COMMENTARY

Direct Primary Care Lets Me 'Be the Doctor I Wanted to Be'

Julie Gunther, MD, MMM, CPE, FAAFP

Disclosures

November 07, 2017

Editorial Collaboration

Medscape &

The AAFP Physician Health First portal provides numerous online resources to support physician well-being.

Hi. I'm Dr Julie Gunther. I'm a board-certified family doctor from Boise, Idaho. In 2014, I opened sparkMD, a direct primary care (DPC) practice. I've been asked to share my story from medical school to DPC.

I actually worked in the technology field at a tech startup straight out of college because I did not want to be a doctor. I thought they worked too much. After 15-hour days and people winning free cars, I realized that what I was doing did not feel like it had any social value. So, I transitioned. I went back to school and then to medical school.

I had an extremely clear vision of what kind of doctor I wanted to be. It was something like [Michaela] Quinn from Dr Quinn, Medicine Woman—but with no horses, because I do not like horses. I wanted to take care of people in rural Idaho. I wanted to buy and renovate an old barn, live upstairs, and have a clinic downstairs. My husband said the barn and the clinic needed to be across the street from each other, so we had some boundary discussions.

I trained in medical school and residency with the notion of being a full-spectrum family doctor. I wanted to do C-sections, colonoscopies, breastfeeding education, birth-to-death care. Everything. By the time I went back to Idaho after residency, family doctors, at least where I wanted to live, were not doing that anymore. My husband and I had a big heart-to-heart talk because residency was very challenging for our marriage. He said, "Julie, you can be a doctor, but you don’t have to be the doctor."

So, I tried a system job. I took an employee job where I was told I would work 9 AM to 5 PM Monday through Thursday and that they would take care of everything for me. After 5 years, I realized that the soul of what I had been called to do had died. I was at a crossroads: Do I leave medicine entirely? Or do I start asking some questions about why physicians like me are no longer finding a sustainable path to remain family doctors?

I was fortunate enough to meet Dr Josh Umbehr in September 2013 at the American Academy of Family Physicians (AAFP) Scientific Assembly (now called the Family Medicine Experience [FMX]) and learn about DPC. For me, the lights just went on. It was a sustainable path to have a small practice and take care of people the way I wanted to. By removing myself from insurance billing, I could simplify primary care to make it exceptionally affordable and sustainable for me to be the doctor I wanted to be.

In October 2013, I "stalked" Dr Umbehr at the first DPC conference. My husband went with me and within an hour said, "Oh my goodness, we have to do this." It was the first time that I was in a room of physicians who were saying the same thing I was: "Why do we have to do things this way? What is happening to our profession? This is insanity. I am spending too much time on paperwork."

In November 2013, I got a massive bank loan after writing a 33-page business plan. I bought a building in downtown Boise, Idaho. We closed on the building in April 2014. One of my favorite patients fell and broke his hip. His family called and said, "We don't care where you are or what you cost; we want you to be his doctor." I was not going to open until summer of 2014, but a wonderful man named Brick became my first patient.

I left my system job in May 2014 and sparkMD hit the ground running. I added a nurse in August. Until then, I had built the practice on my own with my cell phone, a stethoscope, and a 100-square-foot office. My formal, official office opened in September 2014. In under a year, I went from system-employed physician, to totally lost physician, to learning about DPC, to owning my own building and having my own practice.

We have been open for about 3 years. I have what is considered a full practice for a DPC doctor, with 600 patients. We have an in-house dispensary where we sell medications back to patients. A Z-Pak® is $1.52, Cymbalta® is $8.00 a month, and Flonase® is $4.00. Even our insured patients tend to save money on most generic medications. I have negotiated lab and imaging pricing and they are about 10% of traditional cost.

In that time, I have received about 240 thank-you notes, an Edible Arrangements®, and multiple flowers. Repeatedly, people look at me and say, "Thank you so much. We need more doctors doing this."

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