Ever since my friend Tea Nguyen, DPM shared this post on LinkedIn, I’ve been chewing on the idea of the direct care patient mindset. For context, I recommend you read it before continuing.
It brings me joy to know that Dr. Nguyen, instead of leaving medicine due to her frustrations with the system, found a sustainable way that now serves both her patients and her.
This particular bit got me thinking: “People who end up choosing to pay out of pocket for direct care are deeply committed to their health goal and are willing to work with me to get there.”
While a generalization like this of course can’t be 100% accurate, there is undoubtedly a correlation. And it’s a fascinating thought experiment.
As I mentioned in the comments, there is some tantalizing psychology to explore with respect to the mindset people tend to bring to their health care journey when the flow of value is distorted, disjointed, and opaque (e.g., third party payor systems, especially when the bulk of the premium is paid directly by one’s employer as part of one’s compensation) compared to when the flow of value is obvious and tangible (cash/check/credit card at the point of service).
In Dr. Nguyen’s case, I imagine people who choose to see her tend to be more invested in their health outcomes because they they truly feel they are, quite literally, investing in their health outcomes. They key word here is feel.
Conversely, people who see a doctor within a commercial third party payor model are also making an investment, but the investment is so convoluted that once they make it into the exam room, it likely no longer feels like an investment, and they certainly don’t have a clear idea of much they invested (e.g., premium + copay + deductible + co-insurance).
To boot, they may not have had much choice in what doctor they see, or they may have thought they were seeing a doctor but ended up seeing a nurse practitioner or physician assistant instead.
I’m grateful to Dr. Nguyen for her commitment to her craft and her patients and for making us think.
And I’m grateful for the short-sighted, greedy strategy of most commercial insurers. Their ever-increasing deductibles and other “cost-sharing” tactics make it easier for people to consider direct pay alternatives because they have already become used to significant out-of-pocket expenses year in and year out, despite the hefty premiums they pay, which also tend to increase every year.
Dr. Robert Kornfeld is another podiatrist doing excellent work in the direct specialty care space. Consider his course if you are a podiatrist who is frustrating with the status quo, especially if you are curious about functional medicine.
Have you ever chosen a direct pay option for any of your healthcare needs?
If you’re a doctor, do you run a direct pay practice, or have you ever considered it?
Let us know in the comments.
