During Dr. Amy Watson’s pediatric residency in the Bronx, she spent an average of seven minutes with each of her patients.
Though she often wanted to spend time getting to know the children and parents in her care, by the time she finished an examination, the clock was ticking to move onto the next exam room. She said she rarely had time to answer their questions, never mind develop a relationship with them.
“I knew I wasn't able to provide the best care for them because I was so limited in my time and my energy,” she said.
With her husband, Justin Chase, she set out to find a way of practicing medicine
The married duo opened an unconventional kind of doctor’s office in Concord, one that harkens back to the days of old-fashioned family doctors.
Breakthrough Pediatrics, which opened in November, does not accept insurance. Instead, they ask patients to pay a monthly fee (either $150 or $200 depending on the age of the child) that covers office visits and gives members access to discounted medical services.
This fee, the couple argues, allows the practice to accept fewer patients and spend more time on each child. The doctor’s office promises no wait times, hour-long appointments, home-visits and direct access to the doctor via text, email and video.
“I think when they have short visits for their kids, a lot of questions go unanswered because there just isn't time to even ask them,” Watson said. “So there are a lot of like fears and worries that I think kind of go by the wayside.”
The direct primary care model has gained popularity in New Hampshire as an alternative to fee-for-service insurance billing. The state only recently allowed direct care organizations to practice outside of state insurance laws after Gov. Chris Sununu signed HB 508 in 2019.
Several similar practices have cropped up in the last several years, including Active Choice Healthcare in Concord, Maple Family Medicine in Hooksett, Hearthside Family Health in Peterborough, and Monarca Health in Keene.
Though these fees are not a replacement for premiums — insurance is needed in case of an emergency — advocates say the arrangements typically work out to save the patient money in the long run.
Labwork that might cost patients hundreds of dollars in an insurance-based practice costs direct care patients tens of dollars, thanks to deals with suppliers via a group purchasing organization.
Critics of this model of care argue that a monthly payment model gives providers an incentive to limit care, as the practice assumes all of the financial risk for services included under each patient’s retainer.
Chase, who manages the business side of Breakthrough Pediatrics, said their office is centered around making sure patients are satisfied with their care.
“We're following up after the first month asking, ‘is there anything else that you need?’” he said. “We would rather have 200 patients that are using their care and love it then have 400 patients who are not using it and don't really care whether they have it or not.”
This patient-centric care is not just important for the health of the patients but for the health of community, Watson said.
Though the practice has just four clients so far, she said she’s already had several conversations with parents who are hesitant to give their child the COVID-19 vaccine. Her strategy for addressing these concerns involves hours of listening and many gentle conversations, something she could not imagine having time for in a more traditional medical office.
If a patient points to a study that raises concerns about the vaccine’s safety or efficacy, Chase uses his background in statistics to comb through the study’s methodologies.
“Instead of just saying ‘I disagree with that,’ like a lot of doctors do because they don't have time to actually go in and look, I'll go through and look at the study,” he said.
Watson said parents often decide to have their children vaccinated after those discussions.
“Vaccine hesitancy is a huge thing in general, never mind if you feel like your doctor doesn't listen to you,” she said.“They want to help people as much as I do, but they don't have the time. And it's not fair to them. It's not fair to patients.”