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Dr. Martin Luther King, Jr's Personal Physician and Our Moment in History
By Evan Pankey, MMSc

Not many people know this; in fact, I was surprised to find that it was not even on Wikipedia at the time of this writing. Alvin Poussaint, MD, a professor at Harvard Medical School, was the personal physician of Dr Martin Luther King, Jr during the peak of the Civil Rights Movement.

Poussaint, a native of New York City and son of Haitian immigrants, completed medical school at Cornell in 1960 and completed residency at UCLA in psychiatry as chief resident. Despite racial discrimination in the mid-1960s, Poussaint had no lack of remunerative professional opportunities in academia or private practice. Instead, recognizing his moment in history and motivated by deep principles of equality, he chose to serve. In 1965, Poussaint joined the civil rights struggle, becoming the Southern field director of the Medical Committee for Human Rights, a division of the Student Nonviolent Coordinating Committee. So why did a young psychiatrist fresh out of residency become a field director and King's personal physician? "Because no else was crazy enough to take the job," Poussaint told me with a witty smile in an interview 10 years ago.

Poussaint's role as King's personal physician was not your typical doctor-patient relationship. It extended beyond checkups and occasional house calls. As physician and medical field director, Poussaint was physically at King's side at many of the major marches of the American Civil Rights Movement with a brown medical briefcase in hand ready to serve King and other marchers in the vicinity at any given moment. I have seen the color photographs of the unassuming psychiatrist just a few paces back from King on the famous third march from Selma to Montgomery, Alabama, in 1965, the same event depicted in the movie Selma.

After King's assassination in 1968, Poussaint came to Boston and worked as faculty at Tufts and then Harvard Medical School where he remains a staunch advocate for the principles of the Civil Rights Movement and an inspiration to many generations of medical graduates, including myself.

The Civil Rights Movement and the Direct Primary Care Movement
Comparisons of social movements should not be made lightly and I have not had the opportunity to discuss the Direct Primary Care Movement with Poussaint. I certainly do not presume to speak for him. Nonetheless, just as history called Poussaint out of the traditional role of psychiatrist to serve in the Civil Rights Movement, history now calls a growing number of physicians and advocates to a bold new model of primary care delivery. I can say without reservation that the principles of the Civil Rights Movement live on in the Direct Primary Care Movement. Today, thousands of physicians and advocates across the country and the political spectrum are motivated by the opportunity to provide high-quality affordable and sustainable primary care to all people regardless of socioeconomic status, insurance status, immigration status, color, or creed. Direct primary care is the delivery of primary care without the need for third-party insurance. Instead, individuals, businesses, or state governments pay flat monthly membership fees for primary care services with additional services offered as "pay as you go." Direct primary care is often coupled with high-deductible insurance for emergencies and catastrophic events. This model is distinguished by close to 24/7 access to physicians, low costs for ancillary services (lab tests and imaging), and longer visits of 30 minutes to an hour or more. Direct primary care restores the doctor-patient relationship that motivated many physicians to choose a career in medicine in the first place.

Examples of direct primary care include the following:

• Brian Forrest, MD, direct primary care pioneer in Apex, North Carolina, often describes how in his modest waiting room you can find a homeless man and a wealthy entrepreneur sitting adjacent to one another and that they will receive the same quality of care.

• Erika Bliss, MD, CEO of Qliance, a direct primary care network in Washington state, remarks how Qliance delivers high-quality care to thousands of Medicaid patients and employees of Expedia without exception.

• Many direct primary care practices in California, Florida, Kansas, Rhode Island, and Texas report that they are some of the only avenues to high-quality primary care for thousands of undocumented immigrant workers in an era when many "safety net" clinics are contracting under financial and regulatory strain.

Direct Primary Care: An Evidenced-Based Movement
There is mounting evidence of the effectiveness of direct primary services compared with traditional models of insurance-based fee-for-service care. Qliance recently released a report demonstrating a 20% lower cost on average per person compared with insurance-based care. In addition, the report found there were 14% fewer emergency department visits, 60% fewer inpatient hospital days, 14% fewer specialist visits, and 29% fewer advanced imaging orders as a result of a 58% increase in primary care visits. A separate patient satisfaction survey by the Agency for Healthcare Research and Quality noted that Qliance's patient satisfaction was in the 95th percentile. These remarkable results are evidence of the elusive goal of "bending" the cost curve in US health care system. It is likely that other practices and organizations embracing the direct primary care model will be able to report similar results in the months and years ahead.

A Growing Movement
Industry experts estimate there are currently 4,500 physicians practicing some form of direct primary care. It is one of the fastest growing models of practice. In 2015, there will be no fewer than 10 medical conferences addressing direct primary care sponsored by a diverse group of organizations, including The Family Medicine Educational Consortium, Pri-Med, The American Academy of Family Physicians, the Association of American Physician and Surgeons, and the Free Market Medicine Association.

A Living Legacy and Our Moment in History
Poussaint's unique sacrifice and singular contributions to the Civil Rights Movement as medical field director and King's personal physician deserve our gratitude and remembrance. At the same time, we should recognize that our country's march to greater equality for all inhabitants, which stretches back to the Declaration of Independence, continues today. In our current historical moment, men and women across the United States in neighborhoods, physician offices, board rooms, state houses, and the halls of Congress are working to make high-quality health care affordable and accessible to all. The Direct Primary Care Movement is a living example of a viable solution to our national health care dilemma and one that many of us are now called to serve.

— Evan Pankey, MMSc, is a graduate of Harvard Medical School and a health care innovator. He is currently leading the development of InLight EHR, a new EHR for direct primary care at Boston-based Pri-Med.