For some direct care physicians, the idea of being available to patients around the clock may seem daunting. Who wants to be awakened every night in the middle of the night? However, most direct care physicians also find that they are able to develop a relationship with their patients that includes respect, boundaries, and established expectations.

The idea behind the direct care model is that patients pay a monthly fee and, in return, have access to basic primary care services during office hours as well as access to their physician after hours.

That is an enticement for both doctor and patient, that the patient interaction is not limited to a 10-15 minute visit during the day. The physician can spend more time during each visit, getting to know that patient more completely, and the patient feels free to ask follow-up questions and clarify instructions before and after the visit.

Direct care physicians have found that their patients do tend to respect their time and do not take advantage of their 24/7 availability, but it helps to establish expectations up front. Some direct care physicians will state that they are available by text or email – but not phone calls – between certain hours. They may also specify when it is appropriate to contact them after hours. For example, a question about scheduling or administrative issues must wait until office hours.

When the direct care physician offers 24/7 availability and the patient does call in the middle of the night, however, the physician should be responsive to continue that positive relationship. If the call went to voice mail, the physician should return the call. Likewise, a text or email should be answered promptly. Of course, all physicians direct their patients to call 911 when they have such emergency situations as a potential heart attack.