Direct Primary Care Practice vs. Traditional Fee-for-Service | Paul Thomas, MD (Plum Health DPC) & Harsha Moole, MD

Direct Primary Care Practice vs. Traditional Fee-for-Service. We wanted to know more about DPC practice and how it is different from fee-for-service from the perspective of an experienced DPC doctor. We were lucky enough to have a Q&A interview with Dr. Paul Thomas of Plum Health DPC. Dr. Paul Thomas is a board-certified family medicine physician practicing in Corktown Detroit. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit and Wayne County.

In this Q&A blog post interview, he will share about his practice, challenges and milestones in his journey, and tips for physicians who are planning to start their own DPC practice. Are you a physician interested in starting your own DPC practice? This blog post might be helpful for you!

Initial Thoughts on Direct Primary Care

On Background

1. Please tell us a bit about your personal story, growing up, and medical training.

  • I started volunteering in Detroit for homeless and uninsured folks in 2017. I really love taking care of people, but the further and further I got into my training, the less and less time I spend with my patients. Until I get to the end of my residency, I’m spending 10 or 15 minute per patient, and spending a lot more time charting, writing things in the medical record. I thought this was really unsustainable, I felt burned out–I didn’t want to do that anymore.
  • So I wrote a business plan in the last year of my residency, and I launched my practice, Plum Health DPC. And 4 years later, I’ve been doing really well with the practice–we’ve grown, we’ve hired 2 more doctors and we had a second location.

2. What made you develop interest in Direct Primary Care? Motivating factors? Did you pursue any formal education/training that focuses on Direct Primary Care? If so, what was it?

  • I developed an interest in Direct Primary Care because I felt like it was the only way out of a dysfunctional, industrial complex. I didn’t have any formal training in this, I wrote a business plan, I worked with a friend who started a suit company, of all things to write a business plan.
  • I went on a road trip, visited a few mentors across the country who helped me formulate my plans and refine my business plan and make it so that I could develop a thriving practice here in Detroit, Michigan.


Direct Primary Care Specifics

About Plum Health | A Direct Primary Care Platform

3. What is Plum Health? As a platform that specializes in Direct Primary Care practice, what is its unique value proposition? Tell us the story behind its creation. 

  • In Plum Health, we believe that healthcare should be affordable and accessible for everyone, so we really do our best to lower the cost in Detroit and beyond. We contract with a local imaging vendor, a medication wholesale supplier, etc. to lower the costs of all those things.
  • So if you come in for a lab draw, you might get a TSH for $6, that’s what it costs here. But if you go to a hospital, it might cost you $125. So we really try to reduce the cost of healthcare for people.
  • Our unique value proposition is that we have time for our patients. Because our patients pay a monthly membership to be a part of our practice, we have this nice recurring revenue from our patients. We then get to spend more time with them as an individual–we have 1-hour appointments, and we can really listen to them and take care of them and all their concerns.

4. Generally, how do you help educate physicians in the US who are interested in starting their own Direct Primary Care practice? Do you provide any services, courses, coaching, etc?

  • I’m so glad you asked this. I’ve written 2 books about this. The first is called Direct Primary Care–it focuses on how Direct Primary Care serves people in the greater healthcare ecosystem, how you can lower the cost of healthcare for everyone (medications, labs, imaging, etc.) We also discuss how we’ve done this in an equitable and sustainable way in our hometown of Detroit, Michigan.
  • For the book How to Start Your Direct Primary Care Practice, we’ve had so much success here in Detroit. Because I’ve been a speaker at the American Academy of Family Physicians Direct Primary Care Conference and the Nuts and Bolts Conference in Florida, I’ve had a lot of people reach out to me and asked how we were successful, how we did this. To answer that, I wrote a book–it’s called Start Up DPC, how to start and grow your Direct Primary Care practice. I wrote in step-by-step how to start your Direct Primary Care practice. I’ve got a ton of great feedback on this book! We’ve had a lot of people reach out and say how impactful the book has been for them, and we’ve helped other doctors launch their own practices.
  • I’ve been doing consulting throughout this, so people pay me some money each hour that I consult with them, and I’ve also taken everything I’ve learned and put it into some courses on my website I really walk doctors step-by-step through how to start and grow their practices, and I go beyond just the words, I show you how to do it physically. I show you how to do it online and how to leverage your Facebook page and other social media channels to grow your business etc.

Personal Experiences as a Direct Primary Care Physician

Challenges and Milestones

5. What are some of the mistakes you made when you were still starting out with your Direct Primary Care practice? If you had to redo the whole journey, what would you do differently?

  • The biggest mistake was I was thinking too small, I should have hired a medical assistant sooner. I thought I could do everything by myself, and I could–I could draw blood, count all the lab samples and the meds, I can answer all the phone calls, and I did that for about 450 patients, and I hired a medical assistant. And as soon as I did that, it freed up so much of my time to market the practice and help me grow my business.
  • So if I had to redo the whole journey, I would have hired someone sooner. As a business owner you want to control everything, but sometimes you have to delegate and relinquish that control so you can focus on your strengths to help you grow your business.

6. Share a few very milestones you achieved in your Direct Primary Care journey.

  • One of those big milestones was hiring a medical assistant, another doctor to help me lower the cost of healthcare in Detroit. I’m very happy to share it with my partner who is Dr. Raquel Orlich.
  • Another milestone for me is getting to 500 patients, and 200 patients for Dr. Raquel, and now she’s over 250 patients. These are the milestones that we celebrate because we’re actively learning the cost for healthcare in our community, we’re helping patients, we’re liberating doctors from the dysfunctional fee-for-service medical industrial complex system.

7. How do you see Direct Primary Care evolving over the next 5-10 years? How does the political climate and ever so polar political opinions affect the evolution of DPC? 

  • I only see Direct Primary Care growing over time because people hate having to deal with their insurance for their basic healthcare needs. It puts up so many barriers between people and our doctors. Direct Primary Care doctors are problem solvers. We go above and beyond to solve problems for our patients and make our healthcare journey easier. So when you have doctors actively working on behalf of patients, it’s only going to grow because patients see value in that kind of work that doctors provide.
  • As for the political climate, or let’s say medicare for all passes, which does not apply for Donald Trump, or presidential candidate Joe Biden at this time, neither of these political parties want to see medicare for all at this point. But let’s say even if it does pass 20 years from now, the United States government will not be able to outlaw elective procedures. Americans will always be able to opt for paying above and beyond for health insurance, etc.
  • In a nutshell, I don’t foresee paying above and beyond your health insurance for better healthcare experiences through Direct Primary Care or concierge medicine. I don’t ever see that being outlawed in the US.


Unlocking the Difference of Direct Primary Care and Traditional Practice

Direct Primary Care vs. Traditional Fee-for-Service

*This section is for patients and doctors that are not yet aware of DPC

8. In a nutshell, what do you think is the major difference of Direct Primary Care practice vs. Traditional fee-for service? 

  • The number of patients. Fee-for-service doctors have 2,500 patients a year, and they have to see 1% of their panel each day. So they have to see at least 25 patient visits a day. In our model, we only need 500 patients to have a robust, thriving practice. We make about the same amount of money as a fee-for-service doctor.
  • That being said, I have 5 times fewer patients and 5 times more time for each of those patients. It makes a huge difference.

9. Why should a patient consider enrolling in a Direct Primary Care practice over the traditional fee-for-service?

  • You are going to have 5 times more time with your doctor, you’re going to have your doctor’s mobile number and email address, you’re going to be able to reach out to them whenever you need them and not the other way around.
  • We’re not fitting you into our schedule, we’re making time for you anytime you need us.

10. If you are explaining about Direct Primary Care to a layman who doesn’t have a medical background, what would be your 2-minute explanation to make him/her understand Direct Primary Care practice?

  • We really believe that healthcare should be affordable and accessible for everyone. You should sign up for Direct Primary Care practice if you want to have your doctor’s mobile number and text them anytime you need them. Basically if you want to have a better healthcare experience.
  • My patients have my undivided attention for 20-30 minutes to an hour if they need it. I help them with their medications, etc. We take care of everything. If you want that kind of service for yourself and for your family, we’re happy to help you. We do that to all our patients, we deliver high quality, high value services.



11. Favorite book that talks about Direct Primary Care; and favorite book in general about any topic

  • My favorites are the 2 books that I’ve written. Startup DPC and Direct Primary Care: The Cure for Our Broken Healthcare System are available on Amazon. Pick those up, you’ll really understand my ethos, and the ethos of the Direct Primary Care movement. People have a lot of great things to say about them.
  • My favorite book in general about business is Crush It by Gary Vander Truck. If you want to know how to market your business, your Direct Primary Care practice, you can learn a lot from reading Gary V.

12. As someone who is an advocate of Direct Primary Care practice, what are your favorite resources for Direct Primary Care?

  • I would say my website I really took the time to compile all the resources in the ecosystem and give it to you in a palpable, easy-to-understand, easy-to-digest format.

13. Favorite bloggers that have the same passion as you when it comes to Direct Primary Care

  • I blog a lot about this subject, I haven’t seen anyone “out blog” me, so check out our blog at See for yourself.

14. Favorite quote

  • “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better.” –Theodore Roosevelt


Tips for Physicians Who Are Planning to Start Their Own Direct Primary Care Practice

Lessons About Direct Primary Care

15. Many physicians find it challenging to start their own Direct Primary Care practice. As someone who’s been in the Direct Primary Care business for quite some time now, what do you think physicians should first do when they are starting out? Any tips and/or strategies you highly recommend?

  • I really recommend you read my books because I put them all in there.
  • My biggest tip is that doctors think that when they start their Direct Primary Care practice, it’s for everyone. You ask them who’s your ideal customer and they say “everybody”. But it’s not true. You really have to hammer down and hone in on who your ideal customer is. If you don’t, you’re going to try to serve everyone, and your business is going to fail.


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