Direct Primary Care vs. Concierge Medicine

Michael A. Ciampi, M.D.


I often I talk to people who don’t understand Direct Primary Care (DPC) and try to educate them about it.  Very often, when I tell them that in a DPC practice, we expect payment from our patients directly rather than submit bills to an insurance company, they snicker and accuse me of being a greedy concierge doctor who is only affordable for rich patients.

I do my best to smile, bite my tongue, and try to explain the model to them, assuming they are willing to listen and learn about an exciting way to deliver health care to almost every patient.

Technically, DPC has some similarities with the MDVIP style of concierge medicine, namely in that in both models, patients pay a monthly or yearly subscription fee, and both types of physician practices limit their patient panels so that they can be sure the patients they have get plenty of access and attention.  That is pretty much where the similarities end.

Unlike concierge medicine, Direct Primary Care practices ask their patients for far less than their higher charging counterparts.  The yearly subscription fee for a DPC practice is often hundreds, if not over a thousand dollars less than a typical concierge practice.  Also, DPC practices do not bill insurance for visits over and above the subscription fees; concierge practices do.  Because of this, patients may have to pay their concierge doctor even more because of copayments and deductibles that are part of their insurance contract.  DPC practices are more transparent.  All the money they collect is from their patients directly, via the transparent subscription fee.  The patient may have to pay extra (usually the wholesale cost) for vaccines, medications, and labs supplied by the DPC practice, but they are told exactly what those prices are before the services or goods are rendered.

One thing I love about practicing Direct Primary Care medicine is that we are actually much more affordable for people with or without insurance.  Because we do not have to deal with insurance company rules and billing, which is extremely complicated and requires more staff and computer systems, our overhead costs are lower.  We are happy to pass this savings on to our patients.  For example, a patient once told me that before seeing me, he had a five minute visit with his former PCP’s nurse practitioner for a sinus infection.  Because he never meets his insurance deductible, he had to pay the full price of the visit, which was $300!!  His jaw dropped when I told him that that amount of money would be buying him six months worth of unlimited visits, (each up to 30-60 minutes) with me, his personal physician every time.  When I save a patient a visit to the emergency room, I have saved them enough to pay for our services for years to come.

The truth be told, we have very few patients in our practice whom most would describe as rich.  We have a disproportionate number of patients who are self employed small business owners and manual laborers who are either under- or uninsured.  Because they know that we are giving them a fair deal, they are our most loyal customers and best marketing.

If you are rich and could go anywhere for your care, or if you have great insurance and never have to pay out of your own pocket for anything, please don’t worry.  We won’t hold it against you.  We will give you the same high level of service and personal attention we give to everyone else!

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