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  • At Home Primary Care

Direct vs. Traditional Primary Care

The following is an excerpt from “Direct Primary Care. What it is, How it’s different & Who it works best for” ebook by Dr. Richard Samuel, MD.


  1. Longitudinal care. Medical care is delivered by one provider in a variety of settings including, but not limited to, the office, home, workplace or assisted-living facility. This care covers evening, nighttime and weekend hours for urgent and emergent matters. If a medical problem is deemed too complex, the direct primary care provider consults and coordinates care with the appropriate sub-specialist.

  2. Personal. Direct primary care practices tend to be quite small, generally limited to between 400 to 600 patients (compared to 2000-3000 in a traditional practice) allowing more personalized care.

  3. Patient oriented. Due to the small size and the direct payment structure of these practices, providers have plenty of time to spend with each patient. This ultimately saves the patient money by reducing unnecessary medications, sub-specialist appointments, ER visits and hospital stays.

  4. Autonomy. Direct primary care practices provide medical care that is not modified or dictated by insurance companies or government entities. Third party interference is therefore a non-issue.

  5. Convenience. Medical care is provided at a time and place that is most convenient for the patient. Some care can be delivered by webcam, email or phone, saving the patient even more time and money.

  6. Preventative care. Direct primary care encourages wellness visits due to the nature of the prepaid membership fee. Patients are more apt to seek preventative care since this fee has already been paid, ultimately decreasing unnecessary illness and other medical problems.

  7. Transparency of price. Membership fees are clearly posted, and there are no hidden charges. This encourages provider-patient interaction on a more regular basis, saving money and promoting health.


  1. Fragmented care. Medical care is often delivered exclusively by multiple sub-specialists. A similar phenomenon, however, occurs in a primary care office as well, where an individual other than the provider often sees the patient. This problem of multiple medical professionals is further compounded after hours and on the weekends, when yet another provider sees the patient in an urgent care clinic or the emergency room setting.

  2. Impersonal. Traditional offices tend to be larger, more crowded and often less personal. Larger staff sizes make close professional relationships with patients more difficult.

  3. Production oriented. Reimbursement to the physician is primarily based on the number of patients seen. Time spent with the provider is therefore often limited, and patients may feel like “just a number.”

  4. Third party interference. Insurance and/or the government often modify care that is provided by the physician, which frequently is not in the patient’s best interest.

  5. Inconvenience. Crowded office schedules often limit appointment time options, frequently making waits to see the doctor days to weeks away. The doctor’s office is typically the only place to see the provider, with after-hours and weekend care delivered at another location, often involving hours in a crowded waiting room to see yet another provider.

  6. Reactionary “sick” care. Traditional offices are typically so crowded and busy that there is little time for wellness visits and preventative counseling, which has been shown in many studies to decrease illness and extend life.

  7. Hidden charges. Unlike most businesses, the traditional medical model generally does not publish charges and fees. This is largely due to the third-party payer (insurance) system. As a result of this lack of transparency, many patients who pay for treatment out-of-pocket are reluctant to seek medical care.

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