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Family Doctors are Ditching Insurance for Simpler Approach

December 5, 2019

For a doctor, traditional healthcare usually comes along with tight schedules, short appointments, and piles of insurance paperwork.

Dr. Emilie Scott was no exception and got tired of jumping through hoops, being limited to 20 minutes per patient, and dealing with insurance issues. Eventually, Scott quit her job to try out a new approach that would eliminate all of the headaches of traditional healthcare. 

Instead of having to bill insurers, Scott now charges patients a $79 monthly fee that covers office visits, phone calls, emails, texts, and certain medical tests and procedures. Scott generally sees about six patients a day, when she previously would see around 30, and spends more time with each patient. She hired two assistants to help handle paperwork, rather than working with a department of billing specialists. 

This approach is called direct primary care, and aims to leverage the extra time and money from avoiding insurance into improving care for patients. 

"As far as our financial success, it does not depend upon having a team of people to figure out how to get money from the insurance company," said Scott, who co-owns a private practice in Irvine, California that serves about 900 patients. Scott said the practice has grown by word-of-mouth, without advertising.

Although patients appreciate the easy access, and extra attention, healthcare researchers question its cost-effectiveness and whether it will ever be capable of serving large numbers of people. 


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According to Michael Gusmano of the nonprofit Hastings Center, patients considering direct primary care should press doctors on exactly what services are covered by their monthly fee. 

Many direct primary-care doctors acknowledge the limitations and recommend patients carry some type of insuranc to cover emergencies, surgery, and expensive testing. 

Only about 4% of family doctors reported working in direct primary-care practices last year, according to a survey by the American Academy of Family Physicians. There are currently 1,200 practices in the U.S, according to the Direct Primary Care Journal. Typical patient fees are around $75 per month or $900 annually, studies show.

There are patients who have tried direct primary care that say they've gotten their money's worth. Susan Meyer, a 55-year-old attorney, didn't have any urgent health issues when she had her annual physical earlier this year. But she noticed a small blemish on her left wrist. Scott recommended a biopsy. It turned out to be a common form of skin cancer.

Meyer's monthly fee covered the physical, diagnosis and surgery to remove the cancer. She paid about $100 for the biopsy.

"It was exactly the way healthcare should be: remarkably efficient and cost-effective," she said.

Though many patients are satisfied, there are still challenges that come with direct primary care. For example, a direct primary-care model aims to provide more in-depth care to limited number of patients, with most doctors reporting between 400-800. Meanwhile, a traditional practice treats around 2,000 or more. 

If more doctors switch to direct care, critics warn it could worsen physician shortages, especially in rural communities.

However, Dr. Thomas White, who runs a direct care practice in Cherryville, North Carolina, sees the problem differently. He said abandoning insurance could help boost the supply of family physicians by providing them a less stressful way to practice medicine.

"We've got to embrace this model of care and figure out a way to roll it out gradually, because I think it can save family medicine," he said.


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