The open house for a new medical office in Williston looked ordinary enough. On a recent Friday evening, a smattering of prospective patients grazed on fruit and healthy snacks, peeked at the exam room, and chatted with the owner and staff members of Blue Spruce Health. But the flyer announcing the event contained clues that this wasn’t your typical doctor’s office. Asking customers to “Experience Healthcare the Way It Should Be,” the flyer touted $0 co-pays and unlimited visits, wholesale labs and medications, and text and cellphone access to Blue Spruce’s medical staff. The registration fee for the practice, tucked next to a Union Bank branch in a busy commercial plaza, would be waived for those who attended the open house.  The owner, Dr. Umair Malik, started Blue Spruce in Newport in September 21. It’s one of a growing number of practices in Vermont that deliver medical care through a relatively new model known as direct primary care. Physicians who opt in do not accept health insurance and instead charge patients a monthly fee to provide primary care that they say is more personalized. Though similar in concept to a more commonly known version called “concierge medicine,” direct primary care touts cheaper care — fees typically top out at $200 a month — allowing doctors to see patients who are from a range of income levels rather than just high earners. It’s sometimes referred to as “blue-collar concierge.” Doctors who practice direct primary care say cutting out insurance companies allows them to spend more time with patients and less on paperwork. It also saves them the expense of hiring staff to deal with insurance matters and solves the problem of relying on low insurance reimbursements. Though some direct primary care patients are otherwise uninsured, many often carry some form of health insurance to cover specialist visits, medical imaging or emergency care. A recent change in federal law lets patients draw from health savings accounts — pre-tax earnings that can be set aside for medical expenses — to pay for their direct primary care memberships. Though direct primary care originated in the late 1990s, the model has garnered more interest from both doctors and patients of late as a result of “pressure points converging,” said Kelsey Smith, president of the Direct Primary Care Alliance, a national nonprofit that supports around 600 physicians. Those factors include rising overall medical costs and health insurance premiums, increased pressure on doctors to see more patients, and the loss of federal Affordable Care Act subsidies under legislation passed last year by the Republican-controlled U.S. Congress. Some analysts believe the changes could help make the direct primary care sector an attractive target for investors. In Vermont, direct primary care is still relatively uncommon. That may change as the traditional health care system continues to struggle and word of direct primary care spreads, though few see it as the cure-all for broader problems of medical cost and availability that bedevil health care nationwide. Still, five direct primary care doctors interviewed by Seven Days — each in a different part of the state and with various styles of practice — said the model has enabled them to find more job satisfaction and provide better care.  Malik, a native of Montréal, started Blue Spruce after working as a primary care physician at Newport’s North Country Hospital for seven years. In that role, he had more than 2,000 patients. “I just wasn’t feeling like I was a doctor,” he said. “I was an employee. I was part of a system.” The workload made Malik blanch whenever his father, a Pakistani immigrant, would ask if he was healing people. “I felt really disappointed,” Malik said. “Because many days … I didn’t. I prescribed a pill, and I had to rush to the next visit.” I just wasn’t feeling like I was a doctor. I was an employee. I was part of a system.Dr. Umair Malik Starting a practice that operates outside of the medical establishment felt risky, Malik said, but he did so to “feel good about the work I do.”  When he first opened Blue Spruce, Malik recalled, some people thought it was a scam. But gradually he convinced people to join, often by explaining that the model allowed him to work for them rather than insurance companies or a larger, faceless system. Now, Blue Spruce has more than 1,000 patients, mostly in the Newport area but also in a spin-off office in St. Johnsbury and the year-old site in Williston. Across the three sites, the company has 10 employees, including a nurse practitioner, a physician’s assistant, a nurse and medical assistants. Ed and Joan Camp of Newport, both in their nineties, began seeing Malik when he still worked at North Country and followed him to Blue Spruce. At the hospital, they said, he was limited to 15-minute appointments, but now he can spend an hour at a time with them; sometimes, he even makes house calls. The couple, who use Medicare for other medical needs, said the $1,000 they each pay Malik yearly is worth it because of his responsiveness, “supreme” care and help in coordinating with specialists. Corina Vandever, 61, signed up with Malik’s practice after moving to Newport from New York City last year. He’s helped her manage her blood pressure and thyroid issues and gain access to low-cost prescriptions and lab work. Vandever has separate catastrophic health insurance — a plan with cheaper monthly premiums but a high deductible — in case of an emergency but otherwise pays for her medical care out of pocket. She said the $175 monthly fee is more affordable than the high monthly premiums of a more traditional insurance plan. Most direct primary care doctors in Vermont run smaller operations than Malik’s. Such stand-alone practices carry all the risks of any small startup, and the offices may feel spare compared with some larger, better-equipped medical facilities. Practitioners sometimes work on weekends or eschew vacations when they can’t find another doctor to cover for them.  Dr. Umair Malik Credit: Courtesy Dr. Marian Bouchard founded Fiddlehead Family Health Care in 2020 after practicing medicine in Bristol for decades, first in private practice, then at a federally qualified health center. In the latter role, she balked at being rushed from room to room to increase “productivity.” She didn’t feel like the kind of practitioner she had aspired to be while in medical school: working out of a Victorian house in a small town, treating people in the community where she lived, she said. Being a good doctor “is about connecting and building trusting relationships,” Bouchard said. “It’s about assuring the patient that you hear them, care what they have to say, and that their care will be proactive, not reactive.” Her current practice, located on a residential street in Bristol with a hand-lettered wooden sign hanging from the front porch, allows her to do just that, she said.  Bouchard has just one employee — an administrative assistant who has worked with her for 30 years — if you don’t count her disarming golden retriever, Cooper, who eagerly welcomes guests with a plush toy dangling from his mouth. With fewer than 400 patients — about a quarter the amount of a typical primary care doctor — Bouchard said she can really get to know them. Longer appointments also enable her to do more thorough assessments of patients’ ailments, sometimes sparing them costly trips to a specialist. She can freeze off a child’s wart on the spot rather than send them to the dermatologist, for example, or figure out that chest pain is being caused by anxiety or reflux and not something that requires a visit to a cardiologist.  “I pay her a flat fee … to keep me well as opposed to paying a primary care provider when I’m sick to fix me,” said Stephen Harris, 76, who’s been a patient of Bouchard’s through all her modes of practicing medicine. Meeting with her feels like “a social event,” he said, “which is as calming and good for your health as any pill you can take.” In Manchester Center, Dr. Leigh LoPresti, who began practicing family medicine in the 1980s, started his direct primary care practice two years ago after becoming “completely burnt out” practicing in other settings, including hospitals and HMO networks. With around 160 patients today, LoPresti said it doesn’t make financial sense for him to hire additional staff, so he’s doing it all himself — from answering the phone to drawing blood. LoPresti said he is “infinitely happier” being his own boss and delivering medicine in a way that allows him to pay closer attention to his patients and step off “the insurance hamster wheel.” “Five people this week have said, either in an email or text, ‘I really appreciate you,’” he said, noting that he rarely heard that sentiment from patients in other settings.  Dr. Meghan Gunn, who has run Red Clover Pediatrics in North Bennington for 18 months, the state’s only pediatric direct primary care practice, also goes it alone.  “I’m the CEO and the janitor,” she said. Gunn works out of a house in the center of town that “feels like you’re walking into a living room, not an office,” she said. She sees about 125 kids, far fewer than the 1,200 she saw when she was a doctor at Southwestern Vermont Medical Center.  “Ultimately, why doctors have to see so many patients is to get reimbursements from insurance companies to make money,” she said.  If an increasing number of doctors opt to go the direct primary care route, Gunn conceded, that could exacerbate the shortage of primary care physicians. “But I had tried working within the [traditional] model for so long,” she said, “and decided I needed to step out.” That fatigue also spurred Dr. Anton Borja to open Integrative Osteopathic Family Medicine in South Burlington. Initially trained in Eastern medicine, Borja graduated from osteopathic medical school 15 years ago, then did a residency in family medicine. After teaching at several medical schools, then working at the Community Health Centers of Burlington, he launched his direct primary care practice in 2023. He also offers acupuncture for an additional fee.  Borja said he is grateful to return to the “bare bones of medicine,” with the doctor-patient connection at its core.  Sarah Lenes, 43, signed on with Borja after becoming frustrated with the lack of responsiveness from her longtime primary care doctor. She said her experience with Borja has been “vastly different.” She can call or text whenever she has a question or medical issue, and he responds immediately. Lenes likens the monthly fee to a gym membership: something that helps her maintain her “health and well-being.”  Another of Borja’s patients, Spencer Blackman, said he was seeking a more “relationship-based clinician.” Trained as a family physician himself, Blackman said he understands how the demands of insurance companies can hamstring doctors from providing personalized care to patients. For years, Blackman has worked as head of education for One Medical, a national network of primary care physicians owned by Amazon, but he’s leaving that job this month. In May, he plans to launch his own direct primary care practice in South Burlington. ➆ The original print version of this article was headlined “Back-to-Basics Medicine | An affordable model for primary care bypasses health insurance companies. Doctors and patients say they’re happier.” The post Some Vermont Doctors Embrace the New ‘Direct Primary Care’ Model appeared first on Seven Days. ...read more read less