What happens when a smart doctor recognizes that there is a better way?
Is it possible for family physician to operate under a subscription-based business model, priced below what you pay for your mobile phone service? What about services not covered by the subscription? Could those be priced with full certainty and transparency?
For episode 269, we had the pleasure of interviewing Dr. Paul Thomas, founder of Plum Health DPC. Dr. Paul Thomas is a board-certified family medicine physician practicing in Corktown, Detroit. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit and Wayne County. His mission is to deliver affordable, accessible health care services in Detroit and beyond. He has been featured on WDIV-TV Channel 4, WXYZ Channel 7, Crain's Detroit Business and CBS Radio. He has been a speaker at TEDxDetroit. He is a graduate of Wayne State University School of Medicine and now a Clinical Assistant Professor. Finally, he is an author of the book Direct Primary Care: The Cure for Our Broken Healthcare System.
Below are show notes and questions we asked our guest. Use these to help guide you along when listening to the podcast (embedded above).
Ed’s Questions
What is Direct Primary Care?
Based on an interview I saw you do, there’s no wait time for patients?
Why did you go this route—Direct Primary Care?
You were burned out in your residency. What was the moment that you said I can’t do what most people are signing up to do?
Most time patients do get with their doctors is spent with the doctor typing and facing a screen.
What are some of things that are covered in your clinic?
What you are capable of doing in your practice is probably 80-90% of what a healthy patient would need in a given year?
It would cost me personally about $840 in your practice. If you’re so cheap, why is healthcare so expensive?
It’s said America pays more than the average OECD country, but there’s no price transparency in the system, which inflates those prices, correct?
What are some of the barriers you see that are still in the way of physicians getting into DPC and patients being able to access DPC?
When you did start, did you consider other pricing models? Yours is based on age, but did you consider, for example, response times, or different services you would include and exclude?
Do you have any jumpers, and by that I mean people who pay for a month and then leave, then come back six months later?
You’re now also offering rates to small businesses in your area?
And the companies pay your membership as part of the employees benefit package?
You believe that patients should also have a catastrophic health insurance plan?
We don’t expect our auto insurance to pay for gasoline but we do expect our health insurance to pay for a blood test. It’s absurd?
I was struck that in your TedX talk you used the phrase “living my truth,” take us through that, what does that phrase mean to you?
Ron’s Questions
In your book, Direct Primary Care: The Cure for Our Broken Healthcare System, you cite a 2016 study performed by Medscape found 51% of physicians experience burnout. Burnout is defined as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. You felt this in your residency. How long did it take you to work up to 500 patients?
How did you market your practice, was it social media, word-of-mouth, press. I know you did a Tedx talk.
I know DPC is in the same family of Concierge Medicine, which has the reputation of being just for the elite, which isn’t true. But the DPC prices are usually less than a mobile phone bill.
On the cover of your book there’s a picture of you trying to catch sand through your hands. Can you explain that analogy?
You talk about technology and how there’s too much borrowing from Henry Ford’s assembly line, treating customers like commodities rather than human interaction. It’s not very efficient to sit and listen to your patient read you poetry. It is, however, highly effective. Would you agree with that?
You also talk how the average of GP doctors have 2,400 patients. Do you think this DPC model will alleviate this GP doctor shortage?
You talk about the growth of urgent care centers in the US is a symptom of a failed primary care system.
Do you feel that people who are not licensed could do some of the work now being done by physicians? What’s your view of occupational licensing and how it folds into this model/
You mentioned to Ed that insurance companies try to get as many dollars passing through the hands. They don’t seem to like the concierge or DPC models, not because they compete with actuarial based insurance but because they compete with pre-paid medical care. Did Michigan pass a law that made it clear that DPC is not an insurance product?
Just seems to be like insurance companies would like to block this model. Is that a fair statement?
There’s obviously some education going on with doctors with respect to DPC, but we also need to re-educate patients to see you even when they are healthy, not just when they are sick. Has that been an educational process to get patients to see you even when they don’t have an issue?
We talk a lot about the market share myth, that growth for the sake of the growth is the ideology of the cancer cell, not a sustainable, profitable business. You phrase it in your book as “Value over volume.” You must be asked a lot that healthcare is different than any other product or service we buy, how do you explain to people that it can be priced like other things we buy
Your model is restoring the sacred relationship between the patient and doctor. You’re bringing this back to the days of Marcus Welby.
I’ve read that most calls (82%) are received during normal business hours, that patients don’t abuse your time off. Has that been your experience unless there’s been an emergency?
Tell us about your new venture, www.startupdpc.com.
If you could wave a magic wand to reform healthcare, what would you do? [Price transparency and quality scores was Dr. Paul’s answer].
Bonus Content is Available As Well
Did you know that each week after our live show, Ron and Ed take to the microphone for a bonus show? Typically, this bonus show is an extension of the live show topic (sometimes even with the same guest) and a few other pieces of news, current events, or things that have caught our attention.
Here are some links from our bonus show this week. The bonus show, all bonus links, and additional bonus material are available to our Patreon subscribers. Click the “FANATIC” image to learn more about pricing and member benefits.
So what did we discuss during the most recent bonus show?