As a community of entrepreneurs, small business owners and freelancers, HQ Raleigh has a lot of people interested in finding easier (and less expensive) ways of navigated the present, chaotic world of health care. With this in mind, we had a community lunch last month focused on the topic and invited guests who could speak to emerging models that may help our community members.
Direct primary care is one of these emerging models and is a way people are bypassing the whole overpriced, over-regulated insurance world and creating relationships directly with primary care providers. Patients simply pay a flat monthly rate (as low as $15 per child and $50 per adult at the Fischer Clinic) which covers most basic medical issues people encounter short of needing a specialist or hospital visit. Husband and wife team Liz and Ben Fischer run the Fischer Clinic on Blount Street in Raleigh, and Liz presented on what it’s been like for them to start their practice and offer this alternative option.
Sitting down with the Fischer Clinic team
HQ Raleigh followed up with them at their offices and sat down with Dr. Ben Fischer, his partner Dr. Zane Lapinskes, and Liz Fischer, who serves as the practice administrator. In speaking with the three of them, their passion for this form of medicine was immediately evident. Their story has a clear line of “the before time” when there were hours of meaningless paperwork, little potential for real connection with their patients, and the constant threat of burn-out. Dr. Fischer was a successful physician, he was even a finalist for N.C. Medical Society’s Doctor of the Year in 2015, but he often felt like he was running on fumes.
Dr. Fischer said, under both insurance companies and government programs, because they are after efficiency and cost savings, “The agenda of the insurer comes before the concerns of the patient. As a physician you are trying to have human to human interactions under assembly line conditions. Some older patients take 10 minutes just to get from the waiting room to the exam room. That’s often the majority of the time allowed for that visit, and you’ll need another 10 minutes just to do the data entry required by the insurers for the visit. Your only chance of keeping up with the assembly line is if you minimize your time actually speaking with your patients. You can process people at a mechanical pace, but we are trying to care for people, not process them.”
The change came when, “I realized I could control the circumstances. I didn’t have to be a victim of adverse circumstances that are set up to help the insurer, not me or my patients. And we didn’t need an insurer to make it financially feasible.”
So Dr. Fischer and Liz decided to go their own way and start a direct primary care practice. They operate out of a large historic home near the North Carolina Governor’s Mansion. They cut out the middle men (whether corporate or government) that were standing in between them and their patients. In two years of operation, the Fischer’s business grew so quickly they needed to bring on another physician to handle the patients. That’s when Dr. Zane Lapinskes joined the team.
Life in direct primary care, “It’s freedom for mission. I can do what I’m here to do.”
When asked whether he’s noticed a change in his personal quality of life and appreciation of his career, Dr. Fischer took a deep breath, paused, and chuckled.
“Dramatic. It’s freedom for mission. I can do what I’m here to do. My life isn’t necessarily easier — I never thought medicine would be easy — but it’s very rewarding to be able to be fully present with my patients when they need me and know that the long hours I’m working are not wasted on box-checking and form-filling. Now, at the end of my day, I’m not so fried. So if somebody calls me, I’m happy to talk with them, see them, and have the energy to fully be there for them. I’m a lot happier person.”
Streamlined, efficient medicine that improves care quality and lowers costs for patients
Another benefit of eliminating the middle men is you don’t have to pay them or pay people to appease them.
“There are definitely fewer labor hours when we aren’t checking all the boxes and reporting redundant data to third parties. In order to keep up with all those data-reporting responsibilities, at my previous practice we had to hire a lot of people to keep up with all that work. You had to have all these layers of people supporting you — not for direct patient care but for bureaucratic needs. That meant higher overhead, which meant you had to try to see more patients in a day. We just don’t need all those people any more; we don’t even have a billing office.”
Dr. Lapinskes added, “At my last office we had between five and six people we had to hire per doctor to get all it all done. ”
Reducing all of the extra layers of regulation on their work allows them to spend a lot more time with the patients as well. The office was a very casual, almost family-like, atmosphere. During our discussion people would come in and out to speak with the doctors. One of them would step away and take care of the patient for as long as needed and then return. There was no desk to check-in at, no kiosk to fill in data while you wait, no clipboards of forms, and no passing of payments and insurance cards. People just come in if they have a need, they enjoy the complete attention of their physician, and then they’re on their way.
An option worthy of investigation for HQ Raleigh community members
The author of this piece has actually recently began using direct primary care himself after becoming a full-time freelancer. The same day of this interview, I had gone to my doctor to pick up a prescription (many direct primary cares provide common medications out of the office) and was given three-months’ supply of a medication for $2.70; I had previously paid over $50 for a one-month’s supply. The office administrator simply handed it to me, smiled, and said the $2.70 would be added to my next month’s bill (of $50). Hard to beat that.
If you are interested in direct primary care, the Fischer Clinic is happy to answer questions from HQ Raleigh community members. They can be reached by phone at 919-258-2840 or email at firstname.lastname@example.org.