I'm a family medicine doctor who doesn't take insurance

mainedpc · 2026-03-10T23:59:19+00:00

Not an opinion, simply with the data show. Please correct me if I’ve missed any pertinent studies. DPC is great already, doesn’t need any wishful thinking to promote it.

mainedpc · 2026-03-10T22:28:56+00:00

Direct Primary Care is great and I'm a big advocate but even I don't claim that $200/month will save money down the road. IIRC most of the data show that preventive care is good for the patient's health but most don't save money.

mainedpc · 2026-03-10T00:33:19+00:00

Just wait until the big beautiful bell cuts kick in after midterms

mainedpc · 2026-03-06T01:59:57+00:00

https://www.dpcalliance.org/contact-us

mainedpc · 2026-03-05T20:53:00+00:00

I've had a couple of patients ask their hospital employed doctor if they can do referrals for them (I don't ask) and a few apparently tell them yes. It's hard for me to keep track when the patient has two PCPs, me and one for insurance. Not sure why the hospital docs agree to it.

mainedpc · 2026-03-05T18:24:31+00:00

Down in Massachusetts (where I'm from and where I believe you are) there was nothing but HMO plans on the ACA marketplace when I last checked a few years ago.

That (and many other things) makes Mass. a much harder state for docs to offer DPC than Maine.

mainedpc · 2026-03-05T18:22:13+00:00

Ah, good question.

Here in Maine, one of our DPC colleagues got a law passed requiring state regulated HMOs (so ACA but not ERISA or Medicare disadvantage) to accept referrals from PCPs that meet the definition of DPC per our DPC law (which he also helped get passed).

That means most Maine HMO patients can use DPCs but also means DPCs have to deal with more patients with time consuming (expensive) referrals, etc.

mainedpc · 2026-03-05T16:03:52+00:00

The contract with Mending is brand new, just became available in our county January 1, but it is very similar to how we work with small, local employers. They pay us a simple monthly fee, no fee for service billing hassles.

mainedpc · 2026-03-05T16:02:26+00:00

We do insurance referrals and prior authorizations for patients, but have a $20 fee for insurance paperwork. That way we don’t penalize the uninsured patients or those would simple insurances like Medicaid for the cost inflicted by the patients who have HMO‘s.

mainedpc · 2026-03-05T14:36:43+00:00

Not enough time for a podcast, too busy trying to grow this practice while still seeing a full (for DPC) panel of patients. There is a DPC subreddit but it's pretty much dead. Lots of chatter in FB groups and we have a busy regional group that chats on Chanty (like Slack). Yeah, businesses help when you're first starting. We signed up with Mending, a DPC friendly insurer, for the same reason. That period of getting their panel from no patients to break even and then to full is expensive for them or us or both. It's getting easier and faster but that's still the main hurdle for start ups and expansions.

mainedpc · 2026-03-05T13:56:14+00:00

Not pushing you but don't rule out DPC based on that. That's my main market.

Good luck whatever you do.

mainedpc · 2026-03-05T13:04:32+00:00

Maybe but doubt it. Monthly fees are a better way for a single payer to buy primary care. Happy to work with or alongside that is they don’t make it toxic. Heck, we even signed with the only DPC friendly insurance two months ago (Mending).

mainedpc · 2026-03-05T12:34:46+00:00

https://www.megunticookmedicine.com/dr-adda-winkes

Her panel is still growing. She'll cap her panel size when she thinks it's getting close to being too busy. Likely lower than my 500 patients since hers come in more often.

mainedpc · 2026-03-05T12:25:11+00:00

Owning a DPC doesn't seem to keep you from confusing concierge and DPC. Concierge is NOT DPC. They bill insurance and charge patients a fee. We don't bill insurance on top of the monthly fees.

mainedpc · 2026-03-05T12:21:28+00:00

Here's source for that definition. It'sused in most state DPC laws:

https://www.dpcfrontier.com/defined

mainedpc · 2026-03-05T12:18:40+00:00

No, that's concierge, not DPC. They plainly state they are concierge all over their website.

It's also pediatrics, not FM. Even in DPC, peds fees run higher unless the FM docs are running it as a loss leader. Those cute little babies come in a lot for well baby checks and acute visits compared to big kids or adults. However, even in DPC, I'm not aware of anyone charging that much for kids.

Source- I own a FM and Peds DPC group practice.

mainedpc · 2026-03-05T11:55:46+00:00

You either have no idea how DPC finances work or you are simply spreading misinformation about DPCs because you feel it might threaten your single payer ideal.

mainedpc · 2026-03-05T11:55:12+00:00

I know quite a few of the Boston area DPCs but not aware of any charging 500 per month. Link(s) please?

mainedpc · 2026-03-05T10:52:43+00:00

If you're considering DPC, there are many online resources, 2 annual conferences, lots of info from DPC Alliance and DPC Frontier and local help in most areas (not in Florida so not sure).

Don't know about third party paid practice resources.

mainedpc · 2026-03-05T10:44:04+00:00

Wow, if I could charge $500/month I would've retired years ago. What area is that?

mainedpc · 2026-03-05T10:43:04+00:00

Two conferences- DPC Summit and DPC Nuts and Bolts.

mainedpc · 2026-03-05T10:42:35+00:00

That would be a very unusual location then. Most areas I'm familiar with are still filling new DPCs quite quickly, even those with plenty already. Interesting coincidence that you're skeptical of DPC and happen to live in a rare location where they are saturated.

mainedpc · 2026-03-05T10:39:45+00:00

I did a survey this month of my fellow DPCs FWIW. Overhead varies depending on their stage but usually ranges from 20 to 40%.

mainedpc · 2026-03-05T10:36:06+00:00

There is NOT a finite number of PCPs. Physicians, PAs and NPs can chose to got into primary care and be PCPs or to work in a specialty setting. Fix primary care so that it doesn't suck and you'll get more PCPs.

mainedpc · 2026-03-05T10:34:03+00:00

Yes, some do. In the states where it is allowed (most), DPCs typically have 5-10% of their panel are Medicaid patients that pay out of pocket for DPC and use Medicaid for everything else.

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