DPC vs DSC: How are they different?

Feb 18, 2023

When I first learned about Direct Primary Care (DPC) the movement away from insurance with the alternative low monthly membership option, I was completely fascinated. I was excited that doctors are taking back control of their practice and offering a reasonable cost while still able to make the income what they want, without the administrative hassle and confusion typically associated with the insurance model. 

Then I hit a fork in the road as I was deciding on whether my podiatry practice should offer a membership or maintain a fee for service. Could I possibly have both? Should I?

On the one hand, I love being available to patients with chronic conditions who need maintenance or immediate attention, like diabetic foot or wound care. These patients are immune compromised and with access to their doctor who knows their entire medical history, I can save them a trip to the Emergency Room by quickly triaging them. That is the beauty of an independently owned insurance-free practice. Plus, a loyal patient base is cost effective, we don't have to market as much to replenish revenue.

On the other, I live in a community where the need isn't enough to make this a recurring source of revenue. I eventually realized that specialists have a totally different dynamic than our DPC colleagues, and it is an important distinction to share.

Direct Specialty Care (DSC) more often than not, benefit from the fee for service model because

  1. specialty care is needed for a shorter period
  2. people already expect to pay per visit to solve their problem
  3. financially, it's easier to manage and there's no membership tracking to decide if a member is active, inactive or under/over utilizing their membership, or other considerations like what if the patient isn't a good fit after they sign up and I have to let them go?

Although there are specialists, like rheumatology, neurology and others that would benefit from a membership option, I found this wasn't a dominant option for my podiatry practice. I do think there is a place where it can work for podiatry, especially where insurance doesn't pay for necessary services in vulnerable patients or appointment times are months out to be seen. 

At the moment, I offer membership options for diabetic foot care because this is a lifelong maintenance service that I love and understand deeply. A membership like this is preventive  and proactive which can save one from losing their leg or life. However, mostly everything else is fee for service and people are receptive to that.

If a patient chooses surgery, I offer an all inclusive after care package for a short period and they won't need me monthly after that. It's great to solve people's problem quickly but that also means there's a higher turnover that our marketing budget needs to account for. 

This hybrid does cause a little confusion for my staff, since they have to track if the member pays for their visit or not. My members do enjoy the consistent care at an affordable rate so I plan on keeping this model until I can no longer accommodate the volume. After all, I aim for value rather than volume and I refuse to double book. 

So there's the short version of how DPC is different from DSC. For each specialty, you'll have to decide which is going to be your dominant model so that you don't create confusion in your message. Pick one, then decide, then revise. 


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