Direct Primary Care: Guest Post by Dr. Alex Lickerman, Founder and CEO of Imagine MD

I remember sitting in the waiting room for an annual physical. There were four or five people around me reading People Magazines from three years ago. The person behind the counter would answer a phone call, schedule a time with a patient, hang up, and then immediately the phone would ring again.

The image I remember was looking down the hallway and seeing my doctor walk out of one of the rooms. He let out this heavy sigh. Everything in that office felt incredibly busy, like there was no time for him to collect his thoughts. No time to even collect his breath. My appointment was scheduled for 10 a.m. It was now 10:30. And I actually wasn’t mad. I honestly felt bad for my doctor.

This experience is all too common in the world of regular primary care. The doctors are trying hard but they have 5x more patients than they can realistically manage and keep track of. The result is long wait times, fast visits, and a loss of the personal connection between patient and doctor.

Today I’m passing the keyboard over to Dr. Alex Lickerman, who provides an entirely different experience over at Imagine MD located here in Chicago. He’ll explain what Direct Primary Care is, why it provides a better experience for the patient, and how this allows the doctor to think more holistically about each of their patients.

A quick bio on Dr. Lickerman then let’s dive in.

Dr. Alex Lickerman spent the first 20 years of his career as a leader at one of the top academic medical centers in the world, the University of Chicago. He ran primary care for seven years and taught generations of today’s leaders in medicine. There he enjoyed a reputation as “a doctor’s doctor,” caring for many physicians who are themselves today considered leaders in their fields. He is a master clinician, routinely diagnosing medical problems that leave other doctors puzzled.

Direct Primary Care

By: Dr. Alex Lickerman

Direct primary care began as a movement in the mid 2000s as a way to provide medical care to people with no health insurance. Since then, it’s become a way for all individuals and employersregardless of their health insurance statusto obtain better access to medical care and better quality of care, all while lowering overall healthcare costs.

The main way direct primary care achieves this “triple aim” is by providing physicians more time to spend with patients. Patients pay a low monthly subscription fee for unlimited access to their own physician via in-person visits, telephone calls, and texts. Bypassing insurance and charging a flat monthly fee directly to patients enables direct primary care medical practices to cut out anywhere between 30 to 40 percent of their overhead (billing, coding, insurance reimbursement, and so on).

This enables direct primary care physicians to reduce the number of patients for whom they care, typically down to no more than 600. In contrast, primary care physicians practicing in the traditional fee-for-service model usually care for 2,500 to 4,000 patients, seeing 20 – 22 of them per day. (Insurance reimbursement rates for primary care visits are low and the cost of running a primary care practice is high so the only way fee-for-service primary care physicians can survive financially is by piling scores of patients into their practices.)

One reason for the mounting interest in direct primary care from patients is the lack of time that physicians have available to spend with them in the traditional fee-for-service model. The average length of time it takes to be seen by a primary care doctor is 22 days. Once the patient arrives, 30 percent of them wait 20 to 40 minutes to be seen. And, once they’re in the exam room, the average length of time a primary care visit lasts is only 15.7 minutes.

For simple issues like back pain this might be enough. But for patients with multiple, complex issues it is completely inadequate—and further leaves no time to address important topics that require extended dialogue (like end-of-life care in patients with terminal illnesses, for instance). Further, dealing effectively with important emotional issues—stress, anxiety, depression, and so on—in such a timeframe is nearly impossible, as are meaningful and effective discussions surrounding preventive care. In contrast, with patient panel sizes that are 70 to 80 percent smaller than seen in traditional fee-for-service practices, a direct primary care physician can spend enough time with each patient to be able to manage 80 percent of their medical issues.

Because of time constraints inherent in traditional fee-for-service practices, traditional primary care physicians often can’t adequately address issues within their own expertise and, as a result, must refer their patients out to more costly specialists who run more tests and order invasive treatments, many of which are unnecessary, leading to an increased likelihood of complications and additional out-of-pockets costs for individual patients and/or their employers if the patient is covered in a self-insured health plan.

In contrast, direct primary care physicians spend far more time with each patient because they have far fewer patients in their practices. This allows them to care for their patients in the most comprehensive manner possible.

For example, when calling after-hours, patients in a direct primary care practice can expect to talk to their own physician rather than to a nurse or an on-call physician (other than during vacation times). Direct primary care allows patients and doctors to develop a close, trusting relationship that fosters open communication and increased compliance with medical advice, both of which have been demonstrated to lead to better health outcomes.

In the direct primary care model, physicians finally have enough time to gather complete medical histories, perform thorough physical exams, to think through challenging diagnostic dilemmas, and to search the medical literature to find answers when answers aren’t immediately obvious—as well as enough time to explain their thinking clearly enough for patients to understand it precisely. Direct primary care physicians also have time to get to know their patients in a way that enables them to tailor their medical advice to each patient’s lifestyle and values.

With direct primary care, patients at last have in their doctors what they’ve always wanted: a trusted healthcare partner who cares both for and about each of them as they would members of their own family.

ImagineMD is a direct primary care medical practice headquartered in Chicago that seeks to return primary care to what it once was. It offers world-class customer service in addition to world-class medical care, with two-hour new patient appointments and same-day or next-day return appointments. Learn more at

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