As the end of our first year of medical school approached, we received our assignment for where we would complete our primary care apprenticeship for the following year. After the countless hours of studying in isolation, we would finally be fully emerged in a setting to interact with patients and be able to put a face to the multitude of diseases and medications that we spent learning in the prior months. Before our first day at Gold Direct Care, we only had our own experiences as patients as well as the opinions- both positive and negative- from doctors and upperclassman to guide our perceptions of what it would be like to be a primary care physician. Among opinions of fellow classmates, rarely would we hear, “I want to be a primary care doctor.” As for physicians, a compilation of their opinions illustrated the picture of the primary care physician as a half assembly line worker and half paper pusher. Furthermore, in order to provide the best possible “patient centered care,” there were certain rules set by administrators and insurers. Everyday you will see 26 patients. For each appointment, you have 15 minutes to obtain an accurate and complete history and physical exam, strengthen the doctor-patient relationship by establishing rapport and find the time to teach medical students and residents. And the reward for successfully juggling all of these tasks is a stack of endless paperwork waiting to be completed.

As we walked through the doors on our first day, the dreaded barriers that we envisioned were nowhere to be found. In fact, we quickly learned that Direct Primary Care (DPC) and Dr. Gold operated by a different set of rules. There was no time limit for each appointment and the length was determined by no one other than the patient. Thus, there was not only more than sufficient time to address all of the patient’s wants and needs, but also to establish a strong rapport in order to strengthen the relationship between the two most important people in healthcare, the doctor and the patient. Since Dr. Gold never had to worry about a stack of paperwork, he was able to reallocate that time towards teaching. Specifically, we had the opportunity to interview every patient, perform a detailed physical exam and properly document the encounter while being supervised and guided by Dr. Gold in order to maximize every learning opportunity. While these may just seem to be unique characteristics of Dr. Gold, it is the environment created by DPC that allows great people like Dr. Gold to be great doctors to their patients, as well as great teachers to their students. After our experiences working at Gold Direct Care, the negative picture of primary care that we originally envisioned had transformed into one that any current or future doctor would desire.

With a desperate need to attract more medical students into primary care, students are still reluctant to pursue careers in primary care. Dr. Gold and DPC offer solutions to this problem. Doctors can practice medicine the way it ought to be practiced, which is solely focused on the doctor and the patient. Instead of working for an insurance agency, you get to work for your patients, who will ultimately determine your value. No more paper pushing, no more assembly line, just the doctor and the patient working together to improve health outcomes- a recipe that will make primary care a very attractable career path for medical students once again. After arranging an information session for Dr. Gold to share the benefits of DPC with our class, it was quite evident that we were not alone with our enthusiasm regarding DPC. In fact, shortly after its conclusion, a fellow student sent us a text  “Guys, I think I want to do primary care now!”

Thank you to Dr. Gold and Meghann for this incredible learning experience. Everything you taught has been invaluable and will help shape our future careers in medicine. Also we would like to thank all of Dr. Gold’s patients for allowing us to learn through hands on experience and giving us advice that will help improve our abilities as future physicians.

Michael Held & Douglas Rodgers

Tufts Medical School Class of 2018

Direct Primary Care is written into the Affordable Care Act as an approved method of receiving primary care as long as it is combined with a catastrophic insurance plan. (Isn’t that how insurance is supposed to work? But I digress.) The ACA clearly defines that DPC is not “insurance” and purchasing a DPC membership alone does not meet the standards of being “insured.” It is required to purchase at least a high deductible insurance plan along with it to be qualified under the ACA. See great article on this here: DPC Clause in the Affordable Care Act

However, on the State level, many legislators, policy makers, and Department of Insurance commissioners want to claim that DPC is the “business of insurance” and should have to pay licensing and regulatory fees. In other words, paying a reasonable monthly fee for all your primary care needs should be regulated no different than Blue Cross Blue Shield, Harvard Pilgrim, etc etc. Having to pay fees of this magnitude would clearly put a small DPC practice like us out of business. We are not “insurance”. We are a primary care medical practice that chooses to work solely for our patients- not third parties- and therefore be compensated by our patients for what we believe is a reasonable monthly fee. About 15 states in the US have now passed legislation stating this as law. Massachusetts is not one of them and has yet to introduce a bill that by stating such protects us and our patients who choose us. We, along with three new DPC practices in MA, are tirelessly working on getting our legislators to listen to us and sponsor a bill.

As the first DPC practice in MA we were contacted by the Massachusetts Department of Insurance when we first opened in January 2015. With our legal counsel we have met with them and corresponded with them on this issue. It has been months of waiting and practicing medicine in an unclear regulatory environment. This weekend, much to my delight, I was contacted by my attorney with a letter from the DOI that has given us the green light to continue practicing medicine without 3rd party interference. (The letter is attached below a sit is a public document.) We are very thankful to Commissioner Daniel Judson and Deputy Commissioner Kevin Beagan for their understanding that what we are trying to do is solely for the benefit of the people of Massachusetts and the primary care doctors who want to care for them in a manner that echoes the “olden days of medicine.” Hopefully there are better days ahead for healthcare in Massachusetts.  (more…)