Should You Consider Primary Care?


As the growing burden of medical education increases, many ask the question, can I still be a primary care doc? This essay outlines a few possible solutions for pursuing a passion in primary care…

Are you considering primary care?  Or perhaps proctology?…

That is the late, great Richard Jeni.

How about family medicine or internal medicine/primary care practice?  If your parents were in Primary Care, the chances are, they would not suggest you follow in their footsteps.

You probably have heard other complaints such as low pay (you have loans to pay off), burdensome Insurance hurdles, EMR costs, ICD-10 headaches etc.  These problems are real, but can be overcome.

Independent Practice
Opening your own Fee for Service practice can be expensive, and expensive to run.  If this is your dream, start looking to underserved areas, so you reach a full panel quickly.  Joining an existing Independent practice is another option.  An older Physician may take you on and offer equity.  One caveat, the Independent practice is going the way of the millstone.  Hospitals are buying up practices.

Employed by a Hospital
The benefits are a steady income, relative job security, and the software and office staff costs are covered.  Disadvantages may include up to 30 patients/day, rushed appointments were you options are, write a script, order a test, or refer to a Specialist.

Membership Medicine
These are Independent practices that require a fee so the Physician can offer longer appointments, 24/7 access via email, text, phone, etc.  The definitions in this Industry are not in stone, but in general:

  • Concierge Medicine.  This form typically still accepts Insurance, but charges an additional fee to compensate the Physician for their additional time, that is not reimbursed by Insurance.  The downside is the additional office costs to still process Insurance claims.
  • Direct Primary Care (DPC).  In this model the Physician does not accept any Insurance.  All revenue is derived from the Membership fee’s, and the Physician is free to practice medicine without 3rd party payer interference.

I have been contacted by many Medical Students about how to move from Residency directly into DPC.  This is tough, but not impossible.  I call this a “cold-start”, and we are working on a way to help build a panel from scratch.  Just hanging a shingle and taking out a newspaper ad does not work.

In the mean time my suggestion is Network, Network, Network.  Find a DPC who may take you on post Residency.  Call them now.  You will find the vast majority are fantastic people who truly care about their patients and promoting DPC.  What can you do for them now?  Can you refer patients to them?  If you can help a DPC Practice to grow now, you may be creating your own position.

Do you know any employers?  Start telling them about DPC.  A self-insured 200 employee company is ideal.  They will have approximately 600 dependents, and that is a fantastic panel start.

Education of the public is the hardest part.  With rising deductibles and co-pays, DPC makes more sense every day.  Be sure to stress that DPC is not an alternative for Health Insurance.  The patient should of course still have Catastrophic coverage.

DPC can help you practice medicine the way you envisioned it.  Start planning your future now.

Guest Post: by Bill Cossart
-Contact Bill here

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