CARING FOR THE POOR THROUGH DIRECT CARE: A Personal Perspective
One of the questions I hear most often when I speak to other doctors about transitioning to a direct care or direct pay private practice is this: “What about the patients who can’t afford you?”
It’s an important question, and I understand where it’s coming from. As physicians, we’re driven by a deep sense of compassion and responsibility to care for others, especially those who are vulnerable or underserved. But I’ve found that this concern is often based on a misconception—that direct care somehow excludes low-income patients or limits access to care. In my experience, the opposite is true.
Let me tell you why.
You Can’t Treat Everyone—But You Can Make a Difference
The first thing I had to come to terms with in my career was the reality that I can’t treat everyone.
None of us can.
There are only so many hours in a day and so much energy we can give. That doesn’t mean we don’t care—it means we have to be intentional about how we use our time and resources.
When I transitioned to direct care, I realized something profound: my ability to care for low-income or medically indigent patients wasn’t tied to the business model I used. In fact, stepping away from third-party payors gave me more freedom and flexibility to serve my community in meaningful ways. Without the administrative burdens and oversight of insurance companies, I could focus on what really mattered—my patients.
Compassion Without Bureaucracy
One of the most rewarding aspects of direct care is the simplicity of it. It’s just me and my patient. No middlemen, no red tape, no insurance company dictating what I can or can’t do. This freedom has allowed me to volunteer my services in my community in ways that feel authentic and impactful.
For example, I set aside time each month to provide free or reduced-cost care for patients who truly need it. Whether it’s through voluntering a few days with our local community clinics or directly in my own office, I’m able to use my skills and training to help people without interference. These moments remind me why I became a doctor in the first place—to make a difference in people’s lives.
And here’s the thing: this isn’t something unique to me. Any physician in direct care has the ability to do this. The model itself creates space for generosity because it eliminates so much of the inefficiency and waste that comes with traditional insurance-based practices.
Transparent Pricing Empowers Patients
Another aspect of direct care that surprised me was how empowering it is for patients—even those with limited financial means. By offering transparent pricing, I’m able to have honest conversations with my patients about their options. Together, we can come up with solutions that work for their budget, whether that’s a sliding scale fee, bundled pricing (especially for procedures), or a manageable payment plan.
This collaborative approach respects the patient’s dignity and puts them back in control of their healthcare decisions. It’s a stark contrast to the old system, where insurance companies made all the financial decisions for us—often leaving patients feeling disempowered and me feeling like my hands were tied.
It’s Not “Either/Or”— It’s “Both/And”
One of the biggest misconceptions about direct care is that it forces you to choose between running a profitable practice and serving underserved populations. That couldn’t be further from the truth.
In reality, direct care has allowed me to do both. By eliminating third-party payors, reducing overhead costs, and streamlining my operations, I’ve created a practice that’s not only financially sustainable but also gives me more time and energy to dedicate to patients who need extra help. It’s not an “either/or” situation—it’s a “both/and” opportunity.
I’ve also found that many patients who are uninsured or underinsured have the means to pay but the “system” or other circumstances have resulted in their current status; however, they actually benefit from direct care because it offers them affordable access to high-quality services without surprise bills or hidden fees. With direct care you have the ability to offer options including bundled services and payment plans as well as charity.
A Core Part of My Mission
One of the most fulfilling parts of being in direct care is having the flexibility to give back on my own terms. For me, volunteering isn’t just something I do occasionally—it’s part of my mission as a physician. Whether it’s providing free care at a local shelter or offering discounted services for families in need, these opportunities remind me why I chose medicine as my life’s work.
And here’s what I’ve learned: when you’re not bogged down by bureaucracy, you have so much more freedom to serve others. You get to decide how you give back—whether it’s through your practice, your community, or both.
A Call to My Fellow Physicians
If you’re considering transitioning to direct care but are worried about leaving behind your low-income patients, let me reassure you: this model doesn’t limit your ability to serve—it expands it. By freeing yourself from the constraints of third-party payors, you’ll gain the flexibility and autonomy needed to truly make an impact.
You can still treat underserved patients. You can still volunteer your time and expertise. You can still honor your commitment to compassionate care—all while building a practice that sustains you personally and professionally.
So let’s move past the misconceptions and embrace what’s possible. Direct care isn’t just about creating a better system for doctors—it’s about creating a better system for everyone. And together, we can ensure that no one is left behind.
In my community, there are so many underserved populations, but the two non-profit medical clinics that I volunteer to serve the patients are with Our Lady of the Angels Medical Clinic at St. Joseph’s and Health & Hope Clinic.
There are so many more out there, and whether your are in healthcare or not currently, I urge you to look in your communities to help organizations such as these either through your own volunteering of your time, skills, and/or donation.
