The Ethical Case
An overarching theme of the ACP's recommendations concerns the ethics of seeing fewer patients because of the burden it places on other physicians. The ACP is also calling on physicians in these models to see more Medicaid patients and to be advocates for removing barriers to patient care.
Kwan says he and Durani, who met during residency at Parkland Hospital, Dallas County's public hospital, chose a DPC model because of its flexibility to see many types of patients. "We trained at a county hospital and we were still being told, 'You can't order that [test] because it costs too much,' " Kwan says. "This is a way for us to take back control."
Doug Nunamaker, MD
Durani adds that the DPC is a place where the uninsured fit because the prices are affordable ($49 per month, then adjusted for age). "I got to really see what some people have to go through to get medical care," Durani says. "Our goal is to make this a win-win for everyone."
For those who eye DPC models skeptically because the practice model treats fewer patients, consider the patient who is in a traditional practice and gets six to seven minutes with the physician because the physician has to churn through visits just to break even .
"Forcing physicians to see more patients because insurance reimbursements are going down is wrong," Doug Nunamaker, MD, co-founder of Wichita, KS-based, insurance-free AtlasMD, told me.
Now, to be clear, there are other forces that contribute to that model and no physician I talk to is happy about it. But Nunamaker and AtlasMD co-founder Josh Umbehr, also say the DPC practice model is set up to see low-income patients.
"If we take our oath seriously, 'Do No Harm,' that has to mean 'Do No Financial Harm,'" Nunamaker says. He and Umbehr say they've helped patients reduce their financial burden by keeping them out of emergency rooms and managing their medication costs and overall care better.
Qliance Medical Group, in Seattle, is one of the oldest DPC practices that does see Medicaid patients. The six-location practice began in 2007 and grew from seeing individuals only to now providing care to Washington's health insurance exchange members, employers and the state's Medicaid population.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.