As a DPC physician with two years of experience and a private practice physician for almost 10 years prior to my conversion to DPC, I would like to address the two potential casualties you express in your article.

First, I believe my practice and many other DPC practices of which I am aware have failed to see a strong influx of otherwise well patients as the majority patron. Most of my patients have legitimate medical concerns that need to be addressed. They have found that the health care available to them is either too impersonal or too expensive. Many insured patients now have deductibles so high (an attempt primarily designed to find a lower premium) that all primary care services practically become out of pocket expenses. Generally speaking, the well don’t seek health care, which is what I provide as a DPC physician. The sick show up at my door every day, however.

Second, health care consumers within DPC practices may have more assurance of obtaining desired medical care than those consumers in traditional, fee-for-service practices. Ultimately, a FFS practice is beholden to the reimbursement requirements set forth in their insurance contracts and exist only so long as the insurance companies are quality payers. At one time while still in FFS, patients covered by BCBS consisted of nearly 65% of my practice. When BCBS made a unilateral move removing my ability to bill for lab work we lost nearly $250,000 in yearly revenue with no recourse. As such, we were forced to change the mode of our practice, not based on patient needs or concerns, but on the demands placed by the true payer.

Within my DPC practice, I have approximately 440 individual members. Any single payer disruption does not affect my over all ability to offer the quality and type of care I can provide to the other patients. This makes my quality of care extraordinarily stable. As my membership contracts are month to month, as are almost all DPC practices, I am constantly incentivized to keep my costs to a minimum while improving my health care services in order to retain an appropriately sized patient panel. I believe that a free market approach, where services are clearly priced and patients are at liberty to choose alternative options or no care at all, is the most reasonable approach to reduce health care expenditures within primary care while encouraging the highest quality of services to be offered for the patient’s benefit.

Again, thank you for your article and the perspective you bring. I invite you to reach out to your local DPC practice to get to know how the process works in the life of a patient if you have not done so already. You can find a good list of practices at http://www.dpcfrontier.com/mapper/.