The StartUpDPC Show Episode 2
This is Episode 2 of the StartUpDPC Show, this time Dr. Paul Thomas interviews Dr. Shane Purcell of Direct Access MD in Anderson South Carolina. Check out his website, here: https://www.directaccess.md/. Here’s the full episode and read the discussion below!
Deciding to go DPC
Dr. Shane had been practicing for 17 years prior to starting his Direct Primary Care Practice, mostly as an urgent care doctor. But he noticed that many patients were having more and more chronic issues that he wanted to address. However, he lacked the technology resources to start a DPC practice, namely the automated monthly billing option.
He was actually considering a Micropractice option. However, he read more about DPC via journals like Medical Economics and the AAFP Journal, and once the technology component became available, he jumped in on the DPC movement. By leveraging technology like a cell phone and texting, he’s been able to be successful in streamlining his workflow and taking care of patients more efficiently.
Working with Employer Groups
Doc Shane left the urgent care work 3 years ago, and slowly built up 300 patients and then shifted towards working with larger employer groups. Doc Shane has been on the speaking circuit about engaging with larger employers, and you can catch his talk via the Hint Health website, here: https://video.hint.com/magic-pixie-dust-and-miracles-dpc
He’s been steady around the 600 mark for his patient panel, and he’s in a relatively small city with 25,000 people in Anderson South Carolina, and 200,000 people in the County. As a nerd, I looked up these stats – there are 27,293 people in Anderson, SC as of 2017 and 198,759 people in the County of Anderson, SC as of 2017.
All of this is to say that you can be successful with a DPC practice in small towns with relatively low levels of population. Doc Shane says, “People need help everywhere, so even in small towns, DPC is very attractive for a lot of people. And, more and more employers are asking for it and looking for it and looking for ways to save money.”
Doc Shane is also trying to get some good data around taking care of large employer groups and how this translates to cost savings for the companies or larger entities involved. In my opinion, this is really important for growing the movement – proving the efficacy of DPC as a cost-saver for larger companies all while giving a better primary care experience for employees.
Doc Shane and Paul Thomas, MD catch a ride together at the AAFP DPC Summit.
How many patients do you see as a DPC doctor vs as a Fee-for-Service Doctor?
Comparing and contrasting patient volumes, Doc Shane would see 30 to 40 urgent care patients in a day while he was practicing in that model in 2014. Now, in 2019, he’s seeing about 5 or 6 patients a day even with a full panel. But, he notes he does a lot of emailing and texting each day.
For me, I have a full panel of 500 patients and I estimate that I engage in 20 text message conversations and 5 to 10 email conversations daily. Doc Shane agrees with this, and estimates around 20 to 30 technology conversations each day. There are some fluctuations in terms of the days – Mondays and Fridays can be busier than the middle of the week.
On Partnerships in Direct Primary Care and on Hiring Doctors in DPC Practices
Doc Shane is a 50/50 partner with another Family Physician. He also employs two other physicians, and he pays them a certain percentage of their revenue. He and his team take care of collecting the revenue, social media, advertising, or reaching out to employers. We discuss how this allows the employed physicians to work 9 am to 5 pm, take care of their patients and enjoy a good balance between work commitments and home commitments.
One of Doc Shane’s employed physicians brought 300 patients or members with him when he joined the practice. He quickly filled his practice, and got up to 500 members. He works with an assistant and is able to earn just under what he made in the Fee-for-Service system, but with only 500 patients and only working 4 days each week.
I estimate that when you convert your Fee-for-Service practice to a DPC practice, and you have a long-standing relationship with your patients, you can anticipate 10 to 20% of your patients making the transition with you to DPC. Doc Shane agrees and adds that this depends on the time frame. We agree that Kissi Blackwell and Amanda Pennington have had rapid growth and high conversions.
Of your existing patients, it can be very hard to judge who will follow you to DPC. Doc Shane adds that some of those patients who don’t initially make the leap to DPC may reconsider 6 months down the line once they have a bad experience in the Fee-for-Service world without you as their doctor.
AAFP FMX 2019 Recap
Doc Shane is a leader in the Direct Primary Care movement, and also a rebel at heart.
AAFP FMX is perhaps the largest gathering of Family Physicians in the country, with about 5,000 to 6,000 Family Physicians as attendees. If you need live CME, this is a good conference because there’s an opportunity to get 30 or so CME credits. Doc Shane gives high praise to Julie Gunther’s “Trojan Horse” DPC talk aka the Joy in Medicine. However, if you’re focused on learning about DPC, there are few opportunities to zone in on DPC content because the DPC content tends to get washed out by the large volume of other sessions – like lectures on practice management in the Fee-for-Service world and general medicine lectures like Diabetes, Hypertension, and COPD.
However, there is an opportunity to have a little bit of the AAFP’s ear in terms of participating in the DPC MIG aka Direct Primary Care Member Interest Group. There’s also an opportunity to discuss bigger issues via the DPC MIG online, a forum for AAFP members.
Should Midlevel Providers be able to Start and Run Their Own DPC Practices?
We also discuss Mid Level Providers engaging in Direct Primary Care, like Nurse Practitioners and Physician Assistants starting DPC practices. Doc Shane says that this is more of a legal issue, and that if this practice is legal in your state “you’re kind of stuck.” Additionally, he says that the AAFP is unlikely to take a formal stance on this issue.
Ultimately, Doc Shane advises DPC Docs to do the best that they can do in terms of offering services to your patients and letting your work speak for itself. For me, I agree with this. As a Doctor practicing in the DPC model, you have more time to use all of your tools, to deliver an even higher level of care than you could in the FFS model. This ability to practice at the top of your license will set you apart from the typical doctor in the FFS system, the typical doctor in the urgent care setting, and any midlevel provider in any care setting.
Doc Shane then brings up the other market forces, like Walmart setting up care clinics, which are mostly staffed by Nurse Practitioners and Physician Assistants. These are $50 per visit.
To combat this, Doc Shane recommends that we keep generating positive stories about our work as DPC doctors, and focus on the provision of higher levels of care, preventing ER visits, and providing a high level of value for our patients.
How to be Successful in DPC
Find a mentor and spend time with another doctor in your area. The DPC community has good support, and doctors are generally willing to help other, newer doctors to be successful in this model. Hopefully this collegiality and support will continue as the movement gets larger. Use the online resources and attend conferences. Also, get together with your local DPC doctors, try to meet up a few times each year.
Closing Thought from Doc Shane
“It’s not easy doing DPC, but it sure is a lot better than traditional; it’s not easy but nothing worth having and nothing worth enjoying is ever easy.” It’s fulfilling, it’s satisfying, you go home with a full heart, and you’re really helping people, so it makes a big difference.
Thanks for reading and let me know what we should talk about next!
-Dr. Paul Thomas with StartUpDPC