By Sam Sunshine, M.D.
Direct Primary Care (DPC) is also known as concierge medicine, retainer medicine, membership medicine, and a cash-only practice. While there are distinctions among these terms, they are a fundamentally different approach to healthcare that removes insurance as the “middle man” and allows doctors and patients to work directly together. For this post, I’m referring to them collectively as DPC.
Do these complaints about your healthcare provider sound familiar?
- “I can never get an appointment.”
- “I hardly see my doctor.”
- “Why doesn’t my health insurance cover my visit?”
- “Why do I have to pay a co-pay every visit?”
- “Why do I have to drive to the office just to review my labs or refill my medication?”
If so, switching to a DPC physician may be the right choice for you. And it’s not as expensive as you may think.
DPC is where you pay a flat monthly fee for your primary care––you can think of it like a membership fee. This fee is an out-of-pocket expense, not covered by health insurance or Medicare. In return, you see a physician or group of physicians who provide nearly unlimited care with same-day appointments with no wait times. This care can be provided in person, over the phone, and, if you prefer, by text. Care is on-demand, 24×7, and highly personalized. DPC does not cover specialists or hospitalizations, and they require health insurance for access. For both, DPC physicians will make the referral, be your advocate, and help coordinate care.
I’ve been running a private medical practice focusing on functional and sports medicine for the past 23 years. Last year, I transitioned my practice to DPC, which has been transformational for my patients. I have more time to develop deep personal relationships with each patient. I seek the root cause of the symptoms. I rely more on medical histories, physical exams, and lab testing and less on prescribing medications to alleviate symptoms. I work in partnership with my patients to create a long-term healthcare plan that we both believe in.
How much does DPC cost?
WebMD cites that DPC fees range from $600 to $20,000 annually, with $1,750 being the national average. I charge $1,600 per year. The table below compares my practice with DPC averages and physicians who work through insurance.
|Dr. Sunshine’s practice||Average DPC (includes concierge)||Physicians through health insurance|
|Annual per person Membership||$1,600||$1,750||N/A – you pay for health insurance|
|Practice’s average number of patients||300||400-600*||2,000-3,000*|
|Average time spent with patient||45 min||30 min*||15 min**|
|Average visits per year||7||4**||1.6**|
|Cost per visit||0||0||Co-pay + % of services based on your policy|
|Do you need health insurance for office visits?||N||It depends; some concierge groups bill insurance||Y|
|Do you need health insurance for hospitalizations or to see a specialist?||Y||Y||Y|
|Is telemedicine or direct communication with your doctor available?||Y||Y||N|
**University of Wisconsin, Direct Primary Care.
Pros of the DPC model:
- More time with your physician. DPC physicians can spend more time with their patients. My visits are often 30 to 60 minutes in length.
- No wait times. DPC practices have fewer patients, so your doctor is available when you need them. It’s time efficient for patients. I don’t have a waiting room––it’s unnecessary.
- Direct communication. Simple concerns can be handled by email, text, or phone call. Physicians who work with insurance can only bill if they see you in the office, which requires a visit even for routine tasks.
- Comprehensive care. Your doctor manages all your care and is a translator when seeing specialists. This is critical if you are taking medications and advice from various specialists.
- Focus on preventative care. Your doctor has the time to work with you to define your health goals. There is a more significant focus on preventative care which improves long-term outcomes. A 2018 American Journal of Managed Care study showed improved health outcomes for patients who received a high-touch model of care (DPC).
Cons of the DPC model:
- Costs: This care level may be more expensive. Analyze your total costs, as I know people who have saved money by increasing their health insurance deductibles and funding their DPC fees.
DPC is growing in popularity. According to a 2020 NPR poll, more than 20% of the top 1% earners in the U.S. use this new model. I know a number of physicians who use it too, including my father. Maybe it’s the right choice for you.
To learn more or to find a DPC provider near you, go to DPC Frontier Mapper.
Dr. Sunshine is a 3-time Ironman finisher and avid athlete. He thrives on keeping himself and his patients on the playing field. He is board certified in Family Medicine and maintains his Certificate of Added Qualification in Sports Medicine.
He employs a multi-disciplinary approach to patient care, emphasizing the pillars of a healthy lifestyle. Dr. Sunshine integrates hormone balancing, food nutrient diversity, proper sleep, regular exercise, and mindfulness into a personalized wellness program.
He received his undergraduate degree from Stanford University and his M.D. from the USC School of Medicine. He completed his family medicine residency and sports medicine fellowship at Kaiser Permanente in Fontana, CA.
Dr. Sunshine is related to Big Retired Life founder, Diana Sunshine.
Throughout the “The Nuts and Bolts” section of this blog, we will introduce you to the ins and outs of these insurance plans as well as other practical needs in retirement.