Direct Care Is Business. And Its Business Is Serving Patients.

Last year, the New York Times wrote about Orlene Paxson, a 33-year-old, stay-at-home mom. Living on Manhattan’s Upper East Side, she was unable to find an obstetrician that she liked who would accept her insurance. A lot of them weren’t accepting new patients, and one doctor who came highly recommended didn’t return her call for five days and didn’t want to see her until 12 weeks into the pregnancy. This was Mrs. Paxson’s first time being pregnant. She didn’t want to wait. Her policy didn’t cover any out-of-network services, but she and her husband went the cash-only route and paid the entire fee themselves — $13,000.

After their daughter was born, Mrs. Paxson needed a pediatrician. Again, she couldn’t find one in her plan, who was also accepting new patients, so she chose another out-of-network doctor. “We stayed with her for a year and a half because we loved her,” Mrs. Paxson said. During this first scheduled visit after the baby was born, that doctor talked to her for almost three hours.

The Times writes that the country is already facing a shortage of physicians, according to the Association of American Medical Colleges. By 2025, the nation will have 100,000 fewer doctors than needed. With fewer medical students choosing to go into primary care, shortages in this area are expected to become especially acute.

We have a caveat here — if primary care offered physicians better salaries and more job satisfaction, maybe more doctors would join our ranks. Just a thought…

However, the Times goes on to say, “Cash-only practices may exacerbate the access problem.” Since her doctor stopped accepting her insurance, Kathryn Vanasek, 43, a mother of two in Manhattan, hasn’t been back for a checkup or preventive screenings, relying on a new walk-in clinic for urgent problems like an ear infection.

Her annual physical would cost at least $250 out of pocket, Ms. Vanasek said, but she would not get any money back from her insurer until she met the deductible.

The New York Times goes on to say: Ask yourself whether you really must see a doctor who does not take insurance. Is the care really better? Ask acquaintances outside your regular circle for references. If you are willing to travel, you may find a highly recommended physician who takes your insurance.

Wow, it’s like the publication is trying to talk their audience out of cash-only medicine. Although given the price tag on that prenatal care — $13,000 — we can see their point. But we want to clarify: direct care as we envision it is an affordable option that allows doctors to make good livings. It is still business. But it’s the business of serving our patients, not making our services so exclusive that we can charge exorbitant rates.

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