The Limits of One-Size-Fits-All Medicine (and Why Direct Primary Care is Different)
For generations, family doctors were known not just for their knowledge, but for their constancy. They cared for the whole family, through every season of life, with the simple goal of helping people stay well. Medicine in those days moved at a slower pace—less hurried, more attuned to the unique story of each patient. Today, that spirit can feel at odds with the way our healthcare system is structured.
In a fee-for-service model—where doctors are paid for each visit, test, or procedure—the incentives don’t always align with what’s best for patients. Too often, “efficient” care is delivered in a standardized, one-size-fits-all approach, when in truth each patient needs something more thoughtful. Here are five quiet ways that one-size-fits-all medicine leaves patients and doctors feeling shortchanged.
1. Low to No Pay for Prevention
The foundation of good medicine is prevention: helping patients stay healthy, catching problems early, and building habits that last. Yet in fee-for-service, prevention is undervalued. Doctors can bill for one “annual wellness visit,” but if they spend extra time during the year helping you manage diet, exercise, stress, or sleep, there’s often no way to be compensated. In contrast, every cough, infection, or injury creates a billable encounter. The unspoken message is that illness is valuable, while wellness is invisible.
2. Fee-for-Service Rewards Short Visits, Not Long Conversations
In a fee-for-service system, each visit has its own billing code. That means a ten-minute visit and a sixty-minute visit generate nearly the same reimbursement. This system incentivizes scheduling multiple short visits rather than one long, thoughtful appointment. For patients, this can mean bouncing between appointments, retelling the same story, or waiting weeks for follow-up—when what they truly need is one unhurried conversation. Time is the heart of trust, but it isn’t well accounted for in fee-for-service.
3. More Care, Not Always Better Care
Every test ordered, every procedure performed, every referral made adds another line to the billing ledger. Sometimes those interventions are essential. But often, the most important step in diagnosis is to pause, listen, and carefully see how things unfold naturally. The fee-for-service model doesn’t reward watchful waiting or reassurance. It rewards doing more, not necessarily doing what is most measured and appropriate. Patients may walk away with extra tests or medications, not because their doctor doesn’t know better, but because the system doesn’t make it easy to slow down.
4. Paperwork Over People
In fee-for-service medicine, the time spent with a patient is often overshadowed by the time spent documenting the visit. Each detail must be translated into the right billing code, every conversation distilled into checkboxes and templated phrases. While documentation has its place, the balance has tipped so far that many doctors spend more of the day facing a computer screen than sitting across from the people they serve. Patients feel it too—attention on the chart instead of the patient, hurried typing instead of unbroken listening. The result is a system that seems to value paperwork more than people.
5. The Limits of One-Size-Fits-All Care (and Benefits of Slow Medicine)
One of the quiet strengths of family medicine is continuity—the ability to walk alongside patients not just for a single problem, but through the seasons of their lives. Fee-for-service, however, doesn’t reward this kind of relationship. It treats each visit as an isolated transaction, flattening individuality into codes and checkboxes. The result is a kind of “fast food” medicine: quick, standardized, and the same for everyone. But true care is more like “slow medicine”, built on craftsmanship and attention to detail. When we know a patient’s story—their family, their history, their values—we can treat them in context, not as a one-size-fits-all case. This kind of medicine takes time, patience, and trust. It’s not fast, but it’s deeply nourishing—for patients and physicians alike.
At Marin Family Medicine, we believe patients deserve care that brings the focus back to health, to relationships, and to the quiet but essential work of keeping you well. Direct Primary Care was created to realign these mismatched incentives. Because we are not paid per visit or procedure, there’s no need to rush, no pressure to code every conversation, and no barrier to checking in just to keep you well. We can spend time where it belongs—listening, thinking together, and building the kind of relationship that makes patients (and physicians) feel human again. This is family medicine the way it was always meant to be—slow enough to listen, steady enough to last.
If this vision of care resonates with you, you can learn more about our Direct Primary Care model at Marin Family Medicine: