Slow Medicine: A Look At Direct Primary Care In Eugene

Oct 11, 2017

This is the time of year many of us are looking at health insurance coverage and making decisions. There is a non-traditional medical model being embraced by healthcare policymakers on both the left and the right. One doctor in Eugene offers direct-to-patient care for a flat monthly fee.

Dr. Priya Carden used to be a hospitalist at the Willamette Valley’s largest medical provider, PeaceHealth RiverBend. There was a point when she was seeing 20 patients a day. The workload, she says, was sometimes unbearable.

Carden: “I felt like my work could falter. And I knew I would not be able to live with a conscience if I had made a mistake because my workload was so high. Or if I would lose my career—lose my license.”

Sick and tired of what she calls the “big box model of medicine,” in 2011, Carden quit. Soon after she attended a workshop on “building your dream clinic.” That’s when she decided to take the path less traveled: Direct Primary Care.

Dr. Priya Carden in an exam room at her Direct Primary Care clinic in Eugene.
Credit Tiffany Eckert

Carden: “It basically means what it says—it’s very direct. So there’s no bubble wrap around the physician. I get to talk directly with my patients. There’s no phone tree, there’s no triage, there’s no nursing. If they call to talk to the doctor they talk to me.”

And, her clinic does not bill insurance.

Carden: “So I’ve removed myself from third party players in health care. My patients pay me directly. They pay a monthly fee. It’s $75 a month. So, about the cost of a cell phone bill.”

For patients who can’t afford the $75 monthly cash fee, Carden maintains a “Robin Hood Fund.” Patients who want to pay a little more for their care do—and those who need to can pay less can.

For the fixed price, patients can contact or see the doctor as much as they need. And they don’t have to worry about meeting deductibles or hidden costs built-in to office visits to cover the expense of billing insurance in the first place.

Carden: “I don’t have to bill insurance and then rebill them when the insurance claim is denied. I don’t have to have a biller or a coder. I can just practice medicine. And that’s beautiful. That’s why physicians have gone into the field of medicine to actually be able to practice.”

Dr. Priya opens the door to her patients.
Credit Tiffany Eckert

Carden says most primary care physicians have between 2,000 and 3,000 patients to their name. Over the past two years, Carden has grown her practice to over 200 patients. Those manageable numbers leave her more time for the people she treats—office visits are 30 minutes to an hour- and she has more time for her family—she and her husband have three kids.

Carden: “My daughter fills a little bag with little doctor supplies that she plays doctor with. It’s what I imagined my children to grow up with and I’m proud. This is mama’s clinic.”

As a primary care doctor, Carden treats her patients for a wide range of conditions and ailments. Basically anything one would visit an Urgent Care for, but with added benefit of knowing the doctor and her knowing you.

(open the door ambi) “Hi, how are you?”

“Good, how are you doing?  

Carden’s clinic is nestled in a quiet neighborhood in downtown Eugene. She actually opens the door to patients. (door closes)

Patient: “Thank you for getting me in so quickly.”

Dr. Priya Carden with patient, Carl Farlsgraf. He's a self described "evangelist" for the Direct Primary Care the model of medicine.
Credit Tiffany Eckert

Doctor: “Sure, come on back.”

Carl Farlsgraf is fed up with what he calls “corporate medicine.”

Farlsgraf: “The traditional medical model is kinda whack a mole. ‘Oh, you’ve got arthritis. Ok, here’s a pill for that. Oh you’ve got a gall bladder problem, we’ll operate on that. Here’s this here’s that.’”

Farlsgraf and his wife became Direct Primary Care patients a year ago. He’s 59 and she is in her early 60’s.

Farlsgraf: “You know we’re getting at a stage of life where more stuff is gonna go wrong, I mean it just is, that’s what’s going to happen. And I was really intrigued when we met with Dr. Priya and she said, ‘My job is to help you live as healthy a life as you can and die at home.” 

The Farlsgrafs do carry health insurance.

Farlsgraf: “But it really stinks. I think this year it’s a $7,500 deductible.”

Farlsgraf believes this non-traditional medical model harkens back to a different time.

Farlsgraf: “This is the way it used to be. You used to know your doctor. Your doctor used to be someone in the community. You’d see them around town and you had a relationship with them outside the office. And it feels like that and she even makes house calls sometimes.”

That’s what he said. She makes house calls.

Carden’s “dream clinic” doesn’t work for everyone. This doc realizes there is a population of patients who can’t afford to pay anything. And she doesn’t bill Medicaid. That’s why she works 4 hours a week at White Bird’s free clinic.

While she can’t see her practice going any other way, there are risks for Carden switching to this flat-fee model. She’s on her own--literally.

Stana Knez (center) and her husband Shevach Lambert are satisfied patients of Dr. Priya Carden. They say the doctor cares for their bodies, minds and spirits.
Credit Tiffany Eckert

Still, this model seems to be picking up steam. Since Carden started her practice, two other “pure” Direct Primary Care clinics opened in the Eugene/Springfield area. And while less than 2% of the nation’s 900,000 licensed physicians use this model, the current healthcare climate is expected to lead to greater demand for this kind of doctor-patient relationship.