A New Kind of Doctor's Office Charges a Monthly Fee and Doesn't Take Insurance — and It Could Be the Future of Medicine

Dr. Bryan Hill spent his career working as a pediatrician, teaching at a university, and working at a hospital. But in March 2016, he decided he no longer wanted a boss. He took some time off, then one day he got a call asking if he'd be up for doing a house call for a woman whose son was sick. He agreed, and by the end of that visit, he realized he wanted to treat patients without dealing with any of the insurance requirements. Then he learned about a totally different way to run a doctor's office.

Dr. J. Bryan Hill with one of his patients. Courtesy Dr. J Bryan HillIt's called direct primary care, and it works like this: Instead of accepting insurance for routine visits and drugs, these practices charge a monthly membership fee that covers most of what the average patient needs, including visits and drugs at much lower prices. That sounded good to him. In September, Hill opened his direct-primary-care pediatrics practice, Gold Standard Pediatrics, in South Carolina. Hill is part of a small but fast-growing movement of pediatricians, family-medicine physicians, and internists who are opting for this different model. It's happening at a time when high-deductible health plans are on the rise — a survey in September found that 51% of workers had a plan that required them to pay up to $1,000 out of pocket for healthcare until insurance picks up most of the rest.

That means consumers have a clearer picture of how much they're spending on healthcare and are having to pay more. At the same time, primary-care doctors in the traditional system are feeling the pressure under the typical fee-for-service model in which doctors are incentivized to see more patients for less time to maximize profits. Direct primary care has the potential to simplify basic doctor visits, allowing a doctor to focus solely on the patient. But there are also concerns about the effect that separating insurance from primary care could have on the rest of the healthcare system — that and doctors often have to accept lower pay in exchange for less stress...