Practice profile: Direct primary care

NAME:  Albert Fuchs, M.D., FACP

WORK:  Owner of his own direct primary care practice in Beverly Hills, Calif. (albertfuchs.com)

MEDICAL SCHOOL:  University of California, Los Angeles

RESIDENCY:  University of California, Los Angeles

Spending more time with patients is an attractive idea for both physicians and those who need their care. Internist Albert Fuchs, M.D., began his direct care practice about six years ago to enable him to do just that. Paying an annual retainer fee—typically $2,800 at his practice—grants patients 24/7 access to Fuchs, same-day appointments and predictable primary care service fees.

What’s the difference between direct primary care and concierge medicine?

I don’t think there is any. My website does not use the word “concierge,” although I don’t object to it. It sounds much fancier than what I do—and much more expensive. Although, a lot of people call what I do concierge medicine.

I think eventually patients will settle on a name for it. I don’t think paying directly for a service deserves a special name. When you go to an accountant or lawyer and you write a check, it’s not “direct” legal care or “concierge” accounting. It’s just getting an accountant or a lawyer. So what I do should be called medicine and the traditional model should be called “insurance” care or “third-party” care. As this catches on, it will be called medicine. A patient goes and sees any doctor and they pay for them. You may have to have a catastrophic policy such as when you wreck your car. However, for an oil change or tire change, you don’t go to some third party to figure out what’s covered, how much you pay and who’s in your mechanic network.

What do you like best about  practicing direct primary care?

I love the time I have to spend with each patient. I love not having to think of excuses to run out of the room and having the time to answer all of the patient’s questions and be available. If one of them has an issue today, I can see them today, not two weeks from now. The extra pay isn’t bad either, although that took a few years.

Are you available 365 days a year to your annual fee patients?

I am, but the office isn’t open every day. We still have office hours, which are Monday through Friday, 9 to 5. All my patients have my cell number,  and over the phone I am available 24/7.

You have four kids. How does that work with your on-call hours?

Daddy has to occasionally get up and take a phone call from a patient.

What are the challenges of this type of practice?

The rough part is the transition. There are some short-term risks because there’s no guarantee that any physician will get enough patients to succeed. However, I don’t know of any doctor who’s doing it this way and wants to go back to seeing 20 patients a day, spending 7 minutes with each of them and then looking to some third party to collect the fee for that encounter. Patients and doctors both hate that. The only reason that’s happening is that it’s status quo.

Why did you choose direct primary care?

It actually wasn’t my idea. My wife was thinking of ideas such as this and bouncing them past me. One of my patients, who I had been taking care of for a long time, said she felt bad because she has a lot of questions and would call me on the phone, and she knew I wasn’t getting compensated for that. She said she would much rather pay me a retainer, know that I was there when she needed me and didn’t have to compete with a lot of other people for my time. That’s what planted the seed. I spent about a year investigating it and finding out what was legal and how it might work, and then I made the jump.

It sounds as though you would have to build up a clientele before doing this. Is this a practice model that would work for a newer physician?

For the most part, doctors are afraid to try it. I don’t know what the experience of a physician right out of residency would be. When I started it five or six years ago, people hadn’t heard of it. It’s a much better known practice model now and patients might be much more willing to enter a new practice of a direct primary care physician. I’m just not sure. I think 90 percent of the hesitation is that as an industry, we’re all scared. I wouldn’t discourage a trainee from trying it.

Do you have any advice for how a physician should get into this?

I would make phone calls to people who have been doing this for a few years and ask very specific questions about how to make the transition. Twice a year, I get calls from physicians thinking about it who find me on the web. They have questions about how to set up contracts, how to break the news to their existing patients and what to expect during the transition. You don’t want to reinvent those steps. Far from wanting more competition, I think most of us are delighted to talk with physicians because we think this is better for both doctors and patients.

Did you end up losing a number of patients in the transition?

Yes, I have a very small practice now in terms of numbers of patients. However, it’s much better in terms of revenue. I knew going into this I would lose over 90 percent of my patients. From that small nucleus that stayed, I built up a new practice, essentially.

That’s why I’m not sure that having a large successful practice before transition is important because most of those patients aren’t going to stay with you. Most of those people want somebody in their insurance network. One important point I want to make is the 90 percent of your patients who go to other doctors…you want them to leave happy. So the way you present it to them and the way you handle your separation needs to be pleasant. You don’t want them to refer to you as the jerk that fired them. You want them to leave happy thinking you are a terrific doctor but they just can’t afford your services right now. You want them to understand why you are doing what you are doing.

Have you ever had a patient leave and then come back to try your new practice?

Yes, in fact just last week I had that experience. That happens all the time. They’re frustrated by the primary care they are getting so they come back.

Is there anything that surprised you about this once you got into it?

The biggest surprise was how many of my older patients saw the value in this and wanted to keep me. The older, sicker patients already saw how the Medicare system is failing them and they are happy to pay more for the attentive care.

Physicians should ask themselves, especially the younger ones, whether they want to spend their careers working for insurance companies or for patients. There is plenty of room in our niche and physicians and patients both will like it better. Physicians owe it to themselves to spend the next several decades getting paid for what they love to do, not to be getting paid for what disappoints them and the patients both.

Marcia Travelstead