Update after the AAFP DPC Summit

Direct Primary Care MIG Blog - July 2019

I am happy to report for the Direct Primary Care (DPC) MIG, fresh from the camaraderie of the AAFP’s DPC Summit, which was June 28-30 in Rosemont. It was so energizing, educational and yes, entertaining, to be among “my people,” those who are “DPC docs,” and those who are considering or already planning to build a DPC practice of their own.

Because this is the first outbound message from the IAFP’s Direct Primary Care Member Interest Group or DPC MIG, let me give you some background. I have operated my own DPC family medicine practice in Le Roy, Illinois, since 2015, and have chaired this group since it began in 2017.

In simple terms, the Direct Primary Care model is a practice and payment model where patients pay their physician/practice directly in monthly/annual intervals for a defined set of primary care services. Typically, enhanced services are included as compared to traditional fee-for-service medicine, including real time access via advanced communication technology to their personal physician, extended visits, and highly personalized and comprehensive care.

In the fall of 2014, I was introduced to the DPC model when a colleague shared with me a YouTube video featuring fellow AAFP member Dr. Josh Umbehr. In that 10-minute video, he describes how he successfully launched a DPC family medicine practice straight out of residency. I watched this video over and over again, building my belief that I too could hang my own DPC shingle in rural Illinois, and that’s just what I did - out of my home - in January 2015.

Eighteen months later, CHISHOLM Center For Health was 300 members strong and employed two part-time support staff, and we made the transition to a professional space that became available just up the street.

Currently, I employ one part-time office manager who doubles as an MA. We have been at capacity for over two years (600+ members), and we have a generous wait list of folks who would be happy to become members. 

In general, DPC practices boast the following major features: transparency (in pricing), accessibility, and affordability. Each DPC then may have its own “flavor,” if you will. At the DPC Summit, I shared that my “flavor” of DPC includes the following features:

  1. Customized care. For example, I rely on local friendly compounding pharmacies to concoct creative/customized/compounded pharmaceutical interventions for particular health conditions.
  2. Transparency. In this case, I explained that I write a plan in my SOAP notes that is not only useful for charting purposes, but is also useful to the patient; I copy and paste the plan into an email to the patient after every office or phone encounter, and with the help of EMR short-cuts and pre-built macros, this is a quick, easy, and sustainable routine for me.
  3. Family friendly. My DPC practice is not only family-friendly for my patients, but also for my own family. I have created a successful business that allows me the flexibility to enjoy quality time with my husband and five children outside of office hours.

If you who are wondering how to get started on your DPC journey, I would first encourage you to find mentors - both in the business world as well as in medicine - who are doing what you want to do, and learn from their experiences. DPC physicians like me will help build your belief. I also encourage you to put yourself in front of a variety of material that encourages you to take action and be creative in starting your own flavor of DPC right where you are. Develop a vision and a mission for what you what want to do. And then be brave, be bold, be creative, and go for it! Make it happen with the support of those around you, as well as your wider supportive DPC community. You will find support right here within the IAFP DPC MIG as well as in DPC communities online.

At the DPC Summit, I was thrilled to share the stage with two other Illinois DPC practice owners who are also mothers of young children. Clodagh Ryan, MD owns Cara Direct Care in La Grange, and Amber Price, MD is a pediatrician and owner of Willow Pediatrics and Lactation which she built right into her home in Chicago near the medical district. Both of these female physician leaders used drive, determination, creativity and a lot of heart to create DPC practices that work for their communities and their families.  AAFP has posted all the presentations here.  Ours is the final one on Saturday. 

So what does it look like for each of us to manage DPC practices and still have a life with our families outside of work? Dr. Ryan shared that she has an agreeable arrangement with three other area DPC physicians; when one is on vacation, the other three cover the practice and take any patient calls and visits. All these interactions are entirely covered within the patient’s DPC membership. This enables her to travel home to Ireland to see her family every year. I have a trusted PA about 30 minutes away who can cover for me when I am unreachable once or twice annually (remember, I’m in rural Illinois in a town of only 3,500, so you have to go a little farther!). Dr. Price has an agreement with one of her attendings from her days as a resident at UIC who is also a lactation specialist. She pays this physician by the hour for seeing her patients while she is on vacation. She prefers to take the first call from her patients though, even while away, but she is glad to have back-up support while she is traveling.

As part of the presentation we also included videos to illustrate two other Illinois DPCs:
UnityPoint Health Junction Medical in Peoria  is owned by a health system and run by our fellow DPC member Anton “TJ” Grausch, MD, and Medico Directo on Chicago’s North Side, owned by DPC member Alvaro Encinas.
You can view the NBC Chicago interview of Medico Directo and Cara Direct Care

I encourage you to check out each of our practices using the links above and contact any of us if you have specific questions. One thing I did learn from my co-panelists is that we all enjoy mentoring others. In fact, Dr. Ryan had a fan club of mentee physicians at the front table during our presentation. I think we demonstrated how DPC can be the family friendly practice model that fuels your professional fire without the paperwork and administrative burdens that can drown and extinguish that fire when they take away the time that our patients need and deserve.

Once the video of our panel is available from AAFP, we’ll add it here. Special thanks to the IAFP’s executive director, Vince Keenan, who organized and moderated our panel at the summit. In the meantime, here’s my take on the current status of the DPC model in the United States: It is alive, it is strong, and it is growing! And recognition of the value of DPC at the federal and state levels is growing. In fact, President Trump recently signed an executive order stating that “Within 180 days of the date of this order, the Secretary of the Treasury, to the extent consistent with law, shall propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care arrangements and healthcare sharing ministries, as eligible medical expenses under section 213 (d) of title 26, United States Code.” This is encouraging news for the DPC world!

One more exciting bit of good news. During the DPC Summit, our MIG group grew by four members. I extend a big welcome to Lucie Bianchi, MD; Clyde Grady, MD; Joanna Pozdal, MD of We Care Family Clinic in South Barrington; and Khalil Snowber, DO.

Have a wonderful summer and if you’re considering a DPC future, please join our Member Interest Group and we’ll see you at the IAFP Annual Meeting in October!

UPDATE (Aug. 5) - Southern Illinois University student Ben Hauter was also at the DPC and provided a blog post to the Benjamin Rush Institute as part of his scholarship to the DPC Summit. 


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