The unique similarity between FFS (fee for service), and independent DPC (direct primary care, direct care) is that the physician, seller of services, sets the rate based on overhead and market factors and competition. Whether we are talking about an incident-based service like FFS, or a monthly membership service like DPC, the seller must be responsible and responsive to the market and individual patient needs and wants. Solo or small practices can make changes and, “turn on a dime,” unlike large corporate practices are those controlled by middlemen or government.

This phenomenon of individual, unique physician and patient, coupled with first-degree transaction of service for payment at time of care, keeps the patient physician relationship private, se- cure and sacrosanct. Both parties are invested in each other without middleman or government intrusion, which history has shown, always breaks down the healing patient physician relationship.

Both FFS and DPC are subject to piracy by middlemen and the government. Any change in funding source, rules of engagement, or law, can have drastic and destructive effects on the patient physician relationship. This is why organizations like AAFP, ACOFP, AMA and AOA must advocate for physician independence to maintain a unique first party transaction relationship with the patient. This is true of FFS and DPC.

Although FFS is incident based payment at time of service, and DPC is a monthly membership-based model, they both benefit from first-degree transactions. FFS allows personally organized and coordinated individual patients to conserve resources and select the care they need, when they need it. DPC, a membership-based model, allows for peace of mind and potentially greater value if the individual patient would prefer more physician coordination. Choice of FFS or DPC should be up to each individual, unique patient with their own needs and value system.

When seller and buyer are coupled by volitional first-degree transactions, everyone wins and no one has to lose. It is indeed the best case scenario. Physicians have the best opportunity for success, job satisfaction, and personal fulfillment. Patients have the best opportunity to prioritize and allocate the resources based on their own value systems, and have the best opportunity to be healthy.