(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.
Most noteworthy in our observation of DPC in the past year or eighteen months is that DPC has demonstrated some impressive patient savings and outcome data in some interesting doctor-to-employer partnerships in specific suburban markets. Appearing in the last 2-3 years, there are only a few … located in the midwest and southwestern U.S. These “DPC2B” efforts, as we have labeled them, have created considerable momentum for DPC-to-Employer partnerships in parts of Texas, New Mexico, Colorado and Nebraska. But, not every Doctor wants that. Some prefer a DTC approach. Either way, the “DPC2B” component is one of the most exciting and interesting story we see coming out of the DPC space in the past year.
ATLANTA, GA USA | 2019 – The Direct Primary Care Journal (DPC Journal) is an independent observer of the private, direct primary care marketplace. We highlight little known industry trends, efforts and news in the Direct Primary Care (DPC) marketplace that we see will impact Physicians and Patients.
Highlights from the Past Year (July 2018 – July 2019) include:
- Startup isn’t cheap. It is not easy either … but a large DIY-community is trying to help DPC Physicians, particularly younger Doctors in the mid to uper 30’s and even into their early 40’s move into this space. After year number one, remaining startup debt in DPC is averaging $92,083.33 per Physician. 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.
- A six percent decrease in the Baby Boomer patient population is making way for roughly a three percent increase (each) in Millennial and Gen X patient populations subscribing and gaining interest in DPC programs.
- Earlier this year, 2019 in response to the question What Will the Future of YOUR DPC Model Look Like? Are You Planning to Grow Direct to Employer or DTC?
- 20% of DPC Physician respondents said “Some will stay small and will vehemently stay DTC. But, whether we like it or not, we’re competing with retail, onsite, near site and worksite clinics. We’ll always be attractive to a particular demographic in our community but we have to show value constantly if we stay in the DTC space … and that can increase DPC-fatigue.”
- 18% of DPC Physician respondents said “It’s the long-term, scalable play for Doctors in Direct Contracting. DPC-DTC is much to reliant on new patient marketing and constantly proving a PCPs value to the consumer. We’re losing the battle in a highly competitive marketplace to mobile app technology, UCs, Retail Clinics, NPs, etc.”
- 19% said “In the next year I plan to have more than 51% of my patient panel be through [e.g. contracted] through local employers in my area.”
- 17% said “I plan to have no more than 49% of my practice be through local employer relationships/contracts.”
In the past year when asked After Converting A Practice To DPC, What Is The First Environemental/Physical Practice Item That Changed In Your Practice?
- 10% of new DPC Physicians in the last year said “We Moved.”
- 17% said Reduced Staff.
- 3% said Returned Unused Diagnostic & Lab Equipment.
- 7% said Converted Waiting Room Into A Nicer Waiting Room/Lobby.
- 19% said Reduced The Amount of Space Needed In Our Building/Practice.
- 12% said Added Flat Screen TV.
- 7% said Bought New Diagnostic Machines & Lab Equipment.
- Most DPC Physicians do not currently have full patient panels. Full patient panels is also a relative term and each practice “caps” or defines their limit individually. One practice may “cap” their patient panel of subscribers at 600 while others want 1,100.
In the spring and summer of 2019, Physicians were asked nationally about the effectiveness of New Patient Referrals and Word of Mouth Marketing in their subscription-based practice model. Q: How often does it equal ROI with a new Patient enrolling into your practice?
- 41% – ROI directly related to word of mouth marketing providing my practice with a new Patient in my subscription-based worked … Between 76%-100%. It’s almost all I rely on. I spend less than $10K per year on other marketing vehicles — that said, patient experience and customer service is where I spend my “sweat equity.” I am constantly learning, reading and training my staff to be exceptional. It’s a lot of work, but it works for me!
- 24% – ROI directly related to word of mouth marketing providing my practice with a new Patient in my subscription-based worked … Between 51%-75%. Patient experience has to be great since I depend on it so much. Customer service, design, friendliness, all this stuff impact my WOM and referrals.
- 16% – ROI directly related to word of mouth marketing providing my practice with a new Patient in my subscription-based worked … Less than 10% of the time. I find other marketing vehicles work better.
- 15% – ROI directly related to word of mouth marketing providing my practice with a new Patient in my subscription-based worked … Between 25%-50%. It’s helpful for sure, but I have other strategies I deploy to help grow.
- 4% – ROI directly related to word of mouth marketing providing my practice with a new Patient in my subscription-based worked … Between 11%-25% of the time. I depend on it, but if I relied on it more than that, my enrolled subscribing patients would dwindle.
- DPC is becoming a young, female physician marketplace with approximately a large majority of new DPC physicians stating they in the late 30’s.
- 23% of DPC Journal polling respondents indicated that they will NEVER join another network.
- The average wait time at a DPC practice is less than 10-15 minutes.
- 16% of DPC Doctors hope DPC can/will work to partner with more businesses to save healthcare costs for employees in their local area and ease the burden of recruiting new patients one at a time.
- From 2018-2019, the most popular states with the most amount of new patient search/interest in DPC are
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. We are continuing to follow this national trend where younger DPC physicians are entering and few appear to be exiting the space in suburban markets. However, rural markets are struggling and lowering their fees to compete with big box retail clinics and traditional, plan reimbursed primary and family medicine practices. Patients in rural areas simply want to use their insurance and the value proposition behind DPC isn’t quite clear enough for them to make the investment. Additionally, limited data about the closures of DPC, job changes and moonlighting still is not widely reported or available. Therefore, further support for younger Physicians (mid 30s to mid 40’s) and when they are in their first one to three years would greatly assist the industry as a whole if the practice model is primarily DTC-focused.
- 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. Note, 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. from July 2017 – July 2019 … and asked them about their overall ‘faith’ in a Physician’s expertise is in today’s healthcare marketplace.
- Most 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.).
“We never see a Doctor’s office on America’s Best Places to Work. Not surprisingly, the people around us have lost faith in their local Doctor,” said Tetreault. “They’ve simply had too many bad experiences. While the human spirit is willing to forgive, Patients remember what visiting a Doctor’s office is like. They want a change and they will find someone who can spend time with them when their Physician won’t. We took our survey a step further in January of 2018 to July of 2019 and began to ask prospective patients seeking care from a subscription-based healthcare provider [DPC specifically] across the U.S. to choose ‘Cost’ or ‘Convenience’ over ‘Friendship’ with a Doctor they know, like and can trust. Findings from this prospective DPC patient survey tell The DPC Journal that 7.3 out of every 10 Patients want and choose … ‘Friendship with a Physician they can get to know, like and want to trust!’ HOWEVER, when we reverse engineered the question and we asked DPC Physicians … they responded by saying ‘Cost’ is the number one concern for Patients.”
About The Direct Primary Care Journal
The Direct Primary Care Journal (The DPC Journal) is an independent trade journal and online news reporting publication observing, reporting and connecting with experts from all facets of the DPC industry. The DPC Journal was created in order to fill an information void found when reporting, interviewing and researching direct primary care, direct-pay medicine and cash-only practices across the U.S. To learn more, visit: www.DirectPrimaryCare.com.