It was 15 years ago that Brian Forrest, MD, a primary care physician in Apex, North Carolina, founded Access Healthcare—a practice considered one of the earliest direct primary care (DPC) practices in the U.S. and put Forrest on the map as a pioneer of the new practice type.
Medical Economics spoke with Forrest on his motivations for starting a DPC practice and where he sees the movement heading.
Medical Economics: What drove you to start a DPC practice?
Brian Forrest: You know at the time, this was 17 years ago and there was no such thing as DPC around at that time. I read an article about Gordon Moore, who started the micro practice concept, and he was an internist who had been seeing maybe 30 or 40 patients a day and he was really tired of that pace and felt like he couldn’t provide good patient care and felt like that volume was mostly driven by his overhead.
So, he decreased his staffing basically to zero. Instead of having four or five staff, he rented one exam room from another physician and got a headset and became his own receptionist, his own nurse and he was able to go from seeing that high volume of patients down to about 10 a day and make the same salary.
FURTHER READING: Uncertainty in healthcare driving DPC growth
That was the first thing that I took some inspiration from. And then the second thing was, I sort of had this idea that, why couldn’t family medicine be more like a gym membership?
When I was in residency I actually did an elective, and I interviewed practice managers and physicians from all over, and really found out that the biggest problem was all the administrative burden associated with filing insurance. So I had a hypothesis that if I got rid of all that administrative overhead and basically just focused on taking care of patients, I would be able to charge patients a lot less.
I got paid for what I was doing and it was taking at least half of my brain power to do that versus spending all of my efforts trying to optimize patient care.
Q: Why do you think DPC has become such a strong movement and do you think it’s going to keep growing?
Forrest: Yes, I do think it’s going to continue to grow. The reason I think there’s a push is that doctors want to see patients, they want to take care of people. No doctor went to medical school to be a professional coder.