As concierge and DPC grow, the access question looms for safety-net patients

As concierge medicine and direct primary care expand, the bigger question may be what happens to patients who rely on traditional primary care and the safety net. If more clinicians move into membership-based models and see fewer patients on average, overall access could tighten in some markets and widen existing gaps for patients with the greatest need.

In an interview with Physicians Practice, Jane Zhu, M.D., of Oregon Health & Science University, citing the results of a study she led, says the growth of these models should be tracked for unintended spillover effects and paired with continued investment in community health centers and other safety-net systems.

Physicians Practice: You noted there were very few physicians moving into these models from community health centers. As concierge care and DPC expand, are we going to see a widening gap in access for patients who need primary care the most?

Jane Zhu: As I mentioned before, there are clear benefits to patients from these models. But what’s really unknown right now is the implication for systemwide access, and that’s uncertain. It probably varies by market and by the particular model.

What we worry about is unintended spillover effects. If these models are growing and drawing clinicians away from the traditional primary care system, and these clinicians are seeing fewer patients on average, then a key question is, while they expand, do they ultimately increase overall primary care capacity, or are they reallocating care toward patients who are able to access these models and have the means to pay, particularly concierge models, or to have supplemental coverage with direct primary care models?

One key element here is that there are important models of care that already exist: federally qualified community health centers, community primary care centers. If we’re focused on improving access and primary care capacity at a system level, we should be simultaneously making sure we invest in those other systems, our safety-net systems, so that access to care is maintained nationwide and across populations.