Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The emergence of direct specialty care

Diana M. Girnita, MD, PhD
Physician
September 6, 2021
Share
Tweet
Share

One day, a primary care physician located about two hours away called my office in a desperate attempt to find a rheumatologist. His lovely 64-year-old patient, very healthy otherwise, recently developed a severe and disabling inflammatory arthritis. After conservative treatments failed, he tried to refer the patient to the traditional medical system. However, they could not get a sooner than six months appointment. This is a symptom of a broken health care system.

A specialist is supposed to be there for patients when medical care becomes more complicated than a primary care physician can handle. Unfortunately, nowadays, unless patients get admitted to the hospital, the access to a specialist like me in rheumatology will be postponed to the extent that the patient’s health is in jeopardy.

But is it possible to see patients when they need help?

Often, we hear that the U.S. health care system is broken. Physicians are blamed for the lack of patient access, increased costs, copayments, and surprise bills. However, as a physician previously employed in the traditional system, I can testify that there is minimal control of our schedule and definitely no involvement in any of the costs related to the care we provide (consultations, copayments, laboratory, imaging, or medication). There are not enough specialists, and there are not even enough fellowship spots available to close the gap. Additionally, insurance companies limit the number of specialists in their preferred provider panels. And, if that wasn’t enough – because of the pressures on everyone’s schedules, patients are often sent to us too early, creating a bottleneck in the schedule.

On a typical day, most appointments with the patient last, on average seven minutes. Physicians are trapped in productivity models, being incentivized to see more patients, instead of offering a higher quality of care.

This is a symptom of our broken system that needs to be addressed, and fortunately, a few trailblazers have shown that change is possible, and we are now starting to see the market begin changing.

Getting back to this lovely 64-year-old patient and their doctor trying desperately to help – the market came to her support. Fortunately, her physician took the time and researched her options. He called my practice in a desperate effort to help the patient. After a short peer-to-peer consultation, I called and scheduled the patient for a visit the next day. The patient was surprised I did not start greeting her by asking for an insurance card. After our first visit, together with the patient, I planned for further laboratory and medication. All the costs involved in her care from consultations, laboratory tests, imaging were made available upfront to the patient. This time her medical care was reduced from estimated thousands to clear-cut hundreds of dollars. No copayments, no surprise bills in addition to what was disclosed and agreed by the patient. The patient was astonished, and she chose to continue care in my practice.

This is direct specialty care – we even have our own association now: the Direct Specialty Care Alliance.

The idea of being an independent physician seems so frightening these days. Starting a practice that will offer care directly to the patient, without the interference of “middlemen” seems something rather utopic these days for a specialist. Most times, we see referrals from other specialists or primary care physicians. How are we supposed to survive? How do we educate the patients that you are there for them? How can we justify the fact that we are not billing their insurance? How should we set a fair market price?

I am here to testify that it is possible, and I am not alone in this specialist direct care market. There are other specialists’ practices like mine, hidden gems for patient care. During my journey, I learned specialists are thriving to remove the “middlemen” and reconnect with patients. Patients are eager to shop for their health, discover transparent pricing and excellent quality. Patients and physicians desire mutual accountability. Since the direct primary care movement started approximately ten years ago, many patients that signed up to this model quickly realized the benefit of having access, affordability, and price transparency.

Specialists in direct care now exist across the country. In the last two years, I have been in contact with many thriving physicians providing a direct care model. However, it was so hard to find and connect. Our hope – and our patients’ need – is that connecting patients with direct care specialists gets easier. We are working on that now – we are working to change the system because our patients need it – and practicing good health care depends on it.

This is just the beginning of a new era in medicine, where patients and physicians reunite.

Diana M. Girnita is a rheumatologist and founder and CEO, Rheumatologist OnCall. She can also be reached on Facebook, Instagram, and YouTube.

ADVERTISEMENT

Image credit: Shutterstock.com

Prev

A person-to-person strategy is needed in the pandemic war

September 6, 2021 Kevin 3
…
Next

Millions of Americans without ICU doctors due to the "Biden ban"

September 6, 2021 Kevin 10
…

Tagged as: Rheumatology

Post navigation

< Previous Post
A person-to-person strategy is needed in the pandemic war
Next Post >
Millions of Americans without ICU doctors due to the "Biden ban"

ADVERTISEMENT

More by Diana M. Girnita, MD, PhD

  • Why adopt a lifestyle pyramid for rheumatoid arthritis?

    Diana M. Girnita, MD, PhD
  • Why expand telemedicine for arthritis patients?

    Diana M. Girnita, MD, PhD
  • Focus on the rheumatoid arthritis patient, not on their disease

    Diana M. Girnita, MD, PhD

Related Posts

  • Why health care replaced physician care

    Michael Weiss, MD
  • Direct primary care is an answer to volume-based insurance reimbursement models

    Troy A. Burns, MD
  • Forget what you’ve heard. Direct primary care is here to stay.

    Trevin Cardon
  • Can direct primary care save us from the tapeworms of insurance?

    Niran S. Al-Agba, MD
  • How social media can help or hurt your health care career

    Health eCareers
  • Direct primary care: Great for some doctors, but challenging for patients

    Ken Terry

More in Physician

  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • How regulatory overreach is destroying innovation in U.S. health care

    Kayvan Haddadan, MD
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The emergence of direct specialty care
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...