After 16 years in corporate healthcare, physician James Tinsley came home one night and told his wife he couldn’t do it anymore.
He was exhausted from working 12-hour days for more than a year while missing Father’s Day with his daughter.
When his daughter cried and said, “Daddy, you’re never home,” Tinsley realized something had to change.
Looking for a way to practice medicine with more control over his schedule and fewer bureaucratic time sucks, Tinsley found direct primary care, a model where patients pay flat monthly fees to their primary provider instead of going through insurance.
Ranging from $90 to $200 a month depending on age, the direct primary care plan covers annual physicals, preventive care, chronic disease management, and minor illness treatment. Many clinics also offer virtual visits, basic lab tests, and procedures such as skin biopsies or joint injections, with discounts on some surgical services.
That’s often more economical for patients than traditional insurance and more manageable for doctors, as they have fewer patients and spend much less time mired in paperwork and insurance company bureaucracies.
For Tinsley, opening his own direct-pay practice in Newport News meant being able to see fewer patients, allowing him more time with his family.
With Medicaid facing steep cuts, more primary care providers like Tinsley are moving away from traditional insurance and adopting direct primary care. The approach, part of a growing national trend, has taken root in Hampton Roads, where seven clinics have opened since 2018.
The model can reduce overall healthcare costs for patients, as they avoid unnecessary referrals, pay lower cash prices for procedures, and access discounted specialty services, according to Emily O’Rourke, who launched one of the first direct primary care clinics in Hampton Roads and now has about 40 patients.
O’Rourke said physicians usually help patients find affordable care from hospital assistance programs that cover costly treatment or out-of-state surgery centers that charge far less than local hospitals.
Tinsley said he once helped an uninsured laborer get hernia surgery for $2,500 in Maryland through a physician discount site, compared with a $9,000 local hospital estimate.
A study published in the National Library of Medicine found that direct primary care practices meet more than 85% of patients’ healthcare needs, with no deductibles, coinsurance, or claims. Pairing a direct primary care membership with a high-deductible health plan can lower overall costs by almost 30%.
Brett James, one of O’Rourke’s patients who runs a helicopter charter business, has always been in the high risk category on health insurance.
His family’s insurance premiums became unaffordable under the Affordable Care Act, jumping from $900 to $3,800 a month. He now relies on O’Rourke’s clinic, describing her care as “night and day” compared with traditional practices, with more attention and less bureaucracy.
Doctors say the model also gives them greater control over their schedules while offering patients more time and personalized care.
“I schedule two hours for initial assessments, because so many patients have never told their whole story to a physician before,” O’Rourke said. “So they're able to relax in a comfortable environment and tell me their entire health history.”
Richard Boner, one of O’Rourke’s first patients, said he values the holistic approach to care in the direct primary care model.
“I’m not big on just checking a symptom and being told, ‘Here, take this pill.’ I prefer things as simply and as non pharmaceutical as possible, and Dr.O’Rourke agreed with me on that,” Boner said.
There are still exceptions. For serious conditions like cancer, O’Rourke encourages patients to carry insurance to ensure access to long-term care.
