Zoe Crawford’s insightful article on KevinMD examines the shortcomings of direct primary care (DPC) for patients with complex needs. Having experienced difficulties in navigating the healthcare system to obtain imaging, referrals, or specialized care, Crawford’s frustrations resonate with many. Her piece raises significant questions regarding the suitability of various care models to meet diverse patient requirements. Although psychotherapy and DPC share certain traits, such as functioning outside typical insurance frameworks, their objectives differ and present distinct challenges. Psychotherapy tends to be more self-contained, while primary care necessitates coordination with a broader, insurance-driven network, complicating DPC’s ability to fully remove these systemic obstacles.

Crawford expresses discomfort with being labeled a “high utilizer” within a flat-fee DPC structure, indicating a disconnect between patient complexity and practice design. This issue is not unique to DPC; any flat-fee system may encounter challenges with variability in utilization. In contrast to psychotherapy, primary care must be flexible to adapt to potentially swift changes in patient complexity.

The reduced overhead in DPC might restrict the range of services offered, making it crucial for patients to understand what services are provided directly and which necessitate external referrals. This awareness is vital, as limited access or postponed diagnostics in primary care can result in serious consequences.

Crawford’s proposal that fee-for-service could prove more viable mirrors a widespread belief, though fee-for-service models also come with their own difficulties, including hurried consultations and disjointed care. The attractiveness of DPC often lies in its ability to rectify these specific shortcomings by providing enhanced access and continuity.

In conclusion, Crawford’s essay highlights the importance of acknowledging the strengths and weaknesses inherent in each model. DPC is not synonymous with psychotherapy, and conflating the two can lead to misconceptions. The essential conversation should aim to discern which models are most effective for particular patients, under distinct circumstances, with a focus on transparency and clarity. Engaging in such discussions could enhance decision-making for both patients and clinicians within a flawed healthcare system.

Arthur Lazarus, the writer of this commentary, is a previous Doximity Fellow and an adjunct faculty member at Temple University, having authored several books on medicine and psychiatry.