Friday, October 31, 2014

Direct Primary Care = Direct Family Medicine, Direct Pediatrics & Direct Internal Medicine

Direct Primary Care is a business model for medical practice that is gathering momentum with a boost from the American Academy of Family Physicians (AAFP) through the "Health is Primary" Campaign. See it here Find definitions of Direct Primary Care at

My practice, Neighborly Family Medicine in Beavercreek, OH, uses the DPC business model to practice Direct Family Medicine (DFM).  Notice that I'm differentiating the business model from the specialty practice.  The semantics are important, but take a while to understand.  Direct Family Medicine helps me to understand what I'm offering to patients.  I assume that a pediatrician would deliver Direct Pediatrics, while an internist would offer Direct Internal Medicine.  A Med- Peds physician would do Direct Med-Peds. Clarifying how the DPC business model is applied can be very helpful for patients and doctors.  The term Direct Primary Care comes up short of adequate clarification when patients seek care.  I love doing Direct Family Medicine (and saying it, too).

Direct Internal Medicine and Direct Pediatrics are needed.  The physicians in those specialties deserve to have the fun and freedom of using DPC to support their specialty.  We need a lot more internists and pediatricians in a DPC business model.  Join the movement, Folks.  We need you.  There are not enough Family Physicians to meet the care needs for America at the primary care level.  Let's team up and shift the cost curve together.

Patients:  Introduce DPC to your pediatricians and internists.  They'll love Direct Pediatrics and Direct Internal Medicine.

Tuesday, October 28, 2014

Teaching Direct Primary Care: Here We Go!

Direct Primary Care is all the rage.  It's been anointed in the "Health is Primary" initiative as a key business model for success by the AAFP (American Academy of Family Physicians).  The initiative was launched by the AAFP last week in Washington, DC.

A keynote presentation by Erika Bliss, MD CEO of Qliance at the Family Medicine Education Consortium (FMEC) in Arlington, VA two days after the AAFP announcement wowed the students, residents and even some faculty at the FMEC meeting. One big question from the students and residents:  Where can I get DPC training?  One big question from the faculty types:  How do you teach it?

Personal reflection as a DPC innovator, DPC Hybrid private practice owner and Family Medicine educator: Direct Primary Care is the only element in all of medicine that is moving ahead on the offensive.  The rest of medicine is otherwise on the defensive, hunkered down waiting for the next mis-directed initiative.  The AAFP is willing to take the risk of helping Family Physicians and their patients by going against the status quo and endorsing the DPC business model.  The "Health is Primary" Initiative allows Family Physicians to get some reassurance about the Future of Family Medicine.

How do we teach DPC along the entire Family Medicine workforce pipeline?
1.  Define our Dream (and help each individual to define theirs)
2.  Have a burning desire to achieve it (and cheer for each other as we get "fired up")
3.  Believe we can do it (and validate/reaffirm the belief of each other)

Dialog will be one of our powerful resources for spreading the word about DPC.  We are good at it.

The DPC pioneers have paved the way for the model to be accepted, proven and recommended.
The "Health is Primary"  initiative will add energy, deliver AAFP introductory workshops during the next year, and facilitate the DPC Member Interest Group which will help interested members to learn more.

Departments of Family Medicine can be pivotal in promoting DPC by updating faculty on the Health is Primary Initiative and the DPC elements in it.  DPC oriented faculty and clinical faculty and preceptors should be asked to orient faculty and departmental staff to DPC.  A Champion for DPC should be identified by interested Departments.

State Chapters of AAFP should be contacted for information or assistance with DPC resources and contacts.  The state chapter web site should connect with the AAFP "Health is Primary" initiative and its DPC elements.

Family Medicine Interest Groups (FMIG's) should get DPC speakers to introduce DPC elements to the student members at FMIG meetings.  FMIG advisors should find the online DPC info which is plentiful.  Pre-doctoral directors in Departments of Family Medicine should identify their DPC resources such as preceptors, clinical faculty and full time faculty, and social media resources for medical student use.

Students could introduce the DPC business model to preceptors for discussion during their clinical rotations. A list of online resources explaining DPC and its variations should be available on FM Department and FM Residency web sites.  Medical students could refer preceptors who are naive to DPC to these sites.

Residencies that identify how they will teach DPC should quickly add a DPC section to their web site and promotional materials.  Similar to the sports medicine, geriatric, perinatal, genomic initiatives across the last couple decades, the DPC aspect of practice management could be in place within two months for aggressive programs.

A champion for DPC should be identified for each section of the "Family Medicine Pipeline" and connected via social media.

Objectives for practice management training should be quickly modified to add a DPC component.  One key aspect of DPC in practice management is the learners attitude about business, money, commerce, ethics (business and medical), and the patient-physician relationship.

The Family Practice Model Units should explore a DPC track for patients and employers, which is doable (FYI-I was Medical Director of a University and a Community FM training practice- multiple payment models fit nicely.  None of them are inherently evil, but some faculty wondered if something they were unfamiliar with was dishonest--like capitation or fee for service.)

Residencies:  Students are hungry for this model.

All of us:  We're part of the problem as a citizen of the Medical-Industrial Complex.  Let's re-direct the ship around the iceberg with "Heallth is Primary", including DPC and what we learn as a result of having to teach about it.  How will it fit with "The Dream".

What do you think?

Friday, October 24, 2014

Family Medicine: The Myth and the Tension

What do patients expect of their Family Physician?  What do we expect of them?
As we relate to each other, one or the other may seek better connection.  They may press to create more tension to enable a more meaningful engagement.  Relationships, like poems, need tension.

Hopefully, patient or Family Doctor creates the tension to enhance the communication or someone may not get a fair consideration from the other.  Creative tension may enhance the relationship, too.  It can get toned over several engagements to allow high quality communication and better alignment with mutually beneficial values, goals and dreams.

The expectations of each party may be based on a mysterious myth about who the other person is and what has (or hasn't) happened before.  Our profession has some mythical qualities with many patients, especially those with positive expectations.  We may remind them of a TV Dr. like Marcus Welby, MD or Richard Kildare, MD (OK, these were a long time ago) or one of the newer physicians on Gray's Anatomy.  Those myths may be helpful for the patient and the doctor to accomplish their goals.  They believe in something beyond the current situation, and make it through.

What kind of tension do you create?  Or run from?

What myths might you believe about patients, Family Medicine or your Family Doctor that may help or harm your health?  Or your career?

More later from the FMEC meeting in Arlington.