The math wasn’t adding up.
Family medicine physician Dr. Katrice Brooks had over 2,500 patients. On any given day, she was squeezing in appointments with about 25 of them.
That pace was not only difficult to manage during the day – Brooks often had to put in additional hours of work during evenings and weekends to catch up on a backlog of patient notes.
“It started to feel unsustainable,” she said. “… I always spent too much time talking with patients. That’s what I really enjoy, talking to them and helping them, but I would run behind all day.”
The COVID-19 pandemic exacerbated her dilemma. In addition to doing virtual visits, Brooks began managing more emails and calls coming in from patients, and much of that extra work wasn’t reimbursable. She felt burned out. Like many professionals over the past year, she began reevaluating her work arrangement.
“It made me do some internal reflection and really reconsider my values and go back to: why did I do medicine? What is really my purpose? And am I living out my purpose?” she said.
Brooks’ patient panel size was slightly bigger than the national average among family physicians – which was 2,194 in 2017, according to the American Academy of Family Physicians – but her story is familiar among primary care providers. Just under half of doctors that year surveyed by AAFP had 2,000 or more on their patient panel, which is defined as the number attributed to a physician and seen by them in the past 24 months.
Brooks considers those data to be symptomatic of a broken health care system that incentivizes physicians to see as many patients as quickly as possible, resulting in rushed appointments that aren’t conducive to holistic are.
As her contract was coming to a close after eight years with a large area health system, she decided it was time for a change. She began researching online to find career alternatives for someone with her background and discovered an emerging, alternative care model called Direct Primary Care. DPC clinics operate under a membership-based payment system; patients pay a flat membership fee to gain access to all primary health care services, with no fee-for-service payments or third-party billing.
Nationally, there are about 1,500 DPC clinics currently operating. The national Direct Primary Care Coalition counts about 15 practices in Wisconsin as “pure DPCs,” meaning they only see patients via the membership model and don’t participate in any third-party fee-for-service billing. Many more practices in the state are “hybrid DPCs,” where a portion of the practice’s patients are DPC member patients and the remainder use the traditional third-party fee system.
“When I saw the type of doctors that DPC (doctors) were, the doctors who spent an hour with their patients, the doctors who maybe saw four to eight patients a day, but they got to do all the deep medicine I want to do, it seemed perfect,” Brooks said. “It seemed like the type of medicine I had dreamed of doing when I was a kid, and I didn’t even know it was possible to do that type of medicine.”
In October, Brooks opened her own DPC clinic in Wauwatosa, called Quench Clinic.
At Quench, Brooks charges a $99 monthly or $999 annual flat fee for adult patients, and $49 monthly or $499 annually for children. The fee does not act as insurance, nor does Quench accept any insurance for payment.
Under the DPC model, the patient fee covers primary care services, including clinical and laboratory services, consultative services, care coordination and care management, according to the AAFP.
Because some patients will inevitably need more intensive care or will end up in an emergency or needing surgery, Brooks recommends all her patients also maintain a high-deductible wraparound policy.
Quench patients can choose in-person or virtual visits, generally with no wait time or limits on appointment duration.
“They can see me as many times as they need to,” Brooks said. “They also get full access to me – my email, my phone, they can text me, they can send pictures, and I respond to them in an expedited way, usually within two hours.”
Patients opt into DPC membership for various reasons, Brooks said. Some value the access to a doctor it provides. For some uninsured patients, it’s an affordable health care option. Some consumers prefer to not have insurance agencies or the government dictating what kind of care they receive or how it’s reimbursed, she said.
But she acknowledges the model might not be for everyone. If someone has insurance through their employer, they might not want the additional health care expense.
“But there are some people who want more time with their doctor, and (for whom) the extra $99 per month is just worth it,” Brooks said, likening DPCs to the days when doctors would make house calls.
As a Black physician, Brooks serves patients from across the region, including those coming in from Racine and Waukesha who want to receive care from a physician who looks like them. She wanted to create a practice where patients felt safe.
“In Milwaukee, there are not a lot of African American providers,” she said. “… The nice thing about DPCs is that it’s so individualized that I’m able to focus in on what I’m interested in, and I’m interested in providing health care to Black and brown people.”
As of November, Quench had about 45 patients. Brooks envisions capping her panel when she gets to 300 patients.
The rise of DPCs runs counter to a trend of consolidation in the health care industry, in which large health systems continue to acquire small, independent practices. A sign of the model’s decline, 49% of physicians worked in a private practice in 2020, the first year that less than half of doctors worked in a practice wholly owned by physicians, according to the American Medical Association.
As a new entrepreneur, Brooks is faced with not only medical decisions, but also decisions related to her burgeoning business.
“Before I was not a business owner, I was an employee,” she said. “I would show up at work, see my patients, do my notes and go home. That was all I had to worry about. I didn’t have to worry about supplies and rent and all those sorts of things. … It’s a whole new skill set.”
She’s sought out a small business mentor through SCORE SE Wisconsin to help her launch her business.
“I was told that it could help me find resources and get me on track locally,” she said. “I’ve certainly found this to be the case. My mentor, Brian Alves (group project manager for Milwaukee Tool), has been nothing but helpful and encouraging.”
Brooks currently runs the clinic by herself; based on her current projections, she will be able to afford a medical assistant once she reaches 68 patients.
“The whole model of DPC is to keep the overhead as low as possible,” she said. “… Right now, patients like that when they call, they’re reaching me. And when they see me, I start the visit right away because it’s not a waiting room full of people, and we’re not double-, triple-booked.”
Now licensed to also practice in her home state of Illinois, Brooks has plans to begin offering telehealth across state lines in the future and host pop-up clinics in other parts of the Milwaukee area.
In the meantime, Brooks said she’s able to offer additional services she couldn’t before under a traditional clinic model, such as meditation classes and “Walk with the Doc” – an hour-long outdoor walk with patients.
She also envisions being able to do home visits in the future, particularly for post-partum patients or those recovering from surgery
“I can meet people where they are,” she said.