How to Consult with Specialists as a Direct Primary Care Doctor

How to Consult with Specialists as a Direct Primary Care Doctor

This is a big one for folks taking the plunge into Direct Primary Care - how do you as a Direct Primary Care doctor consult with specialists? Because you’re not “in-network”, how do you get patients the care they need outside of your office?

There are a number of ways to go about this and I’ll tackle three of them in this blog below. This blog post was prompted by a community question:

Message: Dr. Thomas,
I am about to start a DPC clinic. I completed family medicine in 2005 and am tired of the headache and hurdles of traditional primary care. One of the biggest things holding me back is how to refer to specialist? In one of your videos--you mentioned using a specialist service(for difficult ekg reading, endocrinology..etc). What was the name of that service?
Also--how do you deal with preventive stuff---like colonoscopy? stress test--if needed?

Any help in this category is greatly appreciated.

I am glad you got away from the insurance companies. I own a medical and day spa and will incorporate the monthly fee to cover facial/massage on the months the members do not need medical care.

Thanks again,

Option #1: Use the time that you have

Because you’re a Direct Primary Care doctor, you now have more time to read up on diagnoses and more time to guide your patients through the care that they need. By leveraging the increased time that you have, you can take care of more problems in your office and therefore have to refer less often.

Option #2: Develop close relationships with specialists in your community

If you are able to develop close relationships with specialists in your community, especially the private and non-hospital-affiliated specialists in your town, you can discuss cash prices for your patients.

I try to keep in close contact with my physician colleagues, and that’s part of the reason why I attend Wayne State University School of Medicine alumni networking events. Many of the opportunities that you find to lower the cost of care for your patients will come from your network.

For example, by working with a local gastroenterologist in our region that owns a free-standing endoscopy suite, we were able to get cash prices for Esophagogastroduodenoscopies and Colonoscopies. They are roughly $1,000 each, which pays $400 for the facility, $300 for the Gastroenterologist to perform the procedure, and $300 for the Anesthesiologist.

Another example is Cardiology. We worked with a local cardiologist to get pricing on common tests that we need for our patients. Specifically, the Echocardiogram is $199, an Exercise Stress Test is $99, and a Holter Monitor is $99. These are very reasonable prices and they help us make better decisions for our patients.

Additionally, you can request visit prices/appointment prices from the specialists in your community.

Option #3: Leverage an online or e-Consult platform

As a Direct Primary Care doctor, you have the option to consult with specialists via online or e-Consult platforms. The platform that I, and many DPC doctors, use is Rubicon. Rubicon allows you to write up a consult and include PDF files or image files - EKGs, skin lesion photos, pathology reports, lab tests - and send this information to the consultant/medical specialist of your choice. The Rubicon platform has over 100 specialists and sub-specialists from Cardiology (Electrophysiology, Pediatric, Heart Failure, Lipid Disorder) to Endocrinology, Plastic Surgery, Transgender Health, and Women’s Health. The spectrum of consultants is quite broad here and the responses are very often thoughtful and helpful.

This is a great service and I enjoy using it, but be aware that you are liable for any decisions that you make for your patients based on using this service. Finally, if malpractice litigation was brought against you or Rubicon for an outcome related to using this service, you would be responsible for not only your only legal costs, but the legal costs related to Rubicon’s involvement. Caveat Emptor, read the Indemnification clause from Rubicon’s Contract:

14.      INDEMNIFICATION; LIMITATION OF LIABILITY:

14.1.    General Indemnity: RMD and CUSTOMER will each indemnify, defend and hold harmless the other and its officers, directors, employees, agents and Specialists from and against any and all direct third party claims, costs or expenses (including reasonable out-of-pocket attorneys’ fees), and payment of damages awarded by a court of competent jurisdiction in a non-appealable final judgment or agreed to in settlement (“Claims”), resulting from the gross negligence or willful misconduct of the indemnifying party; provided, that the indemnified party promptly notifies the indemnifying party of the Claim, gives the indemnifying party sole control over the defense and settlement of the Claim, and reasonably assists the indemnifying party in the defense of the Claim at the indemnifying party’s expense, provided such settlement provides for a full release of all Claims against the indemnifying party and its affiliates. For clarity, CUSTOMER’s indemnification obligation will include indemnification for the gross negligence or willful misconduct of all of the Users and Drafters.

Yeesh.

Thanks for reading, thank you for the question, and let me know what topic you’d like me to tackle next!

-Dr. Paul Thomas with StartUpDPC

How to Get More Patients for your Direct Primary Care Practice

The biggest question doctors have is how to get more patients for their Direct Primary Care practice. How do you attract patients to your Direct Primary Care practice when your name is not on the back of their insurance card? How do you get people to pay over and above their insurance for your Direct Primary Care service?

I’ve come up with a short list on how to get more patients for your Direct Primary Care practice, and it starts with building trust with your community.

Build Trust with your Community

When a patient selects you as their physician, they are entrusting you with their most important asset - their health. The doctor-patient relationship is solemn and sacred, so how do you build trust with people in your community? To build trust you should be consistent, authentic, genuine, and caring. We often form deeper relationships with people who demonstrate these qualities, they are typically our best friends. Bonus points if they’re fun to be around!

Simple actions like speaking at a local school - and documenting the process - can help you build trust with local stakeholders.

Now, it’s one thing to have and possess these qualities, and it’s another thing to communicate these qualities with a broader audience. Many Direct Primary Care doctors have these qualities - people who choose a DPC practice are often phenomenal people with big hearts who want to do the right thing for their patients, their community, and themselves. I’ve been to several meetings of Direct Primary Care doctors and I’m always blown away by their compassion and caring, their willingness to do the right thing no matter the cost.

However, their weakness - the weakness of the DPC doctor - is their ability to communicate with their broader audience. They have a hard time telling folks about their character. Maybe it’s because we’re doctors, and we feel like once we hang a shingle, our neighbors should flock to us for their care. But this simply isn’t the case.

The market is fiercely competitive and you have to communicate your value to the people in your community and you have to do this on a consistent basis. So how do you communicate your value?

How do DPC Doctors Communicate Their Value to the Community?

Direct Primary Care doctors use tools to communicate their value to their broader community. The best known tools are the social media channels that we and our prospective patients use on a daily basis. That’s right - Facebook, Instagram, Twitter, etc… are the mediums by which we communicate to our patients. If you’re able to build a strong personal and professional brand on these channels, you can build a robust DPC practice.

Additionally, DPC doctors leverage other tools like email lists and press releases to reach more patients in the broader community. These can extend your reach beyond the algorithms of Social Media channels.

If you’d like to take a deeper dive on these subjects, check out our courses page.

Thanks for reading and have a great day,

Dr. Paul Thomas, founder of StartupDPC

Why StartupDPC?

StartupDPC exists because we believe in the Direct Primary Care movement and we want to help doctors start and grow their DPC practices.

My name is Dr. Paul Thomas and I’ve been planning, building, and growing my Direct Primary Care practice over the last 3 years and I want to share everything that I’ve learned during that time with you. I went from 0 patients in November 2016 to over 500 patients today and I recently hired a second physician to help me manage the demand.

In addition, I’ve become a thought leader in the Direct Primary Care field, as I have advocated for the advancement of DPC in Washington and I’ve spoken at the national Direct Primary Care conferences on a range of topics.

I want to accelerate your growth, decrease the number of mistakes that you make, and help you achieve a fulfilling practice in Direct Primary Care. I want to do this because I believe in Family Medicine and Family Physicians, and their ability to deliver excellent primary care services to their patients and to their communities.

I’ve consulted with several Direct Primary Care doctors who have gone on to create successful, thriving Direct Primary Care practices. I want to share the knowledge that I’ve gained and share the essence of these consulting sessions with you so that you can grow your practice more quickly.

More to the point, there isn’t a great coaching resource in the marketplace right now, and we want to provide an excellent service to accelerate the growth of the DPC movement.

We aim to answer the most commonly asked questions in the Startup Phase and then we have additional resources for you to use during the growth phase. We will also add modules as needed, specifically around hiring another physician and similar topics.

To get started, head over to our courses page.

Thanks for reading and good luck with starting your DPC practice - let me know if I can be helpful along the way!

-Paul Thomas, MD

Dr. Paul Thomas speaking to an audience of over 300 at the AAFP Direct Primary Care Summit aka DPC Summit in Chicago in June 2019