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Here’s a radical concept. What if we cut the cost of primary care by 80%?

What if we slashed avoidable ER visits and hospitalizations by 50%, by giving people direct access to their primary care doctor? I mean DIRECT access, not just a phone tree that gets you an appointment three weeks out?

What if you could have hour-long visits with your primary care doctor and actually get to the root of your medical concerns?

What if medical debt disappeared, because basic healthcare became affordable again?

A world where you have access to your doctor, time with them, and are understood as a whole person—without the big fees currently surrounding medical care—seems so radical only because we’ve grown accustomed to a fundamentally broken system. But this bold new world of patient-centered, affordable care, isn’t some fantasy. It’s the world of Direct Primary Care.

It’s here. It’s new. It’s what I practice.
Does that make Direct Primary Care doctors, like me, radical?
Maybe. And I’m okay with that.

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Back up to 3 years ago, before I’d even considered giving up my stressful, 60+ hour-per-week insurance-paid primary care position—the usual way doctors work, and patients receive care, in our modern medical system.

I was a busy mom of three, who by all superficial measures, had reached the apex of my career. I was stressed, tired, and burned out, but on the surface, I had “made” it.

I saw an average of 18 patients per day, at an average of 15 minutes per patient. This was 45% of my day. The other 55% was spent behind a computer, filling out prior authorizations, medical billing, and insurance forms. I spent between 52-60% of my time on the computer —rather than with my patients. I knew these numbers exactly, because my time was measured down to the second by our electronic medical record, and compiled in a detailed report sent to me regularly by my employer.

My average day started at 7:30 in the morning, and ended around 8pm at night, 3 hours after my last patient left the building. Each hour of my time was valued at around $450. The average cost for a visit with me was $115. I was paid less than one quarter of this, although I did 90% of the work.

I did not set my own schedule. If I wanted longer time with a patient, I scheduled them before lunch, or at the end of the day, and worked into my personal time to give them the attention they needed. Scheduling an hour-long visit was not feasible, and I might have lost my job if I had insisted. It was significantly easier for me to prescribe thousands of dollars in stop-gap medications to treat uncontrolled diabetes, than to spend just one hour getting to the root of the issue with my patient.

Despite all these challenges, I was grateful, because I was still able to do the work I loved (sort of), support my family, and slowly pay down my more-than-$250,000 of medical student debt.

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Fast-forward to 2019. Exhausted, I finally quit the job I’d worked so hard for. I quit, because I was done trying to fix a broken system from within, and I had three small children who were growing up without their mother.

Then, I met a fellow mama-doctor who was doing what, at the time, seemed impossible. She was running her own solo medical practice, while raising a young family. And, she seemed to be not just surviving, but THRIVING.

I learned about Direct Primary Care. I was hooked. And I've never looked back.

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Fast forward to 2021, and I now run my own solo Direct Primary Care clinic.

My patients have my personal cell phone number, and my email address. When they call the office, they reach me directly, without phone trees or answering services. They only visit the ER, or hospital, for issues that I truly cannot treat in my office. And, my visits are as long as they need to be.

My patients don’t pay inflated retail rates for medications, labs or imaging, because I NEGOTIATE on my patients’ behalf down to realistic, affordable prices, often a 90% discount.

On my own now, I’m free to practice as my patients need me to practice…and I’m able to pass enormous cost-savings on to them, to make modern medicine actually accessible.

“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”--Buckminster Fuller

I’m hoping to start a conversation. I’m hoping to start it among physicians, among patients, and even with you.

If you’re ready to see how Direct Primary Care can lead you to better health, with lower costs, and no insurance needed, reach out. When you call, you’ll get me directly.



For Further Study: By The Numbers
Average United States per capita healthcare spend, 2019: $5,193 per year, or $14.23 per day
Average insurance deductible as of 2019: $1,655
Average membership at a Direct Primary Care Practice: $65 per month, or $2.13 per day
Average cost of an emergency room visit: $2,032
Amount that a Florida hospital system saved by switching their employees to DPC: 54%
In dollars: $1.2 million
Price for a TSH (thyroid stimulating hormone) lab test at Maine Medical Partners/NorDx: $190
At Grace Health: $10
Average length of a new patient visit at Maine Medical Partners: 30 minutes
At Grace Health: 90 minutes

Dr. Norman reflects on the public health costs of racism, and opportunities for change

A few years ago I was trying to find my husband in a sea of other runners competing in our local Beach to Beacon road race. I had a clear memory of seeing him wearing his usual bright orange track shirt at the start line. I could picture exactly how he looked, stretching his legs along the fence, waiting for his pod of runners to be released, the early morning light coming in through the trees and backlighting his golden-brown hair.

However, when he came around the bend, I very nearly missed seeing him, because he was wearing a blue t-shirt, literally the opposite color.

My clear, objective memory, NEVER ACTUALLY HAPPENED. My brain took the available data and literally made up a story on the spot that fit my preconceived notion of what I should be seeing. Was I crazy? Fortunately or unfortunately, this happens to all of us, a lot more often then we’d like to think about.

As illogical as it may seem, my brain is wired to filter everything I touch, taste, smell or see through a web of emotions and expectations. This is partly to save energy (it can only process a fraction of the mind boggling number of electrons encountering our body each moment), and partly because our neural network is laid down in grooves of sorts, like ruts in a dirt road.

Most of our neural networks are set in place early in life. They’re like ruts in a country road. *Technically*, a car driving down a dirt road can go any of 360 directions. However, 99% of the time, it’s just going to follow the rut. We are VASTLY more prone to think about something the way we’ve always thought about it, whether that’s correct, incorrect, or a complete fabrication.

This idea is particularly stuck in my brain right now, because I just took the Harvard University Race IAT (Implicit Association Test) for the first time. This test assumes that an objective person should spend about the same amount of time associating a “Good” descriptor (Happy, Kind, Smiling) with a black face as with a white face.

I have now taken the test several times, and am ABSOLUTELY SURE that I spent an equal amount of time pairing “Good” and black faces, as I did “Bad” and white faces.

However, humblingly and frustratingly, the test knows better.

Racist is a charged word, but I prefer to use it as a descriptor. Turns out, I’m moderately racist. I believe that most racism is not a choice, any more than the typical Kindergartner chooses what brand of footwear they wear on their first day of school. Their clothing choices generally depend more on the resources their parents had available when they were purchased, their culture, and their area of the country or world. Racism is just the soup we find ourselves in. It’s not a moral judgement, it’s just information.

However, knowing our racism matters A LOT. Knowing my blindspots, my brain’s expectations, is critical. At best, unexplored racism may cost a friend or two, or cause me to hire someone who is not as well suited to a job as another candidate. At worst, it may cost someone their life or livelihood.

If there’s anything this year has taught me, it’s that addressing racism isn’t something I can farm out to someone else. My ruts in the road, my blindspots, are mine to own, and I’ve got my Race IAT staring me right in the face. Addressing it, what I consider a public health emergency, starts with me.

And the reason I’m addressing this NOW, is that it IS a public health emergency.
Racism effects health outcomes in almost every area of medicine, from birth outcomes, to school performance, to the likelihood of developing chronic diseases such as asthma, diabetes, and cancer. It is literally EVERYWHERE.
As a physician, and as the founder of a medical clinic, this issue matters to me.

The good news is that our brains are built less like rut-filled dirt roads, and more like muscles. They strengthen along neural pathways we use most often. They are able to adapt, and grow new habits. We can quit smoking, we can eat better, we can brush our teeth every night and make fewer cavities. And, we CAN work on our racism.

Learning my blindspots has been a deeply rewarding journey. I’m learning to love the “me” that truly is, which is a lot more fun, and a lot easier, than trying to pretend to be someone I’m not.

The following are resources which we have found helpful to EDUCATE, and, most importantly, ACT. The systems of racism we live with today will not change unless people like you and I take responsibility for doing so.

Exploring my blindspots with humor and humility has helped me discover “me”, too. This is a process, not a destination. Owning, and appreciating my whole self is a gift. The resources below have helped me, and I hope they may help you, too.

Indigenous People’s History of the United States
--GREAT BOOK, meticulously researched and referenced.

How to Be Anti-Racist
--What is “anti-racist”, and can’t you just be “not racist?” Short answer: No. We’re all racist. You can chose to see it, or not, but it’s there. I like this book for its practical steps, and also self-effacing, cringe-worthy humor.

Waking Up White
--My first book about racism, written by a fellow white mom, living in Maine. Loved it.

Black Girl In Maine
--A conversation with the founder of this media group 2 years ago prompted my self-reflective journey into studying racism, and the articles published here continue to inform my work as a physician. Deeply grateful.

Black Owned Maine
--Support local businesses!

The American Indian College Fund
--Help future leaders and educators get their foot in the door. Lowering the bar to their dreams helps us all.

Dr. Norman remembers the courage of Ruby Bridges as she reflects on the riots at the US Capitol on January 6th, 2021.

As the images of this past week unfolded, many of us struggled to process the fear, uncertainty, and disbelief.

Our family, like many of yours, sought ways to reconnect with each other, “Are you OK?”, despite the distances of time and space which have already turned our lives upside down.
Within this uncertainty, it feels important to reaffirm our core values. The best parts of ourselves, what we aspire to be, what we aspire to create in the world.

“Hate cannot drive out Hate, only Love can do that” –Martin Luther King

When we feel powerless, it is important to realize that this is only because we do not realize our power.
The greatest gift we can give the world is living our truth, what we truly believe in our hearts, with compassion and courage.

I gain strength from knowing that this is NOT the first time our country has been here, and we survived before, and will again.
I gain strength from the stories of the courageous folks who guided us through the prior struggles.
I gain strength from teaching their stories to my children, so that, just maybe, our generation can pass on a better world to theirs.

For adults:
--James Baldwin vs William F Buckley: A legendary debate from 1965
(skip to minute 14 for James Baldwin's famous oration)

For older children:
--Ruby Bridges Shares the Key to Overcoming Racism

For young children:
--The Story of Ruby Bridges

Techniques to help with anxiety:
--Listen to sounds which remind you of a space where you are warm and safe. Whether it’s the lake, the beach…perhaps camping out under the stars, or dawn over the ocean. Perhaps it’s Heart Chakra meditation, or Tibetan Chanting. You know that place. BE THERE. At least 2-3 times a day, even if only for a few minutes. You’ll be amazed what good it can do.
--Scents can help. Scented candles to remind you of holidays with friends, good food, morning coffee, warm tea. Smells can bring up strong feelings, even tears. THAT’S OK!
--Yoga Nidra "meditative sleep", free guided meditations available online.
--Color something. Knit something. Sing something. DANCE LIKE NO ONE’S WATCHING.

Actionable steps to heal our communities:
REACH OUT. Do you know someone who might feel especially vulnerable right now? Check in. Take a walk outdoors. A quick phone call. Text them. There are many stages of grieving, and there’s nobody, NOBODY who hasn’t lost something this year. We all need connection. LEARN: The events of this past week may have been a shock to some of us, but many communities have experienced violence and aggression for years. Learn their stories. “Those who fail to learn history are {doomed} to repeat it”—Winston Churchill
Indigenous Peoples History:
--An Indigenous Peoples History of the United States
--The Abbe Museum
--The Tulsa Race Riots

In Health,
Dr. Annie