Direct primary care
"If you know there is a better model for your life, and you can still make the same income and be available for your family and friends — who wouldn't want to do that?!" said Napoleon Maminta, DO, a primary care physician and founder of Naptown Priority Health, a direct primary care practice in Noblesville, Ind.
That thought pattern is what guided Maminta's decision to make the leap from traditional practice — where he saw upward of 30 patients per day, juggled an on-call commitment, and battled a nightly backlog of electronic charting work that intruded on time with his children — to direct primary care (DPC). Today, Maminta sees fewer than 10 patients per day, but spends at least 45 minutes with each one. With lower stress levels and improved autonomy, the membership-based fee structure allows him to focus on addressing the totality of patients' health issues instead of just one or two primary or acute concerns.
Beyond the patient care advantages, there are significant personal benefits as well. "There is no stress. I look forward to work, it's more fun, [and] it's [freed up] my weekends," says Maminta. "[During the week], I can leave later in the mornings [or] leave early and get home for dinner with [my] kids."
It's an alternate career pathway he encourages his colleagues and those coming out of medical school to contemplate. "Consider how much independence you want and how you want to practice medicine," Maminta said. "No doctor [goes] into medicine to injure people, so if you're burning out [or] in a situation that you don't want to do, it's time to move on."
While there are bound to be impediments that threaten to prevent or delay desired employment changes, Maminta says virtually all of these can be navigated with relative ease. Choosing to go into DPC avoided conflicts with his non-compete agreement, because it was considered different from his previous primary-care position. Malpractice costs, while not necessarily inexpensive, have still been manageable. To stay competitive and profitable, starting out with a low overhead has provided an enormous jumpstart.
"Find a small office space, hire a few people, buy your equipment as inexpensive as possible, let people know that you're there, and establish rapport with your patients," he said. "Yes, there are startup costs, but it's not bad. If you were in practice even for a short period of time [before DPC], your patients can find you and your practice can grow."
Stacey Pierce-Talsma, D.O., an osteopathic physician and associate professor and chair of osteopathic manipulative medicine at Touro University in Vallejo, Calif., has worked in academic medicine her entire career. In her former position at another university, she spent up to 60 hours each week seeing patients, precepting residents, lecturing, and performing administrative duties. Her transition to an administrative role at Touro University has cut her face-to-face patient time in half, shaved upward of 20 hours off her weekly schedule, and allowed her to focus on her primary interest of student engagement. The administrative aspect of Pierce-Talsma's responsibilities allows for a more fluid schedule — for example, attending a yoga class during work hours isn't usually a deal-breaker so long as she makes up the time elsewhere — and there is a considerable amount of flexibility during the summer.