Rhode Island's Attorney General Just Called Doctors 'Air Traffic Controllers.' DPC Should Pay Attention.

Analysis by DPC Insider
#Rhode Island#concierge medicine#membership medicine#equity#primary care access#doctor shortage#DPC policy
Sources: RI leaders concerned with primary care fees amid doctor shortage · RI leaders concerned with primary care fees amid doctor shortage (Yahoo) · Letter: Health care can't only be for the wealthy

Rhode Island’s attorney general thinks of doctors as air traffic controllers. “They are the air traffic controllers of our health,” Peter Neronha told WPRI this week, while raising concerns about physicians leaving traditional practice for membership-based models.

He’s not wrong about the metaphor. But the alarm he’s sounding might be aimed at the wrong target.

What’s Happening in Rhode Island

Rhode Island is watching its primary care workforce thin out. About 6% of the state’s practices have already transitioned to membership medicine, according to the state Department of Health. That might sound small, but in a state already dealing with physician shortages, every doctor who leaves the traditional system is felt.

AG Neronha and House Speaker Joseph Shekarchi both went public this week with concerns. Shekarchi questioned whether patients would “be shut out or limited” as more doctors move to membership models. He cited monthly costs of “$300 or $500 a month” as a barrier for average Rhode Islanders.

The state is responding on multiple fronts. Leaders pointed to reimbursement improvements and a planned public medical school at the University of Rhode Island as longer-term solutions to the access problem.

Meanwhile, in Maine, a letter to the Bangor Daily News from a Westbrook resident made the ethical case more bluntly. “When a vital service is in short supply, conscience demands that it be allocated equitably,” wrote Michael P. Bacon, arguing that physicians charging for enhanced access “compromises medical ethics.”

The equity critique of membership medicine is showing up in statehouses and op-ed pages in the same week. That’s a signal worth reading.

The Conflation Problem

Here’s where it gets complicated for DPC. The pricing numbers Rhode Island officials are citing don’t describe direct primary care. They describe concierge medicine.

Concierge practices typically charge $300 to $500 a month. Some charge significantly more. The model serves affluent patients who want VIP access to their doctor. It’s often layered on top of insurance billing.

DPC is a different model. Most practices charge between $70 and $100 per month for individuals, with some offering sliding-scale pricing for lower-income patients. DPC doesn’t bill insurance. The monthly fee covers all primary care services directly.

The gap between $500/month concierge medicine and $80/month DPC is enormous. But when state officials, journalists, and op-ed writers talk about “membership medicine,” they rarely make the distinction. The WPRI story featured Dr. Lewis Weiner, described as Rhode Island’s first concierge physician through MDVIP. No DPC physician was quoted.

This is the conflation problem DPC has been dealing with for years, and it’s getting worse as the political temperature rises.

Why the Timing Matters

This isn’t happening in a vacuum. A Health Affairs study recently showed that DPC and concierge practice sites grew 83% from 2018 to 2023. Mainstream media is covering the trend. And as we reported this week, corporate-affiliated membership medicine sites grew 576% in the same period.

When politicians see “membership medicine is booming” and “doctors are leaving traditional practice,” they connect the dots. The resulting narrative is straightforward: wealthy patients are buying access, regular patients are losing their doctors, and something needs to be done.

That narrative lands differently depending on whether you’re talking about a $500/month MDVIP practice or an $80/month DPC clinic that accepts patients across income levels. But if DPC doesn’t actively distinguish itself, policymakers will treat it as the same thing.

Colorado’s HB 26-1096, which would have let Medicaid members access DPC, was just shelved in a Senate committee this week. Rhode Island officials are publicly questioning whether membership medicine hurts access. The policy environment is shifting, and DPC is at risk of being regulated as if it were luxury concierge care.

What This Means

If you’re running a DPC practice, the Rhode Island story might feel irrelevant. You’re not charging $500 a month. You’re not turning away patients who can’t afford you. Many DPC physicians deliberately price their practices to be accessible.

But perception shapes policy. And right now, the public perception of membership medicine is being defined by its most expensive version.

The DPC community has a window to shape this conversation. That means showing up when legislators ask questions. It means making the pricing distinction loudly and often. It means pointing to data showing that DPC practices with panels of around 600 patients produce 66% fewer ER visits and 20% fewer specialist referrals, outcomes that benefit the whole system, not just the members who can pay.

Rhode Island’s AG called doctors air traffic controllers. If DPC wants to avoid getting grounded by regulations designed for a different model, it needs to make sure the people writing the rules understand what it actually is.