It’s kind of like Uber or Airbnb for health care, Dr. Steve Baker likes to say.
The outside-the-box thinking that’s changed the way people hail rides, book rooms and watch television works similarly to the way Main Street Family Medicine in Vancouver will provide health care. As the slogan of Baker’s practice goes, it’s “Modern medicine, the old-fashioned way.”
Similar to a gym membership, Main Street Family Medicine in Vancouver provides primary care to its patients for a flat monthly out-of-pocket fee.
The cost is $70 a month for ages 19 through 44; $85 a month for ages 45 through 64; $15 a month for ages newborn to 18 years with an enrolled parent; $30 a month for ages newborn through 18 without an enrolled parent; and $30 a month for ages 19 through 24 with an enrolled parent. The idea is called direct primary care and it’s growing, with more than 620 practices in the U.S., according to the Direct Primary Care Coalition.
“We saw a big need in the community,” Baker, 57, said of his practice, which opened in late July. “There’s a group of people who make too much money to get government programs, but they don’t make enough money to afford to pay out of pocket for health insurance. They want to pay their own way. They’re not looking for a handout. But they’re just kind of stuck in the middle.”
Baker has been practicing medicine in Vancouver for 23 years, and for the past 17 he’s taught doctors as part of a family medical residency program through the University of Washington and PeaceHealth.
Right now Baker has about 40 patients, and only works the practice part time with three nurses, who together make up full-time coverage. His goal is to have 350 patients, and possibly in time add another part-time doctor so the practice can see around 700 patients. But keeping the patient base small is important for Main Street Family Medicine. Each first visit is always an hour long.
“If you grow too big, it kills the reason you’re doing it,” Baker said. “There’s virtually no wait. We call it our reception area instead of our waiting room, because I don’t know if we’ve ever had anyone sitting there waiting.”
Included in the membership are checkups, urgent care (same day or next business day), discounted medications and lab testing, as well as splinting, certain forms of injections, urinalysis, EKG testing, stitches, glucose testing and more.
Baker said he can help find patients find reduced pricing for outside services because, as a doctor, he can reach “deeper into the rabbit hole,” and also leverage options, and even look out of state for help.
Baker said they have one patient who is on a blood thinner for a heart condition. The patient has to take a test once or twice a month to make sure his blood is thin enough, and his medication has to be adjusted for that. Before he joined Main Street Family Medicine, he paid $108 each time with cash. He now gets the same test for $2 to $3.
“He feels dignity because he’s paying his own way,” Baker said.
Baker still recommends that people have insurance for the uncommon, big-ticket items, but notes that a primary physician can probably cover about 80 percent of the ailments someone will encounter.
Baker also commonly helps patients solves issues through texting, emailing or Skyping. Baker even helped a family who was visiting Florida avoid urgent care by diagnosing what over-the-counter medicine they needed through a Skype call. Baker said he’s not overburdened by the setup, and noted patients don’t take advantage of the system.
“We have this idea that people always want to run to the doctor, like if I do something like this, we’ll be flooded by needy people, but the truth is most people … don’t want to miss work, or drag their kid out of school and come to the doctor,” Baker said.
Another way Main Street Family Medicine is old-school is that Baker is open to house visits if needed. He recently hopped in his 2008 dark blue Hyundai Accent with nurse Sue Hartley, and traveled 15 minutes with an otoscope, stethoscope plus scales and weights for measurements to help conduct checkups for a family that was going to come in for a visit. But since one of the three kids had broken his leg days earlier, Baker decided it would be easier to visit them.
“It was fun sitting in their living room,” Baker said. “You get to know people better in their home.”
