 years; don't go out on a limb which is not necessary to make your point about why you want to be a doc. Stating that you are interested in a specific practice model will not make you a more attractive candidate or make you a person more likely to be admitted and that is your goal at this point.

 

[libertyyne]

It was $700 for what was literally a ten minute visit, never even saw a doctor, I saw a PA. I have a high deductible insurance plan, so I had to pay for it completely out of pocket. This is where I think direct primary care could really be advantageous, for people with high deductible insurance (seems to be becoming the norm). If I had had a direct primary care physician I would have been able to call them rather than have to go to the urgent care center (this is what I have seen of most direct care physicians at least, with less patient load they are able to make themselves available on off hours for emergencies).

And to be clear I'm not talking about concierge medicine. I'm talking about the "radical" idea of having patients pay for the actual costs of healthcare rather than the ridiculous prices hospitals charge that in no way actually reflect what the actual cost of the service was. For example I was charged $100 for a urinalysis, which I know for a fact cost much less than $10.

Yeah, patients are still out of luck if they have DPC if they need catastrophic hospital coverage. This is concierge medicine.

This does nothing to curb hospital spending. Nothing to address end of life care costs. or decrease Overutilizaiton. Or improve quality /access to the average joe.

 

[vm26]

Based on the response here I would change topics or make it less about politics/policy and more about your own personal vision

 

[jeb26]

You want to practice medicine. You want to diagnose and treat illnesses in adults and children and offer preventive services. You want to provide the best possible care in your community. That's all you really need to say. From what you have said, I believe that I am not putting words in your mouth. How your practice is structured and how you are compensated should not be part of your personal statement. Too many things are likely to change over the next 10 years; don't go out on a limb which is not necessary to make your point about why you want to be a doc. Stating that you are interested in a specific practice model will not make you a more attractive candidate or make you a person more likely to be admitted and that is your goal at this point.

Okay thank you very much for the advice! I see what you are saying.

 

[jeb26]

Yeah, patients are still out of luck if they have DPC if they need catastrophic hospital coverage. This is concierge medicine.

This does nothing to curb hospital spending. Nothing to address end of life care costs. or decrease Overutilizaiton. Or improve quality /access to the average joe.

Actually if you read another one of my posts, I agree that it needs to be in combination with high deductible insurance (which many people, myself included, have whether we like it or not). It offers affordable preventative, primary care to people who would not seek it otherwise because of their high deductible insurance. It fills a gap in the health care system.
It doesn't do anything to curb hospital spending, it goes around hospitals. Hospital spending is only going to be curbed by political reform of healthcare, unfortunately, something I have no interest getting involved in. However, direct primary care does offer a different solution that does in fact improve quality of care and access for the "average joe". The typical monthly cost of direct primary care (~$50 a month) is absolutely affordable to most people, and will save people money in the long term (for those with high deductible insurance plans). I am sure there are other threads about the advantages of DPC so I won't go too into it, because this was about the controversiality of DPC and whether appropriate to mention in a medical admissions personal statement, which I have decided I will not.

 

[Kissmyabjj]

I really do appreciate how passionate you are. I feel largely the same way. I even founded the first ever finance-related club at my medical school and hosted a teleconference with a direct primary care practitioner.

It really is unfortunate how uninformed most physicians are about this type of medical practice.

Having said that, I would just implore you to be careful not to push this issue too hard until you get accepted. One thing I have struggled to learn throughout my (still quite young) medical career is that most people don't take kindly to subordinates pointing out a better way to do something. And while you may not feel like you are doing that, you need to assume that is how it will be interpreted. Wait until you get accepted to start trying to change the system.

Don't worry that you won't come across as passionate if you don't bring up this issue. You have plenty of passion and trust me, people will notice.

Thank you for directly addressing my question! I will definitely take this into consideration!

This is rather unfortunate for me because I am really very very passionate about it. But I am also very passionate about family medicine (not the type of family medicine where you only get to see patients for 7 minutes as it is now, but the type of family medicine I could do in a DPC practice). I think I could work my way around this though in my application and interviews.

 

[ChrisMack390]

"Direct primary care" aka concierge medicine, has always come off to me as primary care for rich people who think they are too important to sit in a waiting room.

I'm not an adcom, but if I was I would find this a very short sighted career goal.

 

[jqueb29]

THAT is why my bill was $700. Because I was charge $100 for a urinalysis, $100 for a pregnancy test (an unnecessary one at that)

Unless you are a man or a pre-menarche/post-menopausal woman, you ALWAYS get a pregnancy test. You should learn a little bit about how medicine is practiced before you rail against how it is practiced. And this is coming from someone who is a fan of the DPC model. I hate the whole taboo of "oh it's bad ethics to focus on the economics of the system, just focus 100% on patient care!". You can impress adcoms by having a strong knowledge base about the economics of different care models, but you WILL do more harm than good in terms of the adcom's impression of you if you go off about something that you clearly don't understand yet. Passion is great, but it has to be backed up by substance.

 

[deleted547631]

"Direct primary care" aka concierge medicine, has always come off to me as primary care for rich people who think they are too important to sit in a waiting room.

I'm not an adcom, but if I was I would find this a very short sighted career goal.

Direct primary care is not concierge medicine. Is paying $60-$100 per month for immediate 24/7 physician access something only rich people can do?

OP, the post above is reason enough not to discuss it in your personal statement.

 

[ChrisMack390]

Is paying $60-$100 per month for immediate 24/7 physician access something only rich people can do?

Um....yes. Yes it is.

 

[deleted547631]

Um....yes. Yes it is.

We're talking the same price of a monthly cell phone bill here. It comes down to priorities.

Here's some AAFP literature on it:
http://www.aafp.org/practice-management/payment/dpc.html
http://www.aafpins.com/2016/03/direct-primary-care-vs-concierge-medicine-which-is-right-for-you/

KevinMD: http://www.kevinmd.com/blog/2014/08/direct-primary-care-concierge-medicine-theyre.html

 

[LizzyM]

I don't know about you but my husband and I don't have $2400 lying around to pay up front for the opportunity to see the doctor if we need to. Our high deductable plan already covers preventive services and our out of pocket in an average year runs < $1,000 so $2400 seems a bad bargain for a middle class couple without chronic health issues.

 

[libertyyne]

About 36% of all Americans have less than a 1000 dollars saved up. http://www.usatoday.com/story/money...retirement-confidence-survey-savings/6432241/

 

[candbgirl]

So OP what does that ~$50 per month cover? Labs, X-rays, ???


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[deleted547631]

About 36% of all Americans have less than a 1000 dollars saved up. http://www.usatoday.com/story/money...retirement-confidence-survey-savings/6432241/

Yes. Good point! It's mainly 50+ year olds enrolling in DPC from what I gather.

I don't know about you but my husband and I don't have $2400 lying around to pay up front for the opportunity to see the doctor if we need to. Our high deductable plan already covers preventive services and our out of pocket in an average year runs < $1,000 so $2400 seems a bad bargain for a middle class couple without chronic health issues.

I agree with you here, @LizzyM. Many insurers (i.e. NJ teacher's union) are opting to enroll their subscribers into DPC practices or at least have that option for $50/month cost to the insurer. That's a bargain considering the level of care: 45 minute+ appointments, same day or next day scheduling, discount drug dispensing, unlimited appointments, etc.

 

[Kissmyabjj]

So a direct primary care practitioner named Brian Forrest did a teleconference at my med school. There is an awesome YouTube clip of him discussing how he developed his practice model floating around somewhere.

He basically negotiated with the labs directly by offering to pay them cash on the spot and was able to get ridiculous discounts. The one example I can remember off the top of my head was that he could get a PSA for $5. Keep in mind this was in 2010-2011.

As far as other more specialized tests, the one interesting example he gave was a stress echo. He called the cardiologist he was going to refer a patient to and asked how much his office was reimbursed for the procedure by whichever insurance the patient had (I can't remember). The cardiologist told him something like $200, even though his office billed the insurance company like $800. The patient's copay for the procedure was like $300. So Dr. Forrest just asked the cardiologist if he would do the procedure for $200 cash. The end result was that it was cheaper for the patient and less of a hassle for the cardiologist.

Now there are some logistical issues with operating like this, namely that you can't be in-network with any of the major insurance carriers and you have to waive your right to reimbursement from Medicare. This makes getting a practice started difficult.

So OP what does that ~$50 per month cover? Labs, X-rays, ???


Sent from my iPad using SDN mobile app

 

[deleted547631]

So a direct primary care practitioner named Brian Forrest did a teleconference at my med school. There is an awesome YouTube clip of him discussing how he developed his practice model floating around somewhere.

He basically negotiated with the labs directly by offering to pay them cash on the spot and was able to get ridiculous discounts. The one example I can remember off the top of my head was that he could get a PSA for $5. Keep in mind this was in 2010-2011.

As far as other more specialized tests, the one interesting example he gave was a stress echo. He called the cardiologist he was going to refer a patient to and asked how much his office was reimbursed for the procedure by whichever insurance the patient had (I can't remember). The cardiologist told him something like $200, even though his office billed the insurance company like $800. The patient's copay for the procedure was like $300. So Dr. Forrest just asked the cardiologist if he would do the procedure for $200 cash. The end result was that it was cheaper for the patient and less of a hassle for the cardiologist.

Now there are some logistical issues with operating like this, namely that you can't be in-network with any of the major insurance carriers and you have to waive your right to reimbursement from Medicare. This makes getting a practice started difficult.

Dr Brian Forrest is an awesome example of DPC. Here's a great AAFP article profiling him when he was just starting out: http://www.aafp.org/fpm/2007/0600/p19.html

 

[AnatomyGrey12]

Um....yes. Yes it is.

A lot of people can't afford $100 a month for gas, let alone $100 a month for healthcare that they might happen to need. If it isn't an immediate thing then people just won't have healthcare because they won't see it as a need. A lot of people that have never had to pinch pennies here talking about how easy it is to pay $2400 a year for a possible service that might come up.

 

[deleted480308]

A lot of people can't afford $100 a month for gas, let alone $100 a month for healthcare that they might happen to need. If it isn't an immediate thing then people just won't have healthcare because they won't see it as a need. A lot of people that have never had to pinch pennies here talking about how easy it is to pay $2400 a year for a possible service that might come up.

most can afford $100 if they change their priorities.... a lot of DPC patients would qualify as below avg income

 

[AnatomyGrey12]

most can afford $100 if they change their priorities.... a lot of DPC patients would qualify as below avg income

Well yeah but that's the point. People won't pay the $100 because they can either pay for a cell phone that they know they will use compared to paying $100 on the chance they might possibly get a UTI or need an antibiotic. It requires the general public to have foresight and be responsible, with long term planning which, unfortunately, is a lot to ask of a lot of people. Too many people live day to day to be able to make those kinds of decisions.

 

[jeb26]

Unless you are a man or a pre-menarche/post-menopausal woman, you ALWAYS get a pregnancy test. You should learn a little bit about how medicine is practiced before you rail against how it is practiced. And this is coming from someone who is a fan of the DPC model. I hate the whole taboo of "oh it's bad ethics to focus on the economics of the system, just focus 100% on patient care!". You can impress adcoms by having a strong knowledge base about the economics of different care models, but you WILL do more harm than good in terms of the adcom's impression of you if you go off about something that you clearly don't understand yet. Passion is great, but it has to be backed up by substance.

While that is only one small part of the cost and and even smaller part of the point I was trying to get across, I will respond by saying that is not true. I have had UTIs where they did NOT give me a pregnancy test at other clinics. And the issue was not so much the pregnancy test as the fact that they upcharged me about %1000 for it (a general issue with hospitals). Regardless, the whole fee could have been avoided all together if they simply had asked me, because, I won't go into too much detail, it would literally have been impossible for me to be pregnant at that point in time. It was wasteful spending in an effort on the hospital's part to get as much money out of that visit as possible (one problem with fee for service care, they also had two other tests that were unnecessary, I forget the names now but as someone who commonly gets UTIs, I have never had those done at any other clinic and I received the same treatment in the end).

 

[deleted480308]

While that is only one small part of the cost and and even smaller part of the point I was trying to get across, I will respond by saying that is not true. I have had UTIs where they did NOT give me a pregnancy test at other clinics. And the issue was not so much the pregnancy test as the fact that they upcharged me about %1000 for it (a general issue with hospitals). Regardless, the whole fee could have been avoided all together if they simply had asked me, because, I won't go into too much detail, it would literally have been impossible for me to be pregnant at that point in time. It was wasteful spending in an effort on the hospital's part to get as much money out of that visit as possible (one problem with fee for service care, they also had two other tests that were unnecessary, I forget the names now but as someone who commonly gets UTIs, I have never had those done at any other clinic and I received the same treatment in the end).

with the liability involved around pregnancy complications we simply don't trust patients to be good historians (or honest if you want to be cynical).....if you're a lady between about 12 and 60 without a documented hysterectomy you're getting a pregnancy test almost anywhere, as for the other tests without knowing what they are I can't defend them any more than you could condemn them...

 

[jqueb29]

While that is only one small part of the cost and and even smaller part of the point I was trying to get across, I will respond by saying that is not true. I have had UTIs where they did NOT give me a pregnancy test at other clinics.

Well then you've gone to some pretty bad clinics that I would recommend you avoid in the future

 

[Mad Jack]

Too controversial, do not do this.

 

[Pusheen]

Well then you've gone to some pretty bad clinics that I would recommend you avoid in the future

I don't think that's true. I didn't have to have a pregnancy test for mine, I just told the doctor there is no way that I am pregnant and they took my word for it. Had this happen before an x ray as well and they believed me. I would have signed a waiver if they had asked for it. I guess it really depends on who you get.

 

[Matthew9Thirtyfive]

most can afford $100 if they change their priorities.... a lot of DPC patients would qualify as below avg income

What you view as mixed up priorities may not be for someone else. My situation is a little different because we get "free" healthcare, but if we didn't, I certainly wouldn't have $100 a month to pay for DPC. My wife works as a nurse four days a week. Between our two incomes, we barely have enough to pay for childcare for the kids, feed all of us, clothe all of us, keep the vehicles running, pay our cell phone bill (which apparently you don't think should be a priority, and if you don't think it is that's because you don't have kids or a job that requires you to have one), etc.

We have a few things we could cut out, but we'd end up paying more if we did, so that's not really a smart choice. We have a small cushion every two weeks in case something disastrous happens, and paying for all four of us to be on DPC would eat into that significantly.

Think a little outside the box, pardon the cliche. There is a huge population who are not outright poor but could not afford $100+ a month.

 

[jeb26]

Too controversial, do not do this.

Yes from the way this thread has gone I have definitively gotten that

 

[jeb26]

What you view as mixed up priorities may not be for someone else. My situation is a little different because we get "free" healthcare, but if we didn't, I certainly wouldn't have $100 a month to pay for DPC. My wife works as a nurse four days a week. Between our two incomes, we barely have enough to pay for childcare for the kids, feed all of us, clothe all of us, keep the vehicles running, pay our cell phone bill (which apparently you don't think should be a priority, and if you don't think it is that's because you don't have kids or a job that requires you to have one), etc.

We have a few things we could cut out, but we'd end up paying more if we did, so that's not really a smart choice. We have a small cushion every two weeks in case something disastrous happens, and paying for all four of us to be on DPC would eat into that significantly.

Think a little outside the box, pardon the cliche. There is a huge population who are not outright poor but could not afford $100+ a month.

And there is a population who would benefit form it. It is certainly not the ONLY viable model of primary care.

 

[Goro]

Adcom members do NOT want to read essays on the state of health care delivery in the USA.

Stick to "Why Medicine?"

Hello,

I am a senior currently writing my personal statement for medical school (I will not be applying until next summer), and have read time and time again that you should not include controversial topics in your personal statement. I am curious if wanting to go into Direct Primary Care (Family Medicine) is considered controversial? I started talking about it in my personal statement because a year ago I received a truly outrageous medical bill for an urgent care visit that lasted ten minutes for something as minor as a UTI. It really changed what I wanted to do in terms of medicine and it had a profound impact on me by making me aware of some of the serious flaws in our healthcare system. I even volunteer in a mixed direct primary care/ free clinic setting and I think it is truly a solution to a huge failing of our healthcare system. I don't want to get too much into why DPC is or isn't a good model, but I do want to make sure that this isn't something that would turn off anyone reading my personal statement.

Thanks!

 

[deleted480308]

What you view as mixed up priorities may not be for someone else. My situation is a little different because we get "free" healthcare, but if we didn't, I certainly wouldn't have $100 a month to pay for DPC. My wife works as a nurse four days a week. Between our two incomes, we barely have enough to pay for childcare for the kids, feed all of us, clothe all of us, keep the vehicles running, pay our cell phone bill (which apparently you don't think should be a priority, and if you don't think it is that's because you don't have kids or a job that requires you to have one), etc.

We have a few things we could cut out, but we'd end up paying more if we did, so that's not really a smart choice. We have a small cushion every two weeks in case something disastrous happens, and paying for all four of us to be on DPC would eat into that significantly.

Think a little outside the box, pardon the cliche. There is a huge population who are not outright poor but could not afford $100+ a month.

I've got kids and made mediocre money for some of the time since having them.....it's doable with the right priorities

 

[Matthew9Thirtyfive]

And there is a population who would benefit form it. It is certainly not the ONLY viable model of primary care.

Whoosh.