What is Direct Primary Care and How Does it Lead to Better Care?

Jun 20, 2024

The chances are you’ve noticed a decline in your primary care experience in recent years. Maybe you can’t find a primary care doctor at all.

Or you have a doctor, but have to wait months to see him/her.

Or you’ve found that most of the time when you call to see your doctor, you get booked instead with a nurse practitioner or physician assistant. 

When you finally do get to the office, you spend forever in the waiting room before the visit actually starts. And then, after all that, you are rushed in and out quickly while they spend half the visit typing notes into the computer, barely making eye contact with you. 


Maybe you want to try discussing a holistic treatment approach that you’ve heard about, but find the doctor has no time or interest in it, and you leave with nothing other than a prescription for a medication that you aren’t certain you want to take. 

Finally, if you need to schedule a follow up after the visit, it can take weeks or even months to get the next appointment, and the above cycle starts all over again. 

And that doesn’t even get into the fact that later on you might get a surprise bill that makes no sense, and you can’t find anybody at your doctor’s office to call you back to explain it. 

In short, primary care has become scarce, expensive, time consuming, and frustrating. The unifying cause of the above problems is simple: the current insurance system.

Consider the following:

  • A typical doctor has to employ a lot of staff in order to handle all the paperwork for the insurers. This drives overhead to very high levels, so they then have to cram many patients into their schedule each day. Hence, your doctor is booked up, runs late, and can’t spend time with you.
  • Since the above way of practicing is so expensive, many doctors have turned to working for large corporate practices. These practices are driven by the bottom line, so they hire an army of nurse practitioners and physician assistants to be able to see even more patients. This is why you are often booked with these providers, rather than with your doctor.
  • In order to get paid for their services and meet certain regulatory requirements, providers have to document large amounts of information at each visit, so your doctor or NP spends half the visit typing away on the computer, instead of engaging with you.
  • Doctors are pressured to meet “quality measures” set by the insurance companies. These generally involve the prescription of certain medications, which means that even if they had the time, your doctor may not have the freedom to think “outside the box” about how to best treat your issues.
  • Since the bills are ultimately paid by the insurer, the practice’s biggest financial incentive is to keep the insurer happy, so there’s really no reason to invest in creating a better customer service experience for the patient.


The solution to all this? Direct Primary Care, a model that has been successfully implemented all over the country and that I am proud to bring to the Marion, MA area. 

At Dr. Fischer, MD, patients pay one flat monthly fee for my services. 

Patients still need to have insurance for when they go to the lab, see a specialist, have a test done, or go to the hospital, but in terms of dealing with me, there are never any other costs. Checking in and out of my office is a seamless process that requires no paperwork and takes just seconds, and there are never any surprise follow up bills. 

Since I am freed from the insurers, my only financial interest is to provide my patients with a great customer service experience and outstanding medical care. While the typical doctor has to serve two to three THOUSAND patients in order to make ends meet, I am limiting my practice to less than three HUNDRED patients at a time. This allows patients to get visits with me promptly (same or next day for anything urgent, within a week or two at most for routine issues), to have their appointments start on time with the rare exception of a true medical emergency, and to have prolonged visits with me in which there is ample time to discuss medical concerns.

In between visits, patients can call or text me personally for anything important, and they can expect a prompt response – immediately in the case of an emergency, by the next business day for anything more routine.  And since I am not beholden to some insurer’s view of what constitutes good healthcare, I have the flexibility to address my patient’s medical concerns in a broader and more holistic way, whether that involves counseling on diet and lifestyle, using advanced diagnostic testing, the use of “alternative” treatments such as supplements or light therapy, the prescribing of conventional medication, or any combination thereof.

I worked in the corporate/insurance driven model of care for over a decade before starting Dr. Fischer, MD. The fact is, most doctors, nurses, nurse practitioners, etc. are good people who are dedicated to their patients and truly want to do right by them. But people can only function as well as the system they work in will allow them to. Until somebody makes a serious effort to overhaul the U.S. healthcare system, I believe the best move available to doctors and patients is to simply get out of the system entirely by firing the insurance companies and going direct.

If you think direct primary care might be for you and you want to learn more about my practice, feel free to look around my website, to give us a call, or to book a free meet and greet visit.

FROM MY BLOG —  Listen & Learn: February 26, 2024