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The Modern Style of Primary Care Medicine in the US · Doctor Turned Health Coach

• 0:00
  Welcome to the Doctor Turned Health Coach Podcast. My name is Dr. Ashuri.
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  I'm a board-certified family medicine physician who also does direct primary care.
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  In today's episode, we're going to talk about what direct primary care is,
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  what it isn't, how it compares to traditional primary care, and I'll give you
• 0:19
  a little bit of idea of how I do it in my own practice.
• 0:24
  So mainstream primary care is generally a relationship between a doctor and
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  a patient with the insurance company paying the majority or reimbursing the
• 0:35
  physician for that visit.
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  For those reasons, unfortunately, in the U.S., primary care has become a bit strained.
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  There are many things that a patient may want, but the doctor is not able to
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  order those things because the insurance company has explicitly said what they
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  will and will not reimburse.
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  When the patient and the doctor meet, there is usually about 7 to 10 minutes
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  of face-to-face time that the doctor has with the patient, and the rest of the
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  time they have to do a lot of administrative tasks like medication reconciliation,
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  talking to the pharmacy,
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  filling out the electronic health record, writing the note, sending prior authorizations,
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  talking to the insurance company. And for those reasons.
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  Many patients and doctors both feel a very constrained amount of time in that visit.
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  Patients often go home and they have many, many questions that are left unanswered.
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  There is no real good way in traditional primary care to reach out to your doctor
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  and say, hey, doctor, I have a question. What about this?
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  What about that? Or I came across this. I came across that.
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  That is mainstream primary care. Now, in this modern, new primary care style,
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  we call this direct primary care because the doctor contracts directly with
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  the patient. There is no middleman.
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  Nobody's reimbursing the doctor. Nobody's telling the doctor what they can and
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  can't do, what labs they can order, what prescriptions they can send.
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  Everything happens directly between the patient and the doctor.
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  For that reason, it's called direct primary care.
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  Usually it's a membership model, and the reason is that primary care doctors
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  know the importance of a long-term, continuous, longitudinal relationship with the patient.
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  So we prefer that our patients stick with us long-term as opposed to having
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  episodic care where we see them once here, once there, and then they get lost to follow-up.
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  So in the traditional, in the mainstream primary care practice,
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  usually you have about two or three visits with your primary care doctor every year.
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  That's the extent that most primary care doctors will have time for you or will get reimbursed.
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  The average primary care doctor in that setting has a patient panel of about 3,000, maybe 2,500,
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  sometimes 4,000 patients, while the direct primary care doctor has a panel of
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  around 300, maximum 600 patients.
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  The advantage of the traditional primary care system is that you don't have any,
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  you have a copay often, maybe $25 or $45, but you've already paid for your health
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  insurance, which also covers you for catastrophic events, hospitalizations,
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  going to the emergency room, and specialty care.
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  In direct primary care, you pay a monthly fee of somewhere around $100 to $150
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  to your primary care doctor.
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  And it does not cover going to a specialist.
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  It doesn't cover getting lab tests or imaging studies or any hospitalizations.
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  So that fee is outside of the insurance system.
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  The advantage to this is that, as I said, there is no middleman.
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  So for me, my visits aren't 7 to 10 minutes long. My visits are minimum 30 minutes,
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  often an hour, and in the beginning, an hour and a half as we get to know each other.
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  The way I run my practices, everybody initially has to come in through my health
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  coaching practice just so that I can get to know them, make sure they're a good
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  fit for me, I'm a good fit for them.
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  And if they are located in California, which is the state that I have a medical
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  license in, then I offer some of these individuals to be part of my direct primary
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  care panel. We often meet at least once a month.
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  We exchange many, many text messages. There's unlimited number of text messages.
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  They can send me, call me.
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  It's quite flexible. It's not at all like the traditional care.
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  Now, my medical practice is completely virtual. It is online.
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  I don't have a physical practice, though when I'm in Los Angeles,
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  I have a few clients with whom I actually go do kind of the old school method.
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  I just go to their house and I show up and I do home visits for them.
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  I can send my patients in for lab tests, MRIs, x-rays, CTs. I can order prescriptions,
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  just like the traditional doctor.
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  And in fact, I can get these for much, much cheaper.
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  In the traditional healthcare system, you will go to your primary care doctor,
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  and every lab and every prescription that they send, you will pay an exorbitant
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  fee on top of your co-pay.
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  But in the cash-based system, in the direct care method, when I prescribe a
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  generic medication, it's usually very, very cheap.
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  When I send a patient for an x-ray, they can get it for $40,
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  $90, an MRI for $300, a CT scan for $200.
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  So things are much, much cheaper overall. And the good news is because we get
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  to spend much more time with each patient, I found that I don't have to prescribe
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  as many tests, prescribe as many medications, order as many referrals.
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  I can usually manage a lot of things myself.
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  So that's a little bit about direct primary care versus traditional primary care.
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  I hope it gave you a good idea of how it's done.
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  And if you have any questions, please email me, hello, at drashori.com.
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  The information is in the show description below. Thank you. Take care.