New medical practice in Chicago: “direct primary care” medicine

November 10, 2015 • 10:00 am

Although this post may look like an ad, I’m actually putting it up as a public service, at least for those who live in or around Chicago. For some time now, I’ve had as my primary care physician Dr. Alex Lickerman at the University of Chicago, a doctor of enormous skill and empathy. Although I’m a healthy person, like all of us I’ve seen a number of doctors in my life, but have no hesitation in pronouncing Alex not only the best doctor I’ve ever encountered, but also the Official Website Physician™. He’s not only up on all the recent medical advances, but also a secular Buddhist who uses in his practice what he learned over years of study and meditation. And that isn’t woo but compassion: Alex spends a lot of time talking to patients—much more time than simply examining them, for he feels that proper treatment requires that he learn about their lifestyles, previous and ongoing medical treatment and medications, their concerns, other symptoms, and so on. In most appointments there’s simply no time to do this. 

I’ve sent a lot of friends to Alex, and to a person they’ve pronounced him superb. His skills got him promoted (at a young age) to Director of Primary Care at the University of Chicago Hospitals, but then, after 8 years, he took to bureaucracy, becoming in 2011 head of Student Health and Counseling at the University while still practicing one day a week. 

Alex tells me that, after taking his recertification boards, he realized that he was still deeply in love with medicine, and decided to return to primary care practice. But at the University, like most places, he realized that he simply wasn’t given time to treat patients as he wanted, for to make a profit most medical practices and hospitals must turn patients over quickly. As he describes in a white paper on how to save primary care in America, Alex notes that the average length of a primary-care appointment in the U.S. is only 15.7 minutes. That pathetically short time leads primary care doctors to shunt patients off to specialists, or to order unnecessary tests or hospitalization—and that wastes a lot of money and time, both on the patients’ and medical system’s part.

And so Alex decided to strike out on his own, founding a “direct primary care” practice, ImagineMD, that will begin on January 1, 2016.  If you’re familiar with the concept of direct primary care medicine (so called because there’s no third-party insurance), you pay out of your own pocket for access to a doctor (in this case $135/month), an amount not reimbursable by insurance. But then all tests and referrals ordered by the primary-care physician (there will be two doctors besides Alex) do fall under your normal medical insurance. What you’re paying for here—and I was the first patient to sign up—is 24/7 access to a doctor (you get their cellphone numbers to call), appointments within a day or two, and appointments that scheduled to be 1.5 hours long: six times longer than average. And you get the kind of medical care that everyone should have in an ideal world.

Alex will be limited to 350 patients: less than a quarter of the normal load (patient loads for a primary-care physician in the U.S. are between 1500 and 4000 people per doctor!). The other two physicians will each be capped at 600 patients. And while you have to pay out of your own pocket, this kind of care may also save you substantial money (co-pays and so on) for unnecessary tests, referrals, and hospitalizations often ordered by overworked and time-limited doctors.

Alex didn’t ask me to write this post: I’m doing it to give readers the chance to participate in a recently developed form of medical care and see if it’s right for them. (If it isn’t, you can stop going and paying, with no questions asked). You can sign up at the ImagineMD site, where you can read about the services, fees, see the FAQ, and read Alex’s white paper (link above). If you have questions, there’s a “Contact us” page. If you are interested but want to talk to the doctor with questions or concerns, Alex will be glad to call you if you put your phone number on the “contact us” site.

The practice will be in Chicago’s West Loop, at 10 S. Riverside Plaza Drive.

I’m not known to waste money, so believe me, it’s a high recommendation when I’m willing to pay for this kind of medicine. But having interacted with Alex over the years, I can’t imagine having any other primary care doctor, and I’m letting readers know about this before the patient panel fills up. While I’m an advocate of socialized or government-sponsored medicine (and have recently enrolled, as required. in Medicare), this isn’t what we have in the U.S., with many doctors and hospitals simply refusing to take Medicare patients because government reimbursements are low. And you all know about waiting times for appointments, a serious problem in many countries with socialized medicine.

So, if you live in or around Chicago, want a really good doctor and first-rate medical care, and can afford the $135/month for ImagineMD, I give the practice my highest recommendation. I wanted to be “Patient Zero,” but Alex told me that phrase has unsavory connotations, so I’m now Patient One.

15 thoughts on “New medical practice in Chicago: “direct primary care” medicine

  1. I wish him the absolute best of luck for success — and for entirely selfish reasons. If he’s successful, he’ll inspire others to do the same and they’ll outcompete the current standards.

    In the mean time…Chicago is a bit of a ways away for a doctor’s visit. Does Alex have any thoughts of franchising, or are there others already doing this elsewhere?


  2. Interesting. A few thoughts spring to mind:

    1. 90 minutes?!? I don’t think I’d want or need that. Maybe if it were in my area I could ask for the 45 minute plan for $67.50/month.

    2. On the other hand, I probably already spend about an hour every time I visit the doctors office. The difference is I spend it waiting or with an assistant, rather than with the doctor.

    3. Even though this is not formally covered under health insurance, I bet you could use a Health Savings Account or Flex Savings Account to cover it, because those have nothing whatsoever to do with the service-provider submitting anything to the insurance company. So while your insurance wouldn’t co-pay, you could probably at least get this paid for out of pre-tax income.

  3. I wanted to be “Patient Zero,” but Alex told me that phrase has unsavory connotations, so I’m now Patient One.

    Damn right there’s unsavory connotations there [link to PDF of original article]. My co-author colleague Bill Darrow can tell you all about that. But I think I already did, when you were out here. 😉 (here’s the relevant pages from Randy Shilts’s excellent book, as well).

    Excellent post, too. There really are not enough of these great docs out there anymore.

    1. There are even doctors doing it in New Zealand, though it’s rare. The main attraction seems to be the 24/7 access. Normally patients go to an emergency medical centre (staffed by GPs on a rotating basis) in cities, or to public hospitals in small towns.

  4. Good doctors deserve good recommendations.

    And to stay good in light of the majority of patients tending to be hypochondriacs who are unable to motivate themselves to live healthier. I do have enormous respect for doctors who stay good for so long. Well done.

  5. He sounds fantastic. I only wish I lived in Chicago so I could take sign up. I also have a really good doctor here in the UK. However, because he’s so good it’s very difficult to see him and the appointment times are nowhere near 90 minutes – more like 10. One of the pitfalls of a socialised health care system. But all things considered the NHS is an amazing institution. I find it appalling that in the US becoming ill can lead to huge debt or even bankruptcy. Worse than that people live with nasty chronic conditions or simply die because they can’t afford treatment. That’s totally unacceptable in a civilised society.

  6. I agree that this is the level of medical care that everyone should have, and it especially made me think of the patient population (all of whom have a particular genetic disorder) I interacted with in my research study earlier this year. I’m not a physician, but I did the informed consent, and I got the impression that most of these individuals just wanted someone to listen to them. So I did that to the extent allowed by the demands on my physician collaborator (who could often see several other patients in the clinic while I was doing the informed consent). I don’t have a chronic condition myself (yet), and personally, the idea of a 90-min. appointment with a primary care physician freaks me right out. I’m OK with 10-15 minutes.

    Realistically, if you want that level of care and time for everybody in the US, there needs to be much more of a financial investment in the students, faculty, staff, and infrastructure at medical schools across the country. At my university, and many others, basic science and clinical teaching faculty are retiring or leaving and are not being replaced. In general, teaching faculty are paid much less than research and clinical faculty in any given department, so attracting new blood to the education professional track can be difficult, even if there are funds available to replace those who’ve left.

  7. I’m concerned about this model, and I think there are parts of it we need to bring into the whole system– the increased time with patients is important. I’m a pediatrician and it really helps to not be in a rush.

    At the same time, the US has a shortage of primary care docs. If I reduce the number of patients I’m willing to commit to, either another doc has to absorb them (meaning that doc is even more overbooked) or those patients have no doc at all. I am employed (salary) with a med school clinic, and I try to walk that fine line where I know I can do a good job with the patients I’ve committed to be here for, at the same time as accepting as many as I reasonably can– because I don’t want any children in my community to go without care.

    Many people don’t realize that all of our residencies were funded with public money from Medicare. If you include what taxpayers contribute to our entire education from primary school through med school, docs pay only a tiny fraction of the total cost it takes the US to produce a licensed doc. So I feel we have an obligation to use our publicly funded training to provide a decent amount of service in return.

    If very many docs in a community slash their patient panels down this low, there is no way in heck we can possibly have a primary care doc for every person.

    There are things we could do to relieve the over-loading of practices. I’m for universal healthcare, at least single payer and really would prefer a salaried NHS type system. But we need to get Congress to authorize a substantial increase in primary care residencies, cut some of the specialties that are overpaid and oversupplied, expect more out of PCPs so far as actually doing more of their own workups instead of referring everything out, and increase use of mid-level providers at appropriate levels of care.

    I don’t blame you for being glad you found this level of service. I’m just worried that if it increases, more and more folks will be left with only the ER.

    1. Since I have absolutely no need of this level of medical care (so far at least) this would be overkill and a waste of money. My friend in Lisle has a “concierge doctor” and tries to sell me on it. But she’s 15 years older, grossly overweight and has had a heart attack in the past, is in statins, etc. She also has her own business and her schedule is hectic. So having access to her cardiologist and internist 24/7 makes sense.

      And calculating 350*135*12 means that his practice will gross $567,000/year. Considering that he’s going to be on constant call, and that this model will attract mostly those like my friend with chronic health issues, he will definitely earn it.

      I’m in agreement with Pippa — single payer and salaried docs.

  8. As a healthy, active person who doesn’t currently take any prescription medications and who isn’t overweight, I can’t imagine what would go on for a 90-minute PCP appointment. Even 45 minutes would be pushing it for me, and that should cover a neurological and pelvic exam (I think a full physical exam with my PCP, who is quite good IMO, takes ~ 30 minutes). If you need lab work, stress tests, imaging, etc. of course it will take longer, but you’re not with your PCP during that time. I was talking with a colleague yesterday who would love to have a concierge doctor, but xe is older than I am, has some genuine health issues, and is also a hypochondriac. I also suspect that xe, like one of my family members, is a “difficult” patient who has strong opinions about which tests, procedures, and medications xe wants (and often demands).

  9. Just wondering – if anyone knows a bit about how health care things actually work in western Europe and Canada; there are considerable differing opinions. My limited understanding is that Canada and UK have “single-payer” (i.e. government systems), but Netherlands and France have private insurance systems; others, I don’t know about, but they all are often regarded as a LOT better than ours.

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