When Christina Mutch was a medical resident, she asked to take longer on patient visits. Her supervisors laughed. 15 minutes, they told her, was all the system allowed.
Frustrated, Christina wrote a note and taped it above her desk: “No more 15-minute visits.” She called it her act of defiance.
Years later, that same conviction shaped the clinic she and her husband, Jake, opened in Williamsburg – Defiant Direct Primary Care.
Christina, petite and warm, and Jake, tall with a steady smile, greet patients in the waiting room that feels more like a living room, with soft lighting, wooden floors, bookshelves and family art on the walls.
Patients don’t rush in and out; visits last an hour, and calls go straight through to the doctors. Instead of billing insurance, people pay a flat monthly fee – usually ranging from $90 to $200 – for primary care that covers checkups, minor illnesses and routine tests.
The Mutches are part of a growing national wave of physicians who say the traditional system — with its time limits, paperwork, and insurance red tape — makes it harder to truly know patients.
Direct primary care, they believe, offers an alternative built on trust and familiarity.
“We need more time to do our job,” Christina said. “Administrators and insurance companies shouldn't be the ones dictating how long we spend with a patient. ”
Care without the clock
Christina and Jake have been side by side since their undergrad days at William & Mary — same classes, same med school, even the same residency.
Back then, riding the bus home from Target, they’d talk about what it would take to build a better kind of primary care.
“We want to optimize for making it easy for people to actually get excellent health care and to be treated like humans,” Jake said.
At Defiant Direct Primary Care, that means keeping a small patient pool and giving each one more time and attention.
The Mutches put their patients on Emergency Bypass so calls go straight to them 24/7.
Jake said that’s the way they were trained, “the old-fashioned way,” as family physicians.“If there's something urgent that needs to be taken care of, I want to know about it,” he said.
Christina said that being on call isn’t as intimidating as it might sound, because the relationships are so close.
It only takes her a moment to understand what’s happening, she said, since she knows her patients so well. And that familiarity makes her want to help, no matter the hour.
She recalled one evening when a patient reached out, struggling to catch his breath. When emergency responders arrived, they didn’t think he needed to be hospitalized.
But Christina, who knew how he normally spoke and carried himself, urged him to push for further care.
At the hospital, tests revealed heart failure.
“So it doesn't feel like a job,” Christina said. “It feels like, no, these are people that we know and that we've seen for many years, and we want to take care of them too.”
Doug Farrago, editor of DPC News and author of three books on the model, said the practices are steadily popping up as a national trend.
“People are craving this, because this is the only chance to do what we were wanting to do, which is actually treat patients the way we want to treat them and the way they want to be treated with time and respect,” Farrago said.
However, Farrago said that direct primary care isn’t a replacement for insurance – patients still need a catastrophic plan for major emergencies.
The savings, he said, come from everyday care and labs that cost a fraction of traditional prices.
The small moments that matter
The difference at Defiant Direct Primary Care often shows up in the small moments, Christina said, like when a doctor answers the phone on a Saturday or notices something subtle before it turns into a crisis.
In the traditional system, it can take weeks to get an appointment for even a minor issue, Jake said.
By then, a common cold might have turned into something more complicated, or a cut that needed quick attention may have ended up in the emergency room with infection.
“There's many things that are acute and timely that don't need the emergency room, but if you could get in with your primary care doctor in a timely manner, they could take care of it easily and quickly, because they know you well,” Christina said.
So in the Mutches’ clinic, patients can get same-day or next-day visits. Sometimes it’s as simple as dropping off a urine sample on a lunch break and finishing the appointment virtually.
For them, the point of longer visits isn’t just to check vitals or adjust prescriptions.
It’s about understanding the rhythms of a patient’s life — the stress of a demanding job, the weight of caregiving, or the small daily habits that can either strengthen or erode health.
Jake said it often reveals the root cause of an issue that might otherwise go unnoticed.
“One of the joys that I just had this past week was taking medications off because patients were doing so well,” Jake said. “That patients love, and it’s this feeling of connection, because we’re working through a plan together.”
Partners in life, partners in practice
Their clinic is shaped by the fact that they run it as a couple.
The Mutches have been learning and training together for almost 20 years, and now they share an office.
Between patients, they swap ideas and consult on cases. Jake said it is a rhythm that makes the work feel more collaborative than isolating.
“We get to learn from each other, and I certainly learn from her all the time,” Jake said. “And it is a wonderful collegial atmosphere that I really wish every physician could have.”
At home, their kids see it as second nature: mom and dad answering calls at the dinner table, or stepping away for a quick check-in with a patient.
Founded with just the two of them 5 years ago, two more doctors joined the clinic in 2023.
Fighting a system
Still, running an independent clinic is not without challenges.
When outside practices and insurers get involved, referrals can be blocked, lab orders can get delayed and patients can run into lots of red tape.
The Mutches spend hours cutting through those obstacles, calling specialists directly from their private network or even walking into offices to get answers.
Once, when a patient’s test result was delayed by logistical difficulties, Jake said he walked into an ear, nose and throat specialist’s office in his white coat and sat down in the waiting room until someone agreed to talk.
Eventually, the manager came out, and he got the information his patient needed.
“It shouldn’t take a physician throwing their weight around the system to actually make a difference,” he said. “But it does every single day, and that’s what patients need right now, because the system is failing them.”
Instead of relying on hospital networks, the Mutches are creating their own web of connections by hosting community events like dog-walking meetups, to build relationships outside the clinic.
“We don’t work for the hospital system. We don’t work for the insurance company. We work for the patient,” Christina said.
