Different Types of Primary Care
By Melanie J. Bonnes
Reviewed by Joseph J. Starkman, D.O.
Dr. Starkman is a graduate of Midwestern University-Chicago College of Osteopathic Medicine. Dr. Starkman utilizes Family Medicine, Osteopathic Manipulation Therapy (OMT), Nutrition and Functional Medicine to help patients recover from illness and optimize their health. Dr. Joseph Starkman is proud to have been part of the Direct Primary Care Movement since November 2017.
In November of 2017, our office transitioned to Direct Primary Care from a Traditional Practice Model. The different types of primary care offered throughout Chicagoland and the United States can be somewhat confusing. To help simplify, here is a quick explanation of the main types of primary care models.
The Traditional Model
Most Americans are accustomed to this type of medical practice. A traditional practice may see thousands of patients over the course of a year. These physicians are paid through patient co-pays and by billing insurance companies. The administrative responsibilities in the traditional model can be very time consuming and even overwhelming to staff at times, especially given the fact that insurance plans vary in both consistency and expectations.
Since insurance payments are based on the number of patients seen, doctors and nurse practitioners often see 20-30 patients per day to make financial ends meet. This means rushed appointments which results in a lower quality of care for patients and a stressful work environment for practitioners and office staff. The government or insurance companies often interfere with the care a physician wants to provide, which can result in less-than-ideal outcomes for patients. Individuals who do not have insurance are reluctant to visit the doctor since these types of practices do not usually publish their fees due to third-party involvement.
As a result of tight schedules, it can be difficult to get an appointment for an urgent need at a traditional family practice. Patients must choose: Wait 2-4 weeks for an appointment, see a different provider within the practice, or go to an immediate care center/emergency department. The busyness and over-crowdedness of a traditional clinic allows little time for preventative care and patient counseling. This rat race is discouraging to the physician, who is earning a modest salary, while patients remain sick and insurance companies make huge profits.
Direct Primary Care Model
Direct Primary Care (DPC) is a rapidly growing medical practice model in which providers only see a few hundred patients per year. These practices operate based on a monthly membership fee, paid by the patients directly to their medical provider – no third parties involved. DPC clinics generally have one or two practitioners and one to three administrative staff members. Membership costs and other service fees are available to the patients (members) up front and are generally very reasonable. Since these clinics can negotiate directly with labs, imaging centers, supplement companies and pharmaceutical vendors, pricing for these services can be offered at drastically reduced rates.
Because doctors and nurses are not paid per visit, they have time to spend with patients during appointments without either the provider or the member feeling rushed or stressed. The typical appointment in a DPC practice is a minimum of 30 minutes, with longer appointments available by request. Since these practitioners have a smaller patient load, they see fewer patients per day and have availability for same-day and next-day appointments for urgent issues.
DPC clinics encourage preventative care since a comprehensive annual physical is almost always included in the membership plan. In addition, most patients are willing to schedule visits because their membership fee is already paid. It’s convenient to seek medical advice in this type of model since patients can text, email or video chat with their doctor or nurse practitioner, and can expect an answer within hours or, sometimes, within minutes. Medical care is typically provided by one practitioner. If there is more than one practitioner, the nature of this model affords time for these professionals to discuss patient cases, further enhancing the care that is provided to members.
The Concierge or Boutique Model
As part of a Concierge or Boutique practice, patients also pay a membership fee to the practice in exchange for specific benefits. These member fees cost significantly more per month than is typical of a Direct Primary Care practice. Some Concierge practices also bill insurance companies for certain treatments.
Probably the most common benefit received through a Concierge model is greater access to one’s primary doctor. This is due to managing an even smaller patient panel than that of a Direct Primary Care clinic. However, Concierge practices tend to focus on high-end services such as extended office visits, accompaniment to specialist appointments, fitness classes or massage and other spa services. Some even offer perks like in-office carotid dopplers, bone density scans and laser hair removal.
In short, Concierge/Boutique practices lean toward offering premium care while DPC practices offer affordable care. Direct Primary Care members pay for quality care, while Concierge members pay for quantity of care.
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