While strongly endorsing direct primary care, the AAFP’s May 25, 2018 position statement to CMS on direct provider contractor models invoked the structural risk that the prevailing fee for service primary care practice model incentivizes the provision of unnecessary primary care services.

As yet, the fee for service primary care physicians who comprise the vast majority of AAFP members seem to have declined to throw a hissy fit about how their ethics and professionalism had been impugned.

Less than two months later, in an opinion piece in JAMA, Adashi et al., wrote :

[DPC models] are limited by a variety of structural flaws. Foremost, DPC practices lack specific mechanisms to counteract adverse selection that threatens equity in access to care. DPC presents physicians with an incentive structure built on accepting healthier patients with limited health care needs and a willingness to pay a retainer fee. Practices directly benefit when targeting healthier patients and declining coverage to the ill. (Emphasis supplied).

Direct Primary Care: One Step Forward, Two Steps Back
Adashi, et al. JAMA (2018) 320: 637-638

Within two weeks of online prepublication of the JAMA piece, the then-President of the Direct Primary Care Alliance, signing his piece with his official title, replied:

 I find such a perspective completely out of touch and offensive to the entire primary care community. . . . disparaging the ethics and professionalism of over 1000 [DPC] physicians. 

Ryan Neuhofel, A Response to a Clumsy Critique of DPC in JAMA

For good measure, Dr Neuhofel tossed in a direct accusation of academic dishonesty.

Doth protest too much, methinks.

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