Channel 13 reported recently on several Portland area primary care physicians who have joined Florida's MDVIP franchise. These are usually well established practices that convert to a concierge practice model that still bill insurances (with the usual patient copays and deductibles) plus they charge patients a membership fee on top of that. The physicians, in turn, pay a significant percentage of their income to the parent corporation for marketing and legal support.
A lot of people, including many physicians, get this well known form of concierge practice confused with direct primary care. This is understandable since both offer unhurried appointments, excellent access and communication with your own physician and small patient panels. For frustrated physicians, both offer an alternative to becoming an employee of a hospital owned clinic or retirement. Occasionally (to spare someone my long winded explanations), we and others will refer to direct primary care as "blue collar concierge" practice.
Direct primary care has important advantages for both patients and physicians over these insurance plus concierge fee practices. By cutting the insurance middlemen out of primary care, direct primary care lowers the cost of care for many patients, especially those with the now common high deductible plans or no insurance. By removing the complex requirements of insurances and Medicare from the office, direct care simplifies practices for physicians and allows smaller office staffs. The low overhead gives direct primary care physicians an income that can pay off medical school loans while still charging less than both concierge and traditional insurance based practices. Since direct primary care practices are affordable by working class patients, direct practice physicians are not limited to working near densely populated or wealthy areas.
For established physicians in the right location and for wealthy patients, concierge fee plus insurance practices offer one solution to some of the problems of our failing insurance paid model of primary care. It's a great that we have enough of a free market left in medicine to allow them to do this. However, please don't confuse simple, affordable direct primary care with high cost concierge practices.