Patrick Ishmael

Jacqueline DiChiara has a great piece this week about the impact of physician shortages on the future of medicine. Hit the link for the full article, but I want to highlight one section that addresses the growth of direct primary care (DPC) and the interest that doctors—especially younger ones—have in the model.

Seven percent of primary care physicians—i.e. internists, family doctors, and pediatricians—offer direct pay/concierge medicine, reports the Physician Foundation in a 2014 physician survey with 20,000 respondents.
Thirteen percent of respondents say they plan to transition to this type of practice to some extent, either in whole or in part. Additionally, 17 percent of those physicians age 45 or younger confirm they will make this transition in due time.
Affordable direct primary care may be becoming a more mainstreamed option within both the short-term and long-term future of the healthcare industry.


You can find the Physician Foundation's study here. I have talked extensively about why DPC innovations are important not only for patients, but for doctors as well. Patients can generally expect to see cost and access improvements when they join a DPC program; meanwhile, doctors can generally expect to see lower costs and greater control over their practices. Indeed, for many doctors, moving to a DPC model offers them a way to remain in the field of primary care rather than be pushed out of it.

Expanding insurance—as Obamacare has attempted to do—fundamentally doesn't accommodate these cost, access, and professional control priorities. Instead, the Affordable Care Act doubles down on a broken status quo that ignores the system's effect on a host of important policy considerations, including the prices for care paid by patients and the supply of doctors serving the system. Gayle Brekke, a health insurance actuary writing for the Benjamin Rush Institute, captures the quandary well:

In the health care system, when a 3rd party (insurance company, government) is paying the bill from the first dollar of coverage, patients (consumers) do not have an incentive to shop for value. They are not spending their own money at the point of service. In fact, patients often feel like they pay high insurance premiums so they want to consume more health care in order to feel like they are getting value from their insurance coverage.

Until the health care industry grapples with its longstanding cost and, relatedly, access problems, patients will continue to be let down by the system and primary care doctors will continue to get squeezed by it.

About the Author

Patrick Ishmael
Director of Government Accountability

Patrick Ishmael is the director of government accountability at the Show-Me Institute.