Your Doctor’s Office Might Soon Start Charging an Unexpected Fee

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Your last visit to the primary care doctor likely followed a familiar sequence: You waited weeks, if not months, for the appointment. Once you were finally in the exam room, your doctor tried to squeeze a lot into a short visit before moving on to the next patient. In the parking lot, you remembered the question you meant to ask.

This setup misses the point of primary care. In theory, the internal medicine or family medicine doctor oversees your preventive care, ongoing symptoms, chronic conditions, and referrals to specialists. Ideally, it’s an ongoing relationship with a doctor who can take the time to decode why, for instance, that pain in your toe might be a warning of a serious heart condition. All too often, though, it ends up being more of an annual one-off visit.

The ideal kind of primary care model takes time, but it’s not really supported by insurance, which pays for quick visits and specific services—not time spent getting to know a patient’s health history. Most primary care doctors are responsible for more than 2,000 patients , who get visits of about 18 minutes, according to a study published in the Journal of the American Board of Family Medicine that measured electronic health data from over 21 million primary care visits. This is not always enough time to connect seemingly unrelated symptoms—or simply answer every question. And those visits often run over their allotted time, meaning that primary care doctors are often behind.

So: Patients are frustrated because doctors seem rushed. Doctors are frustrated because they are bogged down with patients.

A growing number of primary care doctors say they are finding a way back to an unhurried model of patient care. Instead of billing insurance for routine office visits, they’re charging patients directly through a monthly or annual membership fee, a model known as direct primary care, or DPC.

Each DPC practice sets its own membership price, typically $50 to $100 a month, according to the American Academy of Family Physicians , though it can be more. This cost covers routine primary care visits, from annual physicals to chronic disease management. Patients have direct ongoing access to their doctors when they need it.

Because DPC doctors are being compensated directly by the patients rather than billing insurance, they can operate with smaller patient panels, an average of 402 patients, according to an AAFP study . In theory, this translates to more time with your doctor. How much time varies, but for $200 a month for an adult, one Pennsylvania-based DPC practice promises visits that last up to two hours, which is plenty of time for a doctor to learn the nitty-gritty details of your life. According to the AAFP study, physicians operating on the DPC model were much more likely to report that they were not burned out.

Which might be a reason that DPC is on the rise. A recent Health Affairs study led by Dr.