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By Mike Hazlip—
When Dr. Zinmar Ma first began her career in the medical field, she never expected opening her own office where patients pay a low out-of-pocket monthly fee to have direct access to her — but now she says it’s the best way to care for patients.
Her new office, which opened in Citrus Heights last month in suite 2200 of the office building at 6060 Sunrise Vista Drive, is part of a growing national trend called “Direct Primary Care” or DPC, which bypasses the traditional insurance model for healthcare and promises to offer better quality care by giving a capped number of patients direct access to a doctor for a monthly fee.
For Ma, patients pay between $49 per month up to $109 per month depending on age. The fees include unlimited 30 to 60 minute doctor visits, direct access to Dr. Ma via text, email and phone, and some after-hours appointments. Patients can also receive one home visit each year.
Ma opened North Star Direct Primary Care after becoming disillusioned with what she saw as a health care industry becoming increasingly encumbered with administrative rules and driven by profits.
“Healthcare is becoming so burnout-prone for physicians, and not great for patients either,” Ma told The Sentinel during an interview last month. “I felt like in my job I was expected to see way too many patients and couldn’t really spend enough time with them.”
After graduating from Texas Tech school of medicine in 2015 and completing her residency at UC Davis, Ma started working with a local urgent care facility. She says the relationship with her patients changed after the clinic was bought out by private equity and venture capitalists. The new corporate owners wanted her to see more patients each day, limiting the time she could spend with each person.
“I felt like I was a fast food worker, or a conveyor belt worker just churning out patients left and right,” she said.
Ma even considered quitting medicine and going into real estate when she discovered the benefits of the Direct Primary Care model. She said other doctors who opened DPC offices were describing a level of care that she envisioned when she first decided to go to medical school.
“They get to spend time with their patients, they get to fully address their patients’ needs, their patients can contact them when they need to,” Ma said, also noting her patients can typically book same or next-day appointments with her. “I felt like that was a much better model for practice than trying to survive seeing 30 to 40 patients a day. I felt like it just wasn’t sustainable for me.”
The doctor-patient relationship, Ma says, is the most rewarding part of her job: “That’s what I thought I was going into for medicine.”
Ma says she can treat about 70% of healthcare concerns at her office, including simple procedures such as stitches and wound care, abscess drainage, minor 1st and 2nd degree burn care, splinter removal, ingrown toenail removal, and ear wax removal. Pap smears and skin biopsies are also included in the monthly fee, although laboratory costs are extra.
To cover major injuries, hospitalizations or diseases not able to be treated through Direct Primary Care, patients typically obtain a high deductible health insurance plan or join a health sharing network. Ma says she has a mix of patients with various types of insurance, with most having an insurance plan with a high deductible.
According to a national map of more than 1,700 Direct Primary Care offices published by DPC Frontier, there are at least three physicians in the Sacramento area, including Ma’s office. Another office in downtown Sacramento, Sequoia MD, offers similar monthly pricing, with children at $25 per month, most adults at $85 per month and those age 55 and up paying $100 per month.
The DPC model is not without its critics. A 2018 opinion piece in STAT, a medical-focused news publication, lists four drawbacks the author claims could limit DPC care. Some of the drawbacks cited are lack of scalability, incentives to limit care, and added expense and burden for patients. The column also says doctors working in a DPC model cannot see as many patients as their colleagues who accept medical insurance.
However, Ma sees these same concerns as benefits to the DPC model. She says the direct primary care model is better for patients and doctors alike.
“Healthcare should not be a one-size-fits-all, mass-produced factory product, but individualized for each physician and patient,” Ma said.
The smaller number of patients is what Ma says allows her to provide better care, and she plans to cap enrollment at about 400 to 500 people, a fraction of what she says doctors typically handle. The business model works with smaller numbers of patients than a traditional hospital, since complications with insurance billing are removed from the equation and 400 people paying $100 per month equals $40,000 a month to cover the smaller overhead associated with the direct care model.
With what she describes as a small number of patients to start with, Ma says she networks with other doctors and has more time for research. She is looking for ways to expand benefits and is learning more about LGBTQIA+ care, a group she says is reluctant to seek medical care because of past stigma or fear of discrimination.
“My goal is to have 100 patients by year one, because that’s about the average for direct primary care doctors because the model is still new,” she said.
Ma says Citrus Heights offers a good mix of people at various income levels for the DPC practice model. As a resident of Citrus Heights along with her husband, her office location is also close to home, she says.
Ma hopes more doctors will open direct primary care practices as a way to make healthcare more accessible.
“Primary care needs to be reformed and DPC is one way doctors are combating burnout and elevating the level of care they can provide while keeping it affordable for most people,” says Ma. “It may not be for everyone, but it can definitely add value for many patients.”
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