Direct Primary Care was viewed as potentially beneficial for both patients and physicians. For some survey questions, DPC physicians had significantly different views or held them more strongly than non-DPC physicians.
I’m pleased to share with you that a research paper about how physicians view the Direct Primary Care model has been published. In July of 2017, a survey was conducted through the American Academy of Family Physicians (AAFP); members of their marketing research online community choose the surveys they are interested in responding to.
Survey questions related to knowledge of the DPC model and perspectives about the model and its potential benefits for patients and physicians. Importantly, respondents indicated whether they practice in a DPC model, and responses about perspectives were analyzed by practice model. This is the first peer reviewed scholarly paper that evaluates perspectives about DPC by whether family physicians practice in the model, thereby allowing for interesting comparisons between the perspectives of DPC physicians and those who practice in a traditional insurance-based way.
Eight percent of respondents reported practicing in a DPC model and 79% chose the “correct” (AAFP-endorsed) definition of DPC from a short list of choices.
In the survey, DPC was defined as a model in which physicians do not accept payments from insurance companies or third-party payers, but rather, patients pay a monthly membership fee ranging from $50 to $150 for a defined set of primary care services for no extra charge, and low-cost prescriptions and other services. Given this definition, physicians were asked to indicate their level of agreement with six belief statements about DPC. The statements related to patient confusion, financial sustainability, physician shortage, lack of health improvement, low quality, and that only healthy and wealthy patients benefit. Statements were worded negatively with agreement indicating negative perceptions of DPC.
For all (negatively worded) belief statements, DPC physicians expressed stronger disagreement, and the difference by practice model was statistically significant for four of the six statements.
Family physicians broadly agree that DPC has potential benefits for patients and physicians (i.e. respondents expressed disagreement with the negatively worded statements). For all belief statements, DPC physicians expressed stronger disagreement, and the difference by practice model was statistically significant at the 5% level for four of the six statements. This seems to show that non-DPC physicians are more skeptical of the benefits of the DPC model. These four statements are:
The fact that DPC patient panels are smaller will worsen the primary care physician shortage.
The DPC model only benefits healthy and wealthy patients
Unlimited access to primary care through a DPC model is not likely to lead to improved health outcomes for patients
Lack of control over how DPC physicians practice and what treatments they suggest is likely to result in low quality such as over-treatment or under-treatment
The last section of the survey asked respondents to rank the top three benefits of DPC, selecting from a list of five choices. Topics included administrative burden, time with patients, spending on downstream care, and physician responsiveness to patient needs and preferences. Rankings were statistically significant by practice model. Lower administrative burden was selected as the most important benefit by over half of non-DPC physicians but only 18% of DPC physicians. Better availability of care was selected as the most important benefit by nearly one-fourth of DPC physicians and only 6% of non-DPC physicians made the same selection. It is interesting to note that the non-DPC physicians focused more on benefit to physicians while DPC physicians focused more on benefit to patients. The three other benefits were not statistically different by practice model.
A few words of caution about this study are in order. This survey was conducted more than four years ago; it seems likely that knowledge of and perspectives about DPC have changed during that time. The results may not be fully generalizable as the sample is a select group of family physicians who chose to respond to this particular survey; it seems likely that people with strong views either way would be more likely to respond to the survey.
Still, I believe we can glean some important initial findings from this study. Family physicians broadly agree that DPC has potential benefits for both patients and physicians. Perspectives of DPC differ significantly by practice model, which may indicate that further education about DPC and other alternative delivery and financing approaches would be beneficial for family physicians and other primary care practitioners. Respondents highlighted key potential shortcomings of DPC, namely physician shortages and access for vulnerable patients. For further discussion, please see the full article at https://doi.org/10.18332/popmed/140087.
Certainly, there is much need for scholarly research about DPC, and the open questions about DPC go well beyond physician perspectives of the model. Even so, I am pleased to have made a small dent in the outstanding need for research. I am appreciative of the assistance of the AAFP and my co-authors.