3-Minute case study: A radical approach to primary care reverses burnout

By Erin Graham | April 21, 2020


The problem

To Timothy Wong, MD, medical school seems like a bait and switch. And when it comes to primary care, he’s not afraid to call it a scam. “We aren’t told in school or in training how much administrative burden there is, and we don’t realize it until we’ve already specialized in primary care,” he says. Managing refills. Coordinating care. Haggling with insurance companies. “We didn’t go to medical school to learn how to do that,” he says.

Like a growing number of PCP colleagues, Dr. Wong suffered from primary care burnout. He realized that if he continued down the traditional path, he’d not only be miserable, but would be contributing to a dysfunctional system that makes both physicians and patients feel shortchanged. “I saw how the patient-doctor relationship was getting worse, and how patients weren’t accessing care,” he says. Last year, in his fourth year of practicing, Dr. Wong knew he had to make a major change.

The solution

Dr. Wong rejected the idea of concierge medicine, which many criticize as negatively impacting a healthcare system that’s already failing. Instead, he opened a “micro-practice” called iHealth Clinic in Pittsburgh that uses what he calls “direct access primary care.” It focuses on treating problems and serving patients rather than spending time fighting for insurance reimbursements.

His one-man operation offers a direct primary care model in which (walk-in only) patients pay a flat $35 fee for most visits, which range from annual physicals and concerns about depression to finger injuries and tick removal. If a patient has more than three problems, he charges an extra $10 per problem. No appointments. No insurance claims. No membership fees. No hassle.

While he still does deal with some paperwork, it’s a drop in the bucket since he’s cut out insurance paperwork entirely. He appreciates that his location encourages people to walk in off the street, which makes it easier for people from all walks of life to access affordable care for an issue they might otherwise ignore.

The outcome

“It hasn’t been as hard as I thought it would be,” says Dr. Wong. “Financially, the model has been proven,” he says. His goal is to see at least 20 patients a day, which would give him a decent salary and about a 50-hour work week – less than the typical PCP. After only four months, he’s almost halfway there. He’s finding that the direct payment model – and the fact that he’s the sole employee – allows him to keep his overhead low and his administrative burden at a bare minimum.

While he works most days and long hours at that, Dr. Wong isn’t complaining. And he’s eager to share his success with other PCPs via his website. “It’s important for me to help make this model reproducible so other providers can, hopefully, iterate and improve upon it,” he says.

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