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Letter from Carolyn Guarino-Vogler, MD

The traditional fee-for-service model has pushed physicians to see more patients in less time, compromising the level of care that they are able to provide. These days, a regular appointment with a physician lasts 7-15 minutes on average. That's not enough time for a patient to tell the doctor their symptoms, let alone allow the physician to explain anything or answer questions. That's where Direct Primary Care comes in. 

Many people are familiar with the concept of a concierge medical practice, but they've never heard of Direct Primary Care. Both provide primary care services for patients who pay a monthly or yearly membership fee, to receive more personalized and attentive care. And, while concierge and DPC patients frequently have health insurance, the overriding majority of these practices do not bill insurances for services or accept insurance payment. 

Where the two differ is cost. On average, a concierge practice charges between $1500 to $2400 a year ($125-$200 a month) for a single person. In comparison, the membership fees for an individual in a Direct Primary Care practice run between $75 to $150 a month, depending on the cost of living in different areas of the country and the structure and services of individual practices. 

Why the big difference? It boils down to one thing - the goal of a Direct Primary Care physician is to provide better patient care at a price that is affordable for the average person. 

Direct Primary Care practices are small, usually between 400-500 patients, so doctors are able to dedicate more time to each patient. In contrast, a traditional primary care physician can have a practice population of 2000 or more patients. Appointments with a DPC physician are generally 30-60 minutes in length, and same day or next day appointments more readily available. Care can be delivered by means of phone or virtual appointments, standard in-person visits, email interactions, and even by texting (which we do provide, with patient consent) through programs developed for DPC 


The services I offer at Prometheus Primary Care include (but are not limited to): yearly physicals, well woman exams including Pap smear, EKGs, joint injections, management/treatment of many types of short-term and long-term health conditions such as hypertension, diabetes, high cholesterol, asthma, GERD, IBS, migraines, depression/anxiety, adult ADD, and others, and management of complex cases with multiple diagnoses. Additionally, I have particular interest in and knowledge of Ehlers-Danlos Syndrome, a disorder of the elastic tissues of the body, as I have this condition myself. 

The membership fees for Prometheus Primary Care are: $100 a month for one person membership, $175 for a two-person membership, and $225 for family membership. For businesses interested in providing this benefit for multiple employees, alternative pricing is available based on the number of employees enrolled. This price covers everything I do, there are no hidden charges. 

All this being said, it still leaves the question, "Why would I want to pay a doctor every month if I'm not seeing them every month?" If you are a young woman who only needs her pap exam and birth control refill once a year, this might not be the right thing for you. If you have diabetes, hypertension, or any long-term diagnosis that needs tended, the benefit is more obvious. For those people in between, with problems like migraines or gout or other things that might seem more obnoxious than serious, the benefit is this - by managing the little things that slow you down or detract from your quality of life, things like exercising and maintaining a healthy diet can be a little easier to accomplish. 

And, for those with insurance, "Why do I want to pay a monthly fee when I already spend a lot of money on monthly insurance premiums?" If you have a high deductible plan, it is less expensive to pay a membership fee once a month that is on par with your cable bill, than to pay piecemeal over the year for the same services that would ultimately cost you more. A DPC membership is not considered medical insurance, so it does not cover any services provided by anyone else. 

The big picture is this... 

When medical care can be accessed more easily, and doctors know their patients and their patients' health problems well, the overall utilization of medical services goes down. Urgent care and ER visits decrease significantly when patients can contact their physician directly if they are sick. Redundant or excessive testing is minimized and referrals to specialists are reduced when physicians can invest more time into teasing out a patient's medical problems. Direct Primary Care removes many of the shackles that keep physicians from being the doctor that they want to be and lets them treat the PEOPLE they call patients.

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