LAST UPDATED FEBRUARY 14, 2017
According to The Direct Primary Care Journal [August 2017) there are an estimated 600 plus Direct Primary Care clinic physicians operating in almost (but not all) States across the U.S. The DPC Journal sources caution that despite inaccurate or inflated reports by the space continues to experience slow growth. We do believe growth will continue into and throughout 2017-2018 at a moderate pace among independent practitioners. Consultants and physicians alike caution younger physicians and medical students carefully examine their business plans, capital needed and resources prior to starting a new cash-only (no insurance accepted, no Medicare participation) practice. In fact, polling among physicians is evenly split 50/50 among actively practicing DPC physicians suggesting younger physicians with less than 10-years of experience explore this business model alone. DPC Journal sources, our Publisher and our Editors are all in agreement with MedScape’s April 2016 analysis on cash-only medical practice growth percentages and expectations as well for this market. (SOURCE: Medscape Physician Compensation Report 2016; By Carol Peckham | April 1, 2016 — http://www.medscape.com/features/slideshow/compensation/2016/public/overview#page=19; http://www.hmsreview.org/?article=cash-concierge-based-medicine-roles-health-care-payment-landscape)
The DPC Journal Editor recently told Medical Economics in a follow-up story in early January 2017, “Since federal registration is not required nor are DPC, Micro-Clinics, Hospital-based Executive Medical Programs or Concierge Medicine Memberships considered a categorical specialty on their own [i.e. like, Family Medicine, Osteopath, Cardiologist, etc], these figures are an approximate count of the “true” and more accurately described “full-service” free market healthcare delivery solutions (which includes DPC and Concierge Medicine Physician clinics) operating across the U.S. from 2007-2016. Furthermore, regardless of ones philosophical or business definition or a person(s) predisposition to one business and billing model or another within the larger free market healthcare landscape of medicine today, a Direct Primary Care business model puts the focus entirely on the patient and physician relationship in a manner that is convenient and affordable. It is one of the only business models in medicine that does this. We’ve seen many great physicians build clinics centered around children, families, the extremely poor and it they are all centered people who really need help. It is those visioneering physicians in both careers equations [Direct Primary Care and Concierge Medicine] who are drawing attention the cost and the quality of healthcare across the country. They are designing unique ways for it to be available, affordable and unique to anyone, anywhere. That is truly what we call at Concierge Medicine Today and our sister publication, The DPC Journal, ‘DocPreneurship.’”
By The Direct Primary Care Journal, Editor, Michael Tetreault
LAST UPDATED JANUARY 12, 2017 – To understand the numbers, one must first understand that there are various business models that operate subscription-based or membership medicine programs.
Given the constantly evolving industry at this time, the various business models currently being used with varying degrees of success and definitions, the openings and closures of Direct Primary Care offices we observe and discuss each month – and the lack of consumer awareness – it is impossible to know the exact number in the country, much less by state. Coincidentally, other free market healthcare delivery models suffer from this same “numbers conundrum” and find it difficult to track and organize data related to growth.
In 2007 however, the Washington State Legislature enacted Engrossed Second Substitute Senate Bill 5958, which is codified as RCW 48.150. This bill created an innovative primary health care delivery option called “direct practices.” It requires all of the registered practices to respond annually to the mandatory questions. In 2015, fewer than half of the direct practices chose to report voluntary information. Some said they do not collect this information, and others simply did not respond to the supplementary questions. The bill requires the Office of the Insurance Commissioner (OIC) to report annually to the Legislature on direct health care practices. Under RCW 48.150.100(3), this includes but is not limited to “participation trends, complaints received, voluntary data reported by the direct practices and any necessary modifications to this chapter.”
- Read DECEMBER 2015: Wash. State OIC Annual Report to the Legislature ~Wash. OIC [PDF] Download HERE
- Read December 2014 Wash. State OIC Annual Report on DPC … Says, New OIC Report Says: “Promising model for health care [DPC] sees enrollment plummet as ACA takes off.”
- Read DPC Leadership Response (2014) To Washington State OIC Report: ‘Outlook for DPC is bright throughout U.S.’
- Read OIC, Washington: Direct practices lose 35 percent of enrollees, raise fees 23 percent
- Read 2013 Direct patient provider primary care practices (PDF, 418KB)
- Read 2012 Direct patient provider primary care practices (PDF, 254KB)
Direct health care practices (Washington State Only)
- List of direct health care practices in Washington state
Yes, there are maps, mappers, online directories, online lists and some registries and the like, online that attempt, with some success, to help answer these questions. According to a recent interview with the DPC Coalition in the Fall of 2016, there are an estimated 500+ Direct Primary Care clinic physicians operating in almost (but not all) States across the U.S.
Jim Eischen, Esq., said it best this past April 2015 at a physician meeting in Phoenix, Arizona when he said from the podium …‘let’s focus on substance, not labels.’
In the landscape of Free Market Healthcare, Direct Primary Care is one of the business models working. It’s low monthly fee appeals to a a younger demographic. However, there Free Market Healthcare Delivery landscape is not only about what is happening in Direct Primary Care. There are other Free Market Healthcare Delivery business models and solutions currently operating today as well. In a statement by The Direct Primary Care Journal to the New York Times recently, Catherine Sykes, Publisher and CEO of The DPC Journal, Concierge Medicine CANADA, The American Journal of Retail Medicine and Concierge Medicine Today said …
“Since federal registration is not required nor are DPC, Micro-Clinics, Retail Healthcare Clinics, Urgent Care Clinics, Hospital-based Executive Medicine Programs or Concierge Medicine considered a categorical specialty on their own, these figures are an approximate count of the “true” and more accurately described “full-service” free market healthcare delivery solutions operating across the U.S. from 2007-2016. Until a certification program becomes more widespread, these numbers [including Direct Primary Care appoximations] will continue to be guesstimates, at best. There are new openings and closings each month that we hear about and not every business model fits the description or mold of one particular business model over another. Given these variables, modern-day variations in the payment structures and the ill-defined nature of these healthcare categories defined within the free market healthcare space, it is impossible to calculate an exact number.
However, if we look at the free market healthcare delivery landscape as a whole, figures assimilated from 2001-2017, we believe that there are an additional 6,000 physicians who practice some form of free market healthcare delivery across the U.S. at this time. Additionally, there are those who are not yet discovered that we also meet, interview, and hear from on a weekly basis that must be added to this number. We believe after vetting these questions, talking with consultants, analyzing the past decade of university work we’ve conducted with prominent medical schools and talking thoughtfully and carefully with industry thought leaders and key physicians in this space, there are about 6,000 more free market health care delivery centers operating across the U.S. This equates to a total of approximately 12,000 free market healthcare delivery centers in the U.S. as of November 2016. This figure does not simply represent one business model [i.e. Direct Primary Care] nor does it represent only one specialty. This figure represents just over 1% of all licensed physicians in the U.S. across multiple specialties (2016), practicing some form of free market healthcare delivery.
According to the most accurate observers and news reports we’ve seen, talked to and interviewed in recent past, we caution that exact numbers in any free market healthcare sector (i.e. DPC) are difficult to come by and should be footnoted with this description carefully. Still, today the shift has been gradual into Direct Primary Care specifically. While over 600 Direct Primary Care openings is a positive step in the right direction under the free market healthcare delivery solution, their use, and acceptance by consumers is still somewhat small, but it is growing. Sources, including some veteran physicians, caution that DPC must move beyond and I quote “a mom and pop movement” and begin to work more closely with employers and businesses. Today, DPC continues to be an almost underground success in some circles. We certainly anticipate positive advances forward for Direct Primary Care [and other free market healthcare delivery solutions] as more consumer awareness is drawn to these practices over the next several years and they find ways to formally organize and work more closely with employers.”
But many of the patient reviews, the patient interviews, and even the physician-industry service offerings say something completely different over the past two years since the interest in DPC has given physicians a career alternative and lawmakers pause in their legislative efforts.
“We won’t move the cost-access curve and improve quality by balkanizing ourselves into factions based on subtle differences in practice models, services or billing frequency,” notes Dr. Robert Nelson, a direct primary care physician based in the Atlanta metropolitan area. “I can say with certainty that if we don’t unify for free-market, insurance-free practices of all stripes then the status quo claims culture will continue to march on to dominance while we fight on definitions.”
DPC EDITOR: Successful “Docpreneurs” Know These 6 Things
Dr. Cory Annis, an Internal Medicine and Pediatrics physician who recently transitioned her practice from fee-for-service to Direct Primary Care who spoke recently (Summer 2015) at a Direct-Pay Medicine panel at the Pri-Med Southwest Conference in Houston, TX, said the name “Direct Primary Care” doesn’t do justice to the concept or explain it very well to patients. She makes an analogy between DPC and Community Supported Agriculture (CSA), where consumers purchase “memberships” in farms and receive a share of fruits and vegetables in return. She also uses the term “Blue Collar Concierge” to describe DPC to her patients. Read this full interview here.
Source: The Direct Primary Care Journal, November 2016, June 1, 2015.