By Wayne E. Rivet

Staff Writer

Growing up, Eric Gerchman watched his dad practice family medicine.

He was intrigued by the science.

He learned from his dad the importance of listening, understanding and caring for people. He saw that building relationships was a key component to effectively treating patients, in the moment and long-term.

Eric’s dream was to follow in his father’s footstep. He reached his goal in 1995.

“Watching my dad as a family physician is why I chose to be one. He taught me what it is to be a family physician,” Eric said.

Today’s version of the family physician, however, hardly resembles what Eric strived to be.

“I’ve been in corporate healthcare systems for most of my career — all but two years. I think the focus of primary care (for lots of reasons) became for doctors to see more patients just to make ends meet and keep the doors open,” he said. “Over the years, I’ve sadly watched the scope of what family physicians used to do dwindle away because you have 10 minutes (with a patient); you didn’t have time to take off a lesion or fix that fracture, which I used to do. The electronic record was a bad introduction for primary care. It is a glorified cash register. The more buttons you click, the more money you make the system. That’s where the focus came in. It was no longer a form of communication between physicians and patients… It’s a major stress point on a lot of physicians.”

Feeling frustrated and unfulfilled, Dr. Gerchman plans to try a new approach — direct primary care. He is starting a new practice — Living Well Family Medicine — beginning Oct. 1 in Bridgton.

Direct Primary Care (DPC) is an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee. There is no fee-for-service payments or third-party billing. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider.

“I was introduced to Direct Primary Care seven to eight years ago through an article I read. I’ve been following it for a long time. Last October, I started to seriously think about direct primary care. It allows me to practice medicine and not insurance,” Dr. Gerchman said. “Back 20 years ago, did I get the amount of time I needed to spend with my patients? No. Did I take it, yes. Ask any of my patients and they will tell you I was never on time. They knew that when they were in the room, they would get the time they needed. Most didn’t mind waiting that half hour extra because I was spending it with someone who needed it. It didn’t make corporate healthcare very happy. It was volume based.”

It was time to take a leap of faith.

Well respected, but something was missing

Over two decades of practicing medicine, Dr. Gerchman earned the respect of his colleagues and he has learned a great deal being on staff of several organizations.

He worked in the Central Maine Health Care system for 15 years, spending 10 to 11 of those years in Fryeburg practicing in an office connected to Bridgton Hospital. Dr. Gerchman received the 2014 HEROES Award for exceptional service, The Patience Choice Award (determined from patient surveys) and The Compassionate Doctor Recognition Award. He was named 2016 Maine Family Physician of the Year.

But, as Bridgton Hospital started to see a defection of physicians, Dr. Gerchman also looked elsewhere.

“Things weren’t going well in terms of medical staff decision-making at the administrative level,” he said. “I recognized it was not the kind of practice I wanted.”

So, Dr. Gerchman left. He ended up joining MaineHealth, working at Stephens Memorial in Norway.

“Great group of people. Their philosophy was a lot different. It was refreshing, at the time,” he said. “At the end of the day, it was corporate healthcare. They are driven differently. The focus is different. A lot has to do that corporate healthcare is run by business people, not run by physicians. So, the bottom line is always about money. In corporate healthcare, they bring in specialty care, which is so needed. But, it’s hurt primary care significantly. We’re not nearly what we used to be. You remember the good ole family doc, the one you remember since the doc delivered you. Now, that’s gone by the wayside. Now, we get people to the hospital doors, where you can then be steered to the specialist.”

In sitting in many administrative meetings over the years, Dr. Gerchman heard a familiar message — family medicine and primary care were always thought as money losers. “It’s not the case, depending upon how you do the accounting,” he countered. “The key to primary care is time — the relationship with your patient. In corporate healthcare, you’re not allowed to do it. You have seven minutes to get a person in and out.”

MaineHealth was a good fit, but not necessarily the right one, Dr. Gerchman discovered. Direct Primary Care, a new model on an old approach, is starting to take root across the country, and it piqued Dr. Gerchman’s interest.

“Over the years reading about, it made sense to me. One of my partners, who is now in his own direct primary care in Portland, told me he was leaving, why and about direct primary care. I realized, this is exactly what I want to do. If he is going to do it, why can’t I? I am going to make the leap. It is really jumping off a cliff. It is absolutely a leap of faith,” he said.

Dr. Gerchman went to a “nuts and bolts” conference on direct primary care in Florida. There were about 700 to 800 people in attendance, most of which were in Dr. Gerchman’s seat, thinking about opening a practice; the rest were a year or two into it.

“It broke down steps how to start a practice. It was phenomenal. I came back from that on fire. I was at a point in my career that I was exhausted. I wasn’t feeling that I was making a difference. It was just drudgery going to work every day. I love medicine. Direct primary care has opened up that door, again,” Dr. Gerchman said. “I came back from the conference and my wife, Denyell knew right away this is going to happen. For years, we talked about getting a financial advisor and finally got one. Had our whole life set. Before we sat down for the final discussion, I told my wife, ‘Bye the way, we are about to go to zero income, are you okay with that?’ She’s been phenomenal with this. I sat down with my CEO (Tim Churchill, who has since retired), and I gave a year’s notice. They were surprisingly supportive. And the new CEO has been extremely supportive of this whole process. She understands why I am leaving Stephens.”

Although he will operate his own practice, Dr. Gerchman will retain privileges at Stephens Memorial (look to expand to Memorial Hospital, another MaineHealth entity), and will look to rebuild a relationship with Central Maine Healthcare.

“I still won’t be doing admissions to the hospital, but having privilege to go in and see patients will be really nice and have access to results, consults, etc.” he said.

So how does Direct Primary Care work?

Based on one’s age, members pay a monthly subscription. The subscription covers the cost of services provided, be it an annual check-up, EKG, stitching up a cut, removing a skin tag or an urgent care visit — just to name a few. The practice will offer quick result lab tests (such as strep, pregnancy, flu swab and urinalysis) in-house at no extra cost. Living Well will carry many common prescription medications for member convenience and get others at significantly discounted rates. A one-time start-up fee of $70 per patient or $200 max per family is charged to gather, review and update all medical records. Right now, the practice is holding an open enrollment via its website. Those interested in joining the practice will be scheduled for an appointment after Oct. 1 to speak with Dr. Gerchman, who will explain the model of care, costs and how DPC relates to existing insurance policies. If a patient sees it as a good fit, an agreement will be entered.

“One of the things that drove me to Direct Primary Care is living in this community for as long as I have; working with patients here for as long as I have; we have a lot of small businesses, and with that comes difficult insurance plans, usually have high deductibles, large co-pays that families just can’t meet them so they don’t get care. As much as everyone has health insurance, not everyone is getting care. DPC removes barriers at a very cheap rate. They can adjust their insurance to more catastrophic coverage and lower premiums, which often times pays for my subscription. The way I look at it, it disconnects the fee for service. The service is then allowed to be free,” he said. “If you cut your finger on the weekend, you won’t need to go to urgent care, you call me, I meet you at the office, and sew you up. And there is no charge because it is part of the subscription. To me, my hope and dream is to give back to the community and get healthcare to people who just aren’t getting it. I have a family of five that own a small business. They’re paying $2,300 a month, $6,000 deductible for each one, I talked them about a health-sharing plan and Direct Primary Care, which works really well together, and they would save $1300 month and be able to get care. I don’t think I’ve seen the husband ever in the office, I only see the kids when necessary. That’s a shame.”

Dr. Gerchman sees Direct Primary Care as a chance “to practice medicine, not insurance.”

“I am not held to what insurance tells me to do. I am held to an agreement I have with the patient. This is where you are in your life, this is what is best for you,” he added. “ One advantage is having the time to work with the patient and navigate the system to get them the best cost. In 20 years, I know a lot of docs and specialist, and know which ones work well for certain people. Having the time to do that is a huge benefit.”

Dr. Gerchman has already heard from some small companies inquiring about Direct Primary Care.

“The nice thing about direct primary care is it doesn’t matter if one’s insurance accepts me or not. I tell people I am not accepting any insurances. There is a pause. Then, I explain how it works and they can determine if it is a good fit for them,” he said.

Dr. Gerchman will become either the 13th or 14th DPC physician in Maine; most are currently located in the Portland area. Originally, he looked at opening the practice in Fryeburg, but a building lease fell through. One day, Denyell drove by an empty space off Portland Road in Bridgton and said, “that’s the place.” The building is owned by friend Justin McIver. Dr. Gerchman feels it is the perfect spot since Bridgton is at the center of his circle of patients, who come from neighboring towns of Naples, Norway and South Paris, Fryeburg and North Conway.

The practice opens Oct. 1. To adequately serve his patients, Dr. Gerchman sees the practice serving 500 to 600 enabling him to see five to six people per day, unlike rushing 25 to 30 through to hit visits “corporate healthcare” wants a physician to reach. If the practice grows in numbers, Dr. Gerchman is hopeful he can sway a few colleagues (who are on the fence right now, watching to see how Direct Primary Care plays out) to join him.

“What’s been wearing at me for years is whether I did those patients right?” he said. “What I really feel is important as a family physician is truly knowing the person. Knowing the kind of work they do; knowing their family and their history; knowing the stresses; what kind of foods do you eat and do you exercise; what drives your decisions to do or not to do those things? 54% of our population is obese; it’s more than just eating calories. Stresses; relationship with your spouse; what is going on with your kids? Those all play a role in your health, more than you might realize. It’s not just about the science (blood pressure elevated) but the underlying reasons behind it that’s where the treatment lies. It doesn’t rely on giving you a pill. I want to make you healthy mind, body and soul. That’s my goal. That’s what is missing in the current healthcare system, at least in primary care. It takes time. It’s not just one visit. It takes a lifetime. Knowing a patient enables us to connect the dots and have the tough conversations.”

And, why call it Living Well Family Medicine? There’s a story to it.

“Back in October or November, when I started looking at practices, I pulled into a home that was for sale in downtown Denmark. There was a well. It came to me, Living Well. Living well has lots of different meanings. Living well, living healthy. Living well from a faith standpoint, which is truly important to me because I can’t do what I do without faith. People ask me how I can be faithful and a scientist at the same time, I don’t know how you can’t,” he said.

Dr. Gerchman turned over the task of logo design to his son, who delivered!

Plenty of “firsts” make this proposition both exciting and scary, Dr. Gerchman said. With the help from family, he is becoming more savvy in terms of writing a blog and handling a Facebook page. He’s never run a business before, so he leans on those already in the trenches.

“New England Direct Primary Care Alliance has been phenomenal. There’s a nationwide closed Facebook page, and I’ll put a question out and I’ll get 58 answers in three minutes as to what they’ve done. It’s an incredible family that wants you to succeed; see value what we’re doing; taking family practice and primary care back from the insurance companies and hospitals. A better way to practice,” he said. “It’s a steep curve, but it’s exciting,” he said. “In family practice, running my own business will make the delivery of care better.”

The leap has reinvigorated the long-time doctor.

“I’m getting back the passion for family medicine that I had when I first started out,” he said. “Primary care is dying. Physicians are burned out. They’ve lost their passion because they’re being told they can’t do what they went into medicine to do. The timing is perfect because patients are fed up with get in, get out, I don’t see my doctor most of the time. It’s an opportunity to get back to really knowing your doctor.”

Any fears heading down this different path?

“Besides failing? There is always a question whether I can do this? For 20 years, we’ve been told we can’t. Now, I am jumping off a cliff and saying I don’t have to do it this way. Now, I need to prove it. It’s on my shoulders. One doctor in South Portland has been doing this for 18 years. There are almost 3,000 doctors across the country that are Direct Primary Care physicians. Last week, we had another 18 open doors across the country. It’s happening. It’s working,” he said. “I want to do it justice. That’s my fear, can I do it justice as well as I want to do? My goal is to give back to the community and do it the best that I can. Will I be able to do that?”

Dr. Gerchman is confident about his decision.

“It’s a scary cliff,” he added. “Even if I’m tired, I’ll at least feel fulfilled.”