Subscription health: A different approach to primary care

By on March 6, 2019

Phillip Austin, M.D.

By Matthew Haskett

Now more than ever, individuals and families are trying to decode the arcane American health care system. For the last several years, a health-care mandate compelled thousands to buy insurance, and these legions of new consumers became increasingly curious about what exactly they were purchasing.

Dr. Phil Austin thinks that these recent developments have led many Americans to conflate their insurance with health care and view the doctor-patient relationship as a transactional one.

To him, this is a huge problem, and he has taken steps to join a growing number of doctors leading a revolt against the health-care business model.

After five years as a primary physician at Surf Pediatrics in Kill Devil Hills, he has ventured off on his own to start Dare Direct Primary Care, where he hopes to advance his vision of health care on the Outer Banks.

This vision is one where the health care, insurance and pharmaceutical industries do less to obstruct the doctor-patient relationship.

“Doctors want to practice medicine how they imagined it while they were in medical school and not as a component in an industry,” he said.

The direct primary care model offers an alternative for doctors to follow and a large community of professionals that support each other as they plan their exit from what is likely the only health-care system they’ve ever known.

The American health-care experience varies widely by age, income, and level of health, but for most of us, it is defined by our relationship with our insurance provider. Many Americans go to their doctors only if their insurance covers the visit rather than considering what type of patient-doctor relationship would lead to the best health outcomes.

Direct primary care is a membership-based health-care model where patients pay periodic fees to their primary care provider for access to the health care services they provide.

Those paying for Austin’s Dare Direct Primary Care will have access to same- or next-day appointments, chronic disease management, physicals, lab work and the many other services that are listed his website. The monthly costs range from $30 to $65 per person with discounts available to families with children.

But it isn’t just specific services Austin hopes to provide.

“The current health care system is impersonal, and insurance policies promote a fee for service expectation that is flawed and inadequate in promoting effective primary care,” he said.

To provide effective primary care, Austin and others promoting the Direct Primary Care model believe that doctors cannot be constrained by insurance policies that require them to justify how their time is spent with a patient and itemize the services.

Austin is hoping to send a message to our community: “good insurance doesn’t equal good health care.”

In the years since the passage of the Affordable Care Act, over 90 percent of Americans are insured, but no matter how good the insurance is, it is not a replacement for health care itself.

Consumers might leverage their insurance plans to great benefit, but when an insurance plan is defining your health care habits, it can be an obstacle to health. Advocates of the direct primary care model believe that greater health outcomes come from more doctor availability and increased opportunities to promote wellness, discuss preventive care and an uninhibited opportunity to handle multiple issues in one doctor visit.

Under the Direct Primary Care model, doctors have far more freedom to allocate their time in a way that is most beneficial to their patients. Austin hopes to use his skills and experience to help the whole patient and prescribe interventions that will address the causes of disease and poor health rather than focus on treating the symptom or passing the patient off to a specialist.

This approach takes time and careful research that insurance companies don’t cover. Patients are also encouraged to take a proactive role in their health since it does no mean additional costs and fees.

Advocates of the Direct Primary Care model feel that it provides superior primary health care to patients, but they often point out that it isn’t a replacement for insurance coverage.

Health insurance provides an important service for people during health emergencies and those with a chronic illness that requires regular treatment or the care of a specialist. So while insurance will not cover your Dare Direct Primary Care payments, Austin still recommends that his patients have some form of insurance coverage.

There is one specific service that Dare Direct Primary Care is unable to provide: vaccines. Austin emphasized that he supports and recommends vaccinations, but the cost to personally provide immunizations is prohibitive when working outside the insurance model.

In just a short time, Austin has gathered nearly 300 patients eager to try an alternative to their past primary care experiences. He believes his office can handle nearly 600 patients with a total staff of two — excluding himself.

But for now, his office is operating with a staff of one: his wife Kelley. In the coming months, he will likely recruit an assistant to help with the front desk, blood work, and other tasks.

The office is located at 2522 S. Croatan Highway Suite 1B, Nags Head, NC. The website is

For more information on Direct Primary Care:

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