(LISTEN, Physician SPOTLIGHT) “I can do more in one house call than I could ever do sitting in a box at a clinic, being told I have to see patients every 10 minutes.” ~Dr. E.B.
(C) The Direct Primary Care Journal (The DPC Journal)
AUGUST 13, 2018 – Over a year ago we examined the industry and niche specific side of a DPC-burnout in a May 2017 The DPC Journal reader survey. The fact is, and you probably won’t be surprised to hear it, although some will be … it is extremely low, BUT, it is out there.
It’s a different kind of burnout as you might imagine.
There are several complex contributors. A growing population set of younger Physicians entering DPC with existing debt loads, family responsibilities and time constraints, rural demographics, entering without planning appropriately or due diligence about the demographics of the area, retail clinic competition, frustration with breaking into the employer market, business and financial management education to run a solo practice, more time spent moonlighting whereby Physicians indicate they are limiting their panel sizes so as to spend more time moonlighting to pay the bills.
“I don’t understand why we as Physicians, who by the way take less than a handful of business courses in school, continue to take business advice from other Physicians who’ve also taken less than 5 business courses in school. It’s a cyclical pattern that leads to nowhere.” ~DPC Physician, Texas, 2018.
Retail Clinics, demographic analysis, attitude AND yes, likability of the DPC Physician are more important than you might imagine. As more DPC Physicians dive into the cash-only and subscription-based business models free of insurance, Patients who are of the younger demographic, primarily Millennial’s and Gen-Xers are attracted to these low cost healthcare clinics. Subsequently, the consumer mindset, psychology, whatever you’d like to call it plays more or a role than many Physicians recognize. Simply being free of insurance and having a Facebook page with a few positive reviews won’t cut it anymore. Patients in these demographic subsets actually want more transaction-based care than ongoing membership fees deducted from their credit or debit card accounts. That’s why we’re seeing more DPC-transactions and membership panels stay lower than 150-250 in most cases.
While there are plenty of critics and opinions on retail clinic care, studies about quality and the like, one has to understand that these clinics are a competing and friendly force in the DPC-space. They compete in the following ways:
- On nearly every corner in our communities;
- Provide quick, affordable access to demographics who want short transaction-based care; and
- Attract a patient population that appreciates price transparency as well.
As a friendly force, retail clinics can also help DPC Physicians, something few have discovered.
“Every couple of weeks I take some of my business cards to my local retail clinic,” said one DPC/Concierge Physician in New Jersey in an recent interview with The DPC Journal. “I talk to the providers there. I talk to the pharmacist there. I’m not adversarial in any form. I am building a referral relationship with people I know need more than a transaction in healthcare. I appreciate my retail clinic and pharmacist and they keep calling me asking for more of my business cards.”
DPC JOURNAL Physician Poll: BUSINESS EDU. REQUIREMENTS — How many business education hours [or #er of courses] did you take in medical school?
- Answer/Results: Less Than 5 Business Education Courses – 62.07%
While all of these topics are certainly not popular to talk about at DPC conference round tables, we live and work in a world that has bills to pay and problems to solve. Simply working for free and taking on 1-3 additional jobs to support your family, sustain a fledgeling DPC-practice AND trying to payoff debt in all of its many forms is fine in the short term, but unsustainable for a decades long career.
In part two of our series, we will discuss the frustration DPC physicians feel when trying to partner with employers in there area. Among the rising ways to scale a DPC-practice because patient acquisition and growing a DPC clinic with a low monthly subscription, cash-only, insurance-free practice can be a challenge, only a few dozen DPC practices around the country have figured it out. Meanwhile, others on islands by themselves continue to try to partner with employers but are becoming increasingly frustrated with the process.
EDITOR: What you lack in age or business experience in DPC, make up for in “Likeability” with your Patients/Community.
These are just a few of the reasons I’m certain you are familiar with out there. Many are also saying that moonlighting shortly begets becoming a mobile doctor or within a year OR, they say they take on a FT position elsewhere. While it is a different kind of burnout, it is on the almost nearly miniscule rise upwards.
In 2018 alone, nearly 58% of DPC Physicians said debt for their startup in DPC was an average of $92,083.33 per practice. ~DPC Journal, Jan-May 2018 Physician Poll. The Association of American Medical Colleges reports that the average medical school debt balance for graduating physicians in 2015 was $183,000, and is no doubt higher today. Add that burden to their average undergraduate balance of $24,000 and the total average student loan balance for a doctor is $207,000.
DPC-burnout is on the rise and the issues are primarily centered around: moonlighting; patient retention; and running a business from the management and financial side.
- 47% of Physicians reported that they went into debt to start their DPC medical practice.
- The DPC Journal finds that 41% of practices are female DPC Doctor-owned clinics under the age of 49. Conversely, 36% stated they are male DPC Doctor-owned practices and under the age of 49.
- Nearly 10% of DPC Physician polling respondents stated that they believe some DPC clinics today won’t be able to stay in operation due to lack of local consumer interest. The DPC Journal also found that closures of DPC clinics are not being closely monitored nor reported.
- Less than 18% of DPC Physician stated they believe DPC should be defined by price. A majority of Physicians believe price shouldn’t matter and that the Doctor’s service offering/membership fee should be based upon the services offered, level of education, demographics, etc.
- In 2017, we saw subscription fee increases in monthly memberships rise by an additional $20-$50/pmpm. In 2018, nearly 8/10 monthly DPC subscription fees are now trending between $51-$99/pmpm.
- The DPC Journal surveyed over 1,100 actively seeking patients from across the U.S. in 2017 and asked them about their overall ‘faith’ in a Physician in today’s healthcare marketplace. Nearly 60% of those participants surveyed said ‘If DPC was not an option, they would NOT select an M.D. for their next primary care visit. 34% said they would prefer to see a Doctor of Osteopathic (D.O.) Medicine; 14% would prefer to see a Nurse Practitioner (N.P.) and 7% would prefer to see a Physicians Assistant (P.A.).
RELATED POLL | DPC INDUSTRY SPECIFIC