Episode 110: Birthing Babies and Direct Primary Care with Dr. Nick Tomsen

Direct primary care (DPC) is a style of practicing medicine we have discussed many times on the show. The way DPC works is that instead of using insurance to cover the cost of doctor visits with copays, patients contract directly with the doctor – usually on a monthly basis. This allows them to establish a nice long term relationship where they intimately know their patients. Paying doctors monthly is great for this long term, continuous care. But what happens when care has to be episodic like with a pregnancy? And if you're that doctor covering all the patients in your panel for 24/7/365 how do you ever take time off if one becomes pregnant and needs to be delivered?

Can You do OB in a DPC Practice?

The short answer is yes and quite a few do it. I am not aware of any pure obstetrics practices that use fully transparent pricing and membership (that would be quite the commitment to need years of pre, peri, and post natal care!). The long answer is that if you're a family practice doctor who chooses to do DPC and include pregnancy in your practice you need one thing above all others: friends. In my interview today with Dr. Nicholas Tomsen of Wichita, KS that is his biggest piece of advice for doctors starting out looking to do maternal care. Find either some other physicians in your practice or the community who are willing to provide the coverage you might need at times to allow you to go on vacation.

How Do You Recruit Indebted Doctors to Join Your Group ?

Now that DPC is entering its toddler years and leaving infancy, it needs to solve some problems related to growth. How is it best to grow in a time where most new residents enter the work force with $200,000 in debt from medical school and undergraduate? Large hospital systems and employers (including the government) can afford to forgive that debt and start these new physicians in a busy practice with plenty of patients. But for a small independent practice without piles of capital one must be creative in finding solutions. Fortunately, as DPC groups become established and successful they are finding ways to solve this problem by offering employment agreements paying new grads the same as their resident salary while letting them moonlight while building up a patient panel.