Your Questions, Answered

A relationship based membership model to deliver primary care. DPC was started by physicians for the benefit of patients and physicians. By removing third party payers, DPC allows for the accessibilty, time, and autonomy physicians need to provide the best care possible for their patients at an affordable price. You should know your physician and your physician should know you.
Concierge medicine still charges and collects from third parties (Medicare or insurance) PLUS charges you an additional membership fee. Recent evaluations show that concierge memberships are often 3x or more than DPC membership fees.
(DPC In Name Only - DINO!) These practices are merely dabbling in DPC. It’s not surprising that everyone is trying to get into DPC (urgent cares, large Family Medicine groups, hospitals, health care systems) without actually being pure DPC.
There is also a rise in corporate run DINOs, where, if their is a doctor, the doctor is an employee being directed by an administrator, and very often your “provider” is a mid-level (a PA or NP) to maximize patient panels for increased revenue.
If your physician isn’t the owner, it’s likely a DINO. Why does that matter? It matters because you’re paying the salary of your provider’s boss. And that boss is not providing any care for you or your family.
Let’s start with training. A physican has at least 7 years and over 10,000 hours of training after college. NPs an PAs (midlevels) have a fraction of that.
Physicians specialize; Dr. Dan specializes in Family Medicine. NPs and PAs can work in a dermatology clinic yesterday, an orthopedic clinic today, and a pediatric clinic tomorrow. If a physician wants to switch specialties, they need to complete another residency, requiring a minimum of another two years of training, and often much more.
That training brings value by saving you money. Study after study shows that NPs and PAs order more tests and give more referrals than physicians. Both cost you more time and money. As an aside, this is an excellent win for health systems because each step costs you money and generates revenue for them: midlevel visit, testing, referral. Those systems are financially incentivized to employ more midlevels than physicians.
A DPC physician saves you time and money because their training and experience mean less testing and referrals.
Family Medicine is a medical specialty that cares for girls and boys, women and men, from conception through death for common conditions that affect all the different parts of the body. To become a Family Physician requires a three year residency after medical school (~15,000 hours of structured, supervised clinical education).
In contrast, 60% of family nurse practitioner students complete most or all of their coursework online, and 22% attend direct-entry programs for students without a nursing degree or any nursing experience. Certification as an NP requires just 500 supervised clinical hours before graduation, and students often struggle to find qualified teachers.
Family Medicine physicians are trained to deliver babies, care for the entire family through all stages of life, both in the clinic and in the hospital, and perform a wide variety of common medical procedures. Some Family Medicine physicians choose to obtain further training in a variety of fellowships.
Dr. Dan was broadly trained in a rural Family Medicine residency and is Board Certified in Family Medicine by the American Board of Family Medicine. He has over twenty years of experience. There isn’t much he hasn’t seen.
Adequate time is important for both patients and physicians. Patients need time to be heard, to have their questions answered and to have their concerns addressed. Patients have great questions about treatment options, costs, risks, efficacy, availability, etc. It takes time to review and discuss those important considerations.
But physicians also need time to consider diagnoses, research treatment options, and perform procedures. Medicine is not only a series of conversations, examinations, and prescriptions. It is also knowledge work. Physicians gather incomplete information, weigh probabilities, recognize patterns, identify contradictions, and make decisions under uncertainty. Some of that thinking happens quickly. Some of it should not.
One of the legitimate criticisms of primary care physicians in fee-for-service practices is that they refer more often than they should. In a high-volume system, that work is often squeezed into lunch, evenings, or the few minutes between patients. The problem is not that physicians no longer care or no longer want to think. The problem is that the operating model may not leave a legitimate place for thinking. The ‘easy’ option is to refer out or reschedule for another visit for more time. Both of those burden the patient who has to take even more time off work, find someone to watch children, etc. Both contribute to burn out for the physician that wants to provide care but literally doesn’t have time.
DPC solves this problem for both patients and physicians with longer appointments and smaller patient panels. DPC allows time to follow the problem instead of forcing the problem to fit the appointment slot. That distinction matters. The promise of DPC is not that every appointment becomes an hour. The promise is that time is available when good medicine requires it. Sometimes that time belongs to the patient. Sometimes it belongs to the physician. Often, it belongs to the relationship between them.
The truth increasingly discussed, and experienced, is that American medicine is in serious trouble. The intrusion of third parties into the practice of medicine has caused severe physician moral injury and burnout.
Recent studies show that 20% (1 in 5!) physicians are depressed. Physician suicide rates have skyrocketed over the past decade. Those same studies show 50%, half of physicians are burnt out. Think about that the next time you see a physician the fee-for-service system!
Physicians are leaving medicine in droves for other careers. There is an popular “FIRE” movement in medicine (Financial Independence Retire Early). This is not what our country needs.
DPC (and other direct care?), now about two decades old as a model, when studied, is the antidote to these problems. So much so that other specialists are tring to get into DPC. There are Emergency Medicine physicians that left the ED and opened a DPC. There are oncologists and rheumatologists that provide adult DPC plus specialty care on a direct pay basis.
Dr. Dan decided that he wanted to get back to caring for patients without the interference of third parties so he switched to DPC in 2020.
After that description, you’ll not be surprised to learn the answer is yes! Beyond primary care provided by Family Medicine, Pediatric, Internal Medicine, Med-Peds and Geriatric primary care colleagues, many specialists are increasingly leaving that system.
While some are membership based, others just charge a reasonable per visit fee. Even my surgical specialty colleagues are starting to leave for freestanding surgical centers. Some of my OB/GYN colleagues have left for freestanding birth centers. There are radiology groups that provide low-cost imaging at freestanding imaging centers.
In every case, the goal is to get back to a patient relationship unhindered by third parties that significantly decreases the cost of care.
Even more good news is that it's not just physicians. Health professional colleagues in physical therapy, audiology, speech therapy, occupational therapy and counseling are following suit. There is a growing ecosystem of healthcare outside of government programs and insurance.

About Direct Primary Care (DPC) in general

About Imago Dei DPC specifically

Please call to schedule a no cost, no obligation, “meet and greet” visit with Dr. Dan. This is NOT a pressured sales pitch about the practice. This will allow you to meet him in person and “kick the tires” so to speak. (Please don’t kick Dr. Dan!) If you don’t think it’d be a good fit, no worries - but you really don’t need to kick him.
The Latin phrase Imago Dei (meaning "the image of God") is pronounced as “ih-MAH-go DAY”.
Dr. Dan believes that each of his patients is made in the image of God and has infinite worth and value, from conception to death. His historical, Biblical faith informs the health care he provides.
Dr. Dan assists his patients in stewarding their physical health, with full understanding that 100% of his patients will die, from something, at some time in the future, regardless of his or his patient’s skill and effort because we live in a broken and fallen world.
We have shrugged the bureaucracy, completely. We have shredded red tape. In refusing to recognize any interference with the sanctity of the patient-physician relationship, we have returned Family Medicine to its root values of clinical excellence and compassionate knowledge of every patient. In every aspect of Family Medicine care provided, we deliver affordability, accessibility, comprehensiveness, and personalization, with transparent pricing for everything we do.
While some DPC practices provide common, low cost prescription medications, no clinic-run pharmacy can match the variety of medications prescribed by a Family Medicine physician. Remember, birth to death, for men and women, involving all body parts and organ systems. This isn’t just about pills; medicine involves injections, eye and ear drops, topical medications like creams and ointments, subcutaneous (under the skin) and intrauterine.
I leave prescription dispensing to my pharmacy colleagues. This eliminates any financial conflict of interest to prescribe what I have on hand rather than what may be the best option for you.
It also puts a second eye on prescriptions and possible interactions. An example is that a patient sees a specialist that prescribes a specialty medication. The patient asks the specialist to send me a note and trusts the communication will happen, but, for whatever reason, it never does. At a later visit, I ask about prescriptions and the patient already assumes that I have all their information. I send a new prescription to the pharmacy. The pharmacist catches a possible interaction between what the specialist prescribed (that I didn't know about) and the new prescription.
Locally, we are blessed to have two independent pharmacies:
Bunte’s Pharmacy in Zeeland
Skip’s Pharmacy in Holland
My experience is that independent pharmacist find the best prices outside of insurance and have the time to answer your questions thoroughly.
Vaccine manufacturers only sell vaccines in large quantities that expire. Some vaccines are needed much less frquently than others. For a small DPC practice, it’s not financially feasible - the price I’d have to charge per vaccine would be so high that you’d go elsewhere anyway.
So, at this time, we are not able to provide vaccinations but we will happily work with you to arrange these with your local pharmacy or public health department.
No. Happily, no!
Perhaps the most critical distinction of our Family Medicine practice is that it focuses on a direct, personal relationship between you and your doctor. That directness carries over to our business model as well. We forgo insurance payments in order to save our patients from the arbitrary, intrusive decisions that inevitably come with third-party payers. Furthermore, this direct membership arrangement frees us from the typical contractual agreements that prevent physicians from offering wholesale prices on laboratory tests, pathology, etc.

About how DPC works with other healthcare

Yes, absolutely! We recommend that our patients enroll in either a government plan (Medicare or Medicaid), a medical health insurance plan (preferably with a Health Savings Account - HSA), or a medical cost-sharing plan (what the majority of DPC patients choose because of affordability and coverage), thereby ensuring financial help should an expensive medication, a hospitalization or a referral to a specialist be necessary.
We accept all patients (insured, Medicare, uninsured, etc). We just don’t bill these third parties. But just because you have insurance doesn’t mean you still don’t pay twice. Each copay and office visit adds up. With four visits a year you have paid the same amount as a year of our membership! In fact, the dirty little secret to health insurance is that “employees will pay an average of $2,487 in out-of-pocket costs, such as copayments, coinsurance and deductibles”. So, you may SAVE money if you have insurance and join our practice!
You should have some type of medical insurance or medical cost-sharing for any medications, ancillary testing, specialist consultations or hospitalizations that you may require.
Your monthly fee does NOT count toward your medical insurance deductible. Some patients have Health Savings Accounts (HSAs) which allow for your monthly fees to be paid with pre-tax dollars.
Yes! You need only sign a waiver declaring that neither you nor Drs. Dan or Jeff will directly bill Medicare for our services. Medicare will still cover any laboratory testing, imaging, medications, or hospitalizations prescribed by our offices per Medicare’s rules.
Of course. We might argue that everyone benefits from a service tailored directly to them. Our practice is devoted to the maintenance of your good health, to the enhancements of your daily experience that only physical well-being can bring.
In wellness and therapeutic care alike, Imago Dei DPC’s greatest ally is time. Large amounts of precious, irretrievable time given to you as you wish. Every visit will be easy-going in its absolute thoroughness and relaxed in answering your questions and addressing your needs. Then, as the months and years go by, we’ll build a comprehensive and intimate knowledge of your health, an invaluable understanding rarely seen in today’s healthcare model.
In providing comprehensive care with unprecedented access, we strive to prevent or reduce hospitalizations and specialty referrals. In those instances where those types of care are required, we are available to communicate with your hospitalist during your hospital stay or to work closely with any specialist. In some cases, depending on the level of care and the sorts of expertise required, we may need to rely on those specialized caregivers to manage your treatment.
You will go to the hospital of your choice (but ‘your choice’ may be limited by your insurance!). We are able to stay in consultation the hospital staff during your hospitalization so long as you provide them with our contact information and permission.
Nothing changes. As your personal physician, I will be able to coordinate appointments, and, to the best of my ability, will expedite the waiting time for the visit.
There’s a growing list of specialists that charge a direct fee for a telehealth visit with you or for an online consultation regarding your health need.
If you need to see a specialist in person, it will be a conventional visit using your Medicare, insurance or medical cost-sharing plan. We are then able to follow-up with you and your specialist about the visit.
Any outside tests (like a nerve conduction test), studies (like an echocardiogram) and procedures (like an endometrial ablation) are ordered and scheduled just like in a regular Family Medicine practice.

About Dr. Dan’s accessibility

Yes, but both the Dr. Dan and the patient need to be comfortable that a telehealth visit is appropriate for the concern.
Sometimes a patient wants to be seen in person even if it could be taken care of with a telehealth visit.
Other times, Dr. Dan knows that a physical exam is important to arrive at the correct diagnosis and treament plan.
Yes! Because illness and injury do not respect regular clinic hours, you may call your physician any day, at any hour for urgent concerns. Always call 911 for medical emergencies!
Most patient calls to a physician fall into one of three categories:
The first is a curiosity question or simple inquiry, such as a prescription refill. For those, we ask that you call the clinic during business hours or email Dr. Dan.
The second group of questions are about clear medical emergencies. If you have blood squirting out of your eyeball, a bone sticking through your flesh, or crushing chest pain, you should NOT call Dr. Dan. Do not pass go, go directly to the emergency department!
The third group of concerns is somewhere in between the first two. It's actually not common. Most questions can wait until clinic hours or are obviously something that should go to the emergency department. However, if something is occurring that seems to be in this “in between” space, patients of the practice can contact Dr. Dan directly.
Naturally we provide such care – yet another freedom we enjoy together as a result of our independence from the restrictions of third-party payment. Because we know you well, we can streamline your care when you’re sick away from home. In the age of telemedicine, some illnesses can be diagnosed and treated with a telehealth visit. We’ll locate the nearest pharmacy and order the medications most appropriate for your needs. If it’s something that can’t be handled with a telehealth visit, we’ll let you know.

About the ‘elephants’ in the room (those tough questions you may be embarrassed to ask in person)

Nothing changes. As your personal doctor, I will be able to coordinate appointments, and, to the best of my ability, will expedite the waiting time for the visit. When you see a specialist, it will be a conventional visit using your medical insurance or medical cost-sharing plan. We are then able to follow-up with you and your specialist about the visit.
Any studies are ordered and scheduled just like in a regular practice.
Your prescriptions go to the pharmacies you choose. It is that simple and seamless.
While some DPC practice dabble in providing common, low cost prescription medications, no primary care clinic can match the variety of medications prescribed by a Family Medicine physician.
I leave prescription dispensing to my pharmacy colleagues. This eliminates any financial conflict of interest to prescribe what I have on hand rather than what may be the ‘best’ option for you.
It also puts a second eye on prescriptions and possible interactions. A common scenario is that a patient sees a specialist that prescribes a specialty medication. The patient asks the specialist to send me a note and trusts the communication will happen, but, for whatever reason, it never does. At a leader visit, I ask about prescriptions and the patient already assumes that I have all their information. I send a prescription to the pharmacy that catches a possible interaction between what the specialist prescribed that I didn't know about and the new prescription.
Locally, we are blessed to have two independent pharmacies:
Bunte’s Pharmacy in Zeeland
Skip’s Pharmacy in Holland
My experience is that independent pharmacist find the best prices outside of insurance and have the time to answer your questions thoroughly.
At this time, we are not able to provide vaccinations but we will happily work with you to arrange these with your local pharmacy or public health department.
Dr. Dan enjoys caring for whole families but understands that some family members may already have or prefer another physician. An individual or as much of the family that wants to join are welcome.
Glad you asked! The short answer is no. But those services are offered to save you time and money.
Dr. Dan will ALWAYS have a female chaperone for any breast or pelvic exams that may be necessary. With over twenty years of experience, including over a decade delivering babies, Dr. Dan is comfortable caring for many female specific concerns.
If a female patient prefers seeing a female for any reason, Dr. Dan is happy to refer to another female physician.
While a bit of a loaded question, the short answer is yes.
Although no vaccines are provided at Imago Dei DPC, Dr. Dan does recommend vaccines, after careful consideration and discussion of the risks and benefits, when appropriate.
Because the patient-physician relationship is built upon trust in mutual respect, Dr. Dan is more than willing to listen to concerns about vaccines and, in return, expects that patients will respectfully listen to his clinical reasoning for specific vaccine recommendations for their care.
Nonetheless, at the end of the day, it is always the patient's choice whether or not to follow through with any treatment plan.
Lastly, it is important to understand that if you or your loved one is incompletely vaccinated and a serious, vaccine preventable disease is potentially causing a severe illness, you may need to be urgently referred to an emergency room that can conduct testing that cannot be done at Imago Dei DPC.
The short answer is no to ‘pill pushing’.
Medication can be helpful, but, like driving your vehicle, they always carry the potential for harm. Dr. Dan does his best to only prescribe when necessary, the least amount, for the shortest time.
Dr. Dan recognizes that BIG VITAMIN and BIG SUPPLEMENT, like BIG PHARMA, are multibillion dollar economies that do NOT always have your best interest in mind and at heart. Dr. Dan welcomes conversation and will do his best to clarify the evidence, risks, benefits, costs, etc. of any treatment.
Call (616) 407-4968 to schedule a visit to discuss your needs for healthcare, a visit that will be free and unconditional. It’s the only reasonable way to begin what, I trust, will be a long, productive, altogether healthy relationship.