Direct primary care might be a better healthcare model for you if you’re fed up with dealing with insurance-based physicians who see you as a number, rather than a person and a patient with unique healthcare needs. 

What is direct primary care? It’s a healthcare model that strips away the bureaucracy that often leaves patients frustrated with the level of care they receive and makes well-intentioned physicians feel powerless. 

Direct primary care means you pay your primary care doctor without an insurance company acting as an intermediary. There are multiple business models possible, with some direct primary care offices offering a monthly membership fee for comprehensive care that doesn’t involve insurance claims or co-pays for primary care services. 

What is Direct Primary Care? 

So, how does direct primary care work? Think of it as healthcare’s version of a gym membership. You pay a monthly fee and gain access to the gym (your health clinic), the personal trainers who work there (your physicians), and all the standard equipment and amenities available (exams and basic procedures). 

A direct primary care (DPC) clinic employs a similar membership model to that used by many gyms. You receive various primary care services, which can include:

• A certain tier of access to office visits (in-person and often direct primary care telemedicine services).
• Same-day or next-day appointments.
• Extended visits that often last 30 to 60 minutes, so you get to discuss your concerns with a physician who isn’t in a rush.
• Direct communication with your doctor via phone, text, or email.

• Deeply discounted direct primary care prescriptions.

• Direct primary care bloodwork pricing that is transparent and often shockingly low.
• Streamlined care through better resource identification and coordination with third-party companies, such as companies designed to locate imaging centers local to you and facilitate your scheduling with those centers, so you can avoid endless hours on the phone for healthcare organizations that have not updated for the 2020s and require patients to sit on hold on the phone to book an imaging appointment. 

The primary goal of the direct primary care business model is to eliminate the intermediary role that insurance companies play between physicians and patients who require primary care services. This reduces considerable administrative overhead, allowing savings on time and money to be passed down to patients. 

Direct Primary Care vs. Traditional Primary Care: A Head-to-Head Showdown

The main differences between concierge medicine/direct primary care and traditional care include: 

Our table shows that the benefits of direct primary care for patients are plentiful. It’s an excellent healthcare model for patients who value their time, money, and relationships with their primary care physicians. 

The Ecuadorian Model of Efficiency: A Food-First, Team-Based Blueprint

So, how can a U.S. physician offer patients elite value without elite prices? The answer to that question is surprisingly simple: We look to models that prioritize efficiency and quality care. Consider the Ecuadorian approach, where a blend of front-line dietitians and general practitioners works in tandem.

Many patients in the U.S. are desperate for clinicians who practice an efficient food-first, low-risk, comprehensive approach to addressing health issues, instead of only managing symptoms with medication. 

However, in addition to having difficulty finding clinicians who offer tailored care, many patients also find that costs in some direct primary care clinics are inflated due to inefficient workflows. Where U.S. clinicians could have utilized the flexibility of a cash-based practice to meet patient needs, some have not broken free from the same inefficiency common in insurance-based practices; thus, the costs remain high while needs are not met.

For example, a U.S. doctor might charge $5,000 to personally visit a patient to draw their blood and ask them to pay cash for lab tests, citing that “insurance providers are bad,” which is an oversimplification. 

Many insurance providers might cover labs at flat rates, making these highly affordable for patients with insurance. What might be happening here is that a physician in a direct primary care model is attempting to avoid administrative work by writing a justification to order labs, while spending unnecessary time traveling to patients’ homes. 

This isn’t a sustainable healthcare model as it overcharges patients while providing so little. Typically, a mixed model of cash- and insurance-based coverage with improved workflows works better. 

For example, a direct primary care physician can meet with patients remotely and submit lab orders with medical justifications, as this is within their specific scope. Then, they can coordinate with mobile phlebotomists to draw blood at patients’ homes and drop it off at an in-network lab for the patient. 

The five minutes of administrative work per lab test order is a task that only the physicians can do among the aforementioned team members, while phlebotomists are specifically trained in drawing blood, and mobile phlebotomists already have setups for traveling to patients’ homes. 

At times, when reviewing expenses for clinics, we identify key areas where physicians claim their costs are extraordinarily high, and thus, they must charge unusually high prices for services. However, the root cause is often inefficiency in our experience.       

Here’s what the efficient, Ecuadorian-inspired model looks like in practice for a remote direct primary care approach:

1. The physician conducts a consultation via direct primary care telemedicine services in a legally compliant manner and begins streamlining workflows, such as setting up tests to assess the patient.
2. The doctor places a lab order, which can often still be run through the patient’s insurance even if the doctor is out-of-network.
3. The physician coordinates with a mobile phlebotomist (that costs around $90 to $150 in the Greater Atlanta Area, for example) to draw the patient’s blood at home.
4. The patient meets with the primary care physician, who has conducted a risk-benefit analysis based on the lab analysis; for example, if the patient has high cholesterol but with an excellent ratio due to a high HDL and no risk factors, the primary care physician might decide that a statin is not worth the risk due to research that has come out recently. While many primary care physicians often choose a do-nothing approach or a medication-only approach in the US in such situations, there is a happy intermediate ground, such as sending the patients to a dietitian to see how the patients respond to education on a balanced Omega-3 to 6 diet and then observing how the patients respond to such a diet.
5. If a food-first approach is appropriate, as determined by the physician, the patient meets with a dietitian remotely who is working in tandem with the direct primary care physician. The dietitian cannot order lab tests, but can review lab work for nutritional aspects as part of their scope of practice. The dietitian can then create a plan of action for a food-first approach where appropriate. 
6. The patient can then continue to meet with the dietitian and physician regularly, including completing blood work via the mobile phlebotomist at regular intervals to provide insight to the medical team on chronic condition management. 

With the Ecuadorian model, the physician doesn’t waste time taking on all tasks for a patient. Instead, they conduct risk-benefit analyses and delegate tasks appropriately. They spend their time only on tasks that require their expertise, such as diagnosing patients, ordering tests, and creating care plans. 

This significantly reduces the physician’s overhead, enabling the practice to charge fairer prices for its affordable direct primary care membership, while typically enjoying a higher profit margin than inefficient practices. The patient gets quality care at a fraction of the cost, while the practice builds a reputation for providing value, not profiting off patients. 

Gaining Competency: The Dietitian-GP Tandem in Action

The second aspect of Ecuador's efficient model is clinical competency. We often see general practitioners who avoid ordering labs because they lack confidence in interpreting them, especially when it comes to non-pharmaceutical next steps.

Physicians must become more comfortable reading and interacting with lab results to better serve their patients. An evidence-based registered dietitian can be a valuable partner for DPC clinics, providing diet-based solutions for identified health issues. 

Registered Dietitian Nutritionists (RDNs) are qualified to interpret laboratory tests within the scope of nutritional assessments. 

An RDN with an understanding of whole-body care recognizes that a dip in iron absorption for a hypothyroid patient on a high-iron diet does not automatically signal the need for supplements. RDNs understand that iron absorption is influenced rapidly by thyroid health and that the potential side effects of supplements can exacerbate the issue. 

Physicians don’t always understand these things and might prescribe medication or heavy-duty, costly approaches such as iron infusions as a standard solution for all of their patients with the goal of rapid changes, when often slow change can be better for the body when dealing with chronic conditions, as opposed to life-or-death emergencies. 

Healthcare That Makes Sense Again

Direct primary care, as we explained, isn't just a different payment model for clinics.  It’s a return to a time when your doctor knew your name, your history, and had the time to help you craft a personalized path to good health. 

It’s a rejection of the price gouging that sometimes occurs in the medical industry and an embrace of the Ecuadorian model, which values quality and accessible care from a place of necessity due to limited national resources in the public healthcare system. It’s healthcare, finally focused on you.

Purchase our course, Are You Consuming Too Much Iodine?, to learn more about how a food-first approach is sometimes more effective than medication for resolving thyroid disorders. It offers a deep dive into the exact kind of lab-based, non-pharmaceutical health management we champion. You'll learn how subtle imbalances can have a profound impact on your body. 

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We are developing future courses based on the Ecuadorian general medicine approach discussed here, detailing exactly how their GPs and dietitians work in tandem to deliver astounding results. Subscribe to our newsletter for notifications about future courses.