I would rather have a doctor who knows me better, has time to listen, etc., but even if I somehow find one who follows the direct practice model, I’ll be missing the reassurance that a large practice gives (namely, that the doctors in a large practice have been closely evaluated and chosen because they are good doctors). There’s no screening process for a doctor who decides to go it alone. – from a concerned patient.
Thanks for your question. What we are lacking right now in the direct practice space is a national directory of providers. The closest thing is what SIMPD is doing, as well as the work by HelloHealth to create a University for physicians who want to learn to implement and operate direct practices.
In terms of the quality of the physician, that is still open for discussion. I realize that you feel that practicing in a large practice implies that your physician has been “screened”, but I can tell you from the inside that physicians themselves have no idea how good they are because there is very little information about their practice outcomes. The variations in care are astounding, and disappointing, and we need to continue to push for doctor rating systems that are based on objective evidence of quality – instead of the Zagat-style popularity contest. We need real clinical outcomes measures to help people know that their knee surgeon has performed 4,123 arthroscopies, is currently 75 days without an adverse outcome, has a 2.5% infection rates, and and overall patient satisfaction score of 4.23 (out of 5) with access to former patients comments and contact information.
It is only in that environment that you are going to be able to truly judge the quality of the physicians. We are not there, but there are some early signs we are heading there.
Scott Shreeve, MD 