Written by Dr. Joel Warshaw | Published on Wednesday, November 11th, 2015

When I converted to the Direct Care model of practicing medicine in 2008, I was somewhat surprised to see the response from local physicians. Specialists in my area were very supportive and quite interested in my model. However, the response from other primary care doctors was not as welcoming. Most comments I heard were through the grapevine and often negative, as most doctors were not willing to speak to me directly. It felt as though I was in High School once more, hearing comments such as, “Does he think he is better than us? ”. After eight years of practicing the Direct Care/Concierge model, I would like to address this question. Am I a better physician because I practice a model without insurance? Absolutely not! Do I think I offer better access and service to my patients? Hell yes!!

Let’s look at the basics. According to the Annals of Family Medicine 2012, the average Primary Care Doctor has about 2,300 patients on their panel. On average, they will see 20 to 25 patients per workday, with some days reaching 30 patients! According to Statista 2015, the majority of physicians will spend 13-16 minutes with each patient per visit, with up to 25% of doctors spending less than 12 minutes with their patient! According to the Physicians Foundation Survey, Primary Care Doctors spend 20% of their time on non-clinical paperwork, including billing, insurance approvals, financials and other miscellaneous work.

Now let’s look at the Direct Care/Concierge Practice. The average practice has 600 members and sees 6 to 8 patients per workday (Concierge Medicine Today). The average time spent with a patient for a routine visit is 30 minutes, and 90 minutes is blocked for a physical. There is plenty of optional time if needed. With the Direct Care model, such as mine, there is minimal insurance involvement. A few insurance companies require prior authorizations for select tests, and some require peer-to-peer discussions. These are the calls that remind me why I converted my practice years ago! With no insurance billing, the physician is able to spend 95% of his or her time with patient care. The way it should be!!!

It is hard to argue the fact that the Direct Care/Concierge model offers way better ACCESS and SERVICE to patients.

  • ACCESS means that when someone calls the office the staff, sometimes even the doctor, will answer immediately. There are no automated phone trees or answering services to field calls. Patients have direct access to the physician through cell phones, texting or emailing, with a rapid response in return, including evenings and weekends. Scheduling appointments is quick and easy. Patients never have to wait long for appointments, including complete physicals, with same day or next day appointments readily available. With the Traditional Model seeing the doctor can take months!
  • SERVICE, with the Direct Care/Concierge model is superior. When patients come in for their scheduled appointment, they are brought into the exam room and seen on time. Appointments last as long as the patient needs, without the doctor’s hand on the doorknob ready to get out as quickly as possible, so they don’t get too far behind. Patients are offered assistance with same day prescriptions, setting up appointments for tests and arranging follow-up time with specialists. As Physicians and staff come to know their patients, the personal touch becomes part of patient care.

Switching to the Direct Care model years ago was not because I wanted to be “better” than other doctors in my area. I knew I wanted something better for my patients, and I also knew that if that happened, I would get something better for myself. During those years, when I was practicing the “Traditional Model”, I felt that Healthcare and I were being smothered in the proverbial “hamster-wheel” environment of patient volume, bureaucratic government regulations and insurance policies.

I strongly believe that Direct Care/Concierge Medicine offers one solution to our many healthcare system problems, and should be heavily promoted and expanded upon throughout the nation. I never marketed myself as any “better” than other primary care doctors in the area, but I will honestly market myself as offering better access and service for my patients. Based on the approval rating of multiple patient satisfaction studies, it’s a point that is hard to argue.