Doctors to leave Medicare for direct primary care

Doctors against ObamaCare

Doctors demonstrate against ObamaCare

U.S. physicians do not cotton to Obamacare or any form of socialized medicine. That is clear from surveys conducted through the years.

In March 2010, before Congress passed Obamacare, a survey by the New England Journal of Medicine found that more than 46% of primary care physicians (family medicine and internal medicine) said Obamacare’s passage would either force them out of medicine or make them want to leave medicine.

Two years later, after Obamacare became law, the percentage of disaffected doctors had markedly increased. A survey released by the Doctor Patient Medical Association found that a shocking 83% of U.S. physicians considered leaving their practices over Obamacare.

Now, disaffected physicians say they are leaving Medicare for direct primary care.

Bruce Japsen reports for Forbes, Jan. 30, 2013, that as Medicare whacks away at what doctors are paid and health insurers move away from paying fees for service to bundled payments, more physicians who own their own practices say they will leave Medicare for direct pay.

A national survey of nearly 14,000 physicians conducted by Merritt Hawkins — a physician staffing firm — for The Physicians Foundation, found that 1 of 10 (9.6%) of “practice owners” are planning to convert to direct pay practices in 1 to 3 years.

The movement is across all medical disciplines.

Mark Smith, president of Merritt Hawkins, explains: “Physicians have been running for cover for several years now. There is a lot of uncertainty in health care now and the only certainty is there is a lot of talk about cutting physicians fees. One way to get out of it is to go off the grid.”

Doctors are unhappy about the lack of a permanent solution for dramatic cuts to doctor payments from the Medicare health insurance program for the elderly under the sustainable growth rate (SGR) formula.

Already, one in five physicians is restricting the number of Medicare patients in their practice and one in three primary care doctors – the providers on the front lines of keeping the cost of seniors’ care low – are restricting Medicare patients, according to a 2010 AMA survey of more than 9,000 physicians who care for Medicare patients.

Under direct primary care, doctors contract directly with patients to provide all of their primary care needs free of insurance interference at a price generally between $50 and $60 a month per patient.

That is much cheaper than the “concierge medicine” found by some Congressional investigators, of $5,000 to $15,000 a year or more. Merritt Hawkins’ Smith said of direct primary care practice, which the New York Times dubs “concierge medicine for the masses”: “It’s not just for the rich and famous anymore. If you can afford a gym membership, you can afford this kind of care.”

The direct primary care approach provides unlimited visits to a physician’s office plus 24-hour access to doctors through e-mail consultations. The primary care model has drawn insurance industry opposition in part because the health insurer middleman is cut out of the equation as doctors are no longer paid by the likes of Aetna (AET), Humana (HUM) or a UnitedHealth Group (UNH).

Under a proposal under consideration by Congress and Medicare officials, a pilot program would provide “monthly fee-based payments for direct primary care medical homes” for certain Medicare beneficiaries, according to the legislation introduced by Congressman Bill Cassidy (R-Louisiana), who is a physician.

Supporters of the direct primary care approach see the pilots as a way to show Congress and an Obama administration eager to reign in Medicare spending, that the concept can provide quality medical care and lower costs.



11 responses to “Doctors to leave Medicare for direct primary care

  1. My doctor went out of business. My brother-in-law moved his practice to Brazil.


    • Upaces–my sister-in-law quit primary care, my brother-in-law retired from a huge Nephrology practice that he founded, and my husband dislikes going to work now!! People ned to get ready for foreign PA’s and nurse practitioners.


  2. Reblogged this on cedarridge2007.


  3. As a healthcare professional, and near to be senior citizen, I think this concept of direct primary care sounds very good,
    With the costs of Medicare or private insurance-why not pay a monthly fee direct to your Dr. to provide care ! It would certainly cut out all the red tape with insurance.


    • Lilly–this may sound good and could work in some cases. That said, we have quite a number of Medicare patients, who would expect nothing less than constant attention from our staff and attention from the doc at all hours. Not surprisingly, these types of patients, tend to be the most well-off. They are already quite demanding on even the best day.


  4. My physican has informedme that he is reducing his practice from over 3500 patients to about 600 patients and it will cost my wife and I an additional $3250.00 over and above our health insurance to continue to have him as our doctor. Thanks obamacare.


  5. My husband is also cutting back. He is home every Friday, comes to dinner at a reasonable time, and no longer goes to the hospital or takes new nursing home patients.


  6. Concierge medicine has only changed its price tag. The business model has been tested by some very brave and entrepreneurial doctors, seeking to give their patients the care they deserve and still keep the lights on without dependence on insurance companies. Many of these doctors are able to provide extended access, extra time, and personal preventive plans for less than $100 an month. The trend seems to moving towards adding in-house labs, prescription access and house calls.

    Bottom Line: Concierge Medicine offers physicians the freedom to practice and thrive, while providing patients the care they deserve. What needs to happen will be the protection of the private primary care doctor, and the public’s willingness to take an active role in their own care.


  7. Thank you Dr. Eowyn for this great post. It sounds most reasonable to me, direct care. I really do not think Americans realize the horrible effects of Obamatax! I feel sorry for the wonderful physicians in our country and medical professionals who oppose this regime’s idea of health care.


  8. Think about the last time your doctor didn’t have to look at your medical file or chart to know your name? I can tell you from one of my own experience with hospitals, insurance carriers and enough over-worked, hurried and administratively burdened doctors that I too am ready for a change to occur in the primary care family medicine and group practice across America. In the new world of medicine, medical homes and concierge medicine practices are delivering some very big results. The health care providers and the medical offices they operate are becoming so successful in today’s over-crowded marketplace because of the simplicity of its delivery. The marketplace is ready for this type of healthcare delivery model and people are looking for alternatives to expensive health insurance. Not to mention, there is a huge uninsured population in America that can’t afford health insurance – concierge medical care and direct primary care practices’ are perfect for patients at under $135 per month (Source: As we well know, a new generation of people are lining up at doctor’s offices across the U.S. and abroad to experience old-fashioned healthcare with a modern, relational twist. The idea of a doctor who sees us without delay, gets reimbursed fairly for his time, expertise, returns phone calls promptly, sends us emails, video chats and receives texts is completely foreign. Doctors like this, work in medical offices across the country and are now offering their patients affordable access and personal attention when insurance is a hassle and time is tight. The time is now for this!


  9. its very good post about Doctors to leave Medicare for direct primary care .
    addiction CME for physician


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