Portland Direct Primary Care
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Beyond 7 minutes

I trained as a Family Doctor so that I would be ready to help patients with any challenge. The old school family doc used to take that skill set out into the community on house calls, sports sidelines, and town hall meetings. At some point the job description was boiled down into a job that started and ended with a 7 minute office visit. That setup is not good for patients, and it's not good for doctors. In this column I hope to start to push the boundary of where the doctor patient interaction takes place - onto the page, into the community, and beyond 7 minutes.

Letter to the editor

Here is a good read from the June 29 issue of the New Yorker Magazine, The Promise and Peril of Virtual Care, with Dr. Oren’s response.

https://www.newyorker.com/magazine/2020/06/29/the-promise-and-the-peril-of-virtual-health-care

As a Family Physician and fellow New Englander I was excited to read John Seabrook's June piece on virtual care. The piece illustrated the breadth of applications for virtual care and also some of the economic drivers that have influenced our current healthcare model. It did not mention an up and coming model called Direct Primary Care (DPC). DPC doctors were using virtual care as well as text messaging, app based appointment scheduling, and in house medication dispensing long before COVID. The reason DPC is more adaptable than traditional fee for service medicine is that practices are by and large small and operate independently from insurance reimbursement. Patients simply pay a monthly fee (usually less than the monthly cost of a cell phone plan) directly to their doctor. This frees up practices to innovate and accommodate services that are best for the patient. Not only is this a more adaptable health delivery system, it's also more sustainable. Since most DPC practices already had virtual care built into their monthly fee structure there was little to no impact on revenue or patient retention for these offices. As we evaluate the future of primary care in the US we should consider the risks and benefits of alternative models, such as DPC.

Oren Gersten, MD