Dr. Natalie Gentile is not only a physician, but a pillar in the community dedicated to breaking down the barriers between patients and doctors. Her direct primary care practice is one of the many ways she’s rebelling against the traditional health and wellness industries.

Image: Janine Essey

There’s never been any doubt that Dr. Natalie Gentile would work in the medical field in some capacity. As a young girl, she would often accompany her father as he made his rounds as a physician. It was this experience in which she was able to witness the importance of the doctor-patient relationship first hand. Throughout high school and college, she explored the different types of medical specialties through volunteering and shadowing – which further confirmed that there was nothing else she’d rather do with her career. She followed that passion to Saint Vincent College and then to the University of Pittsburgh School of Medicine, earning her M.D. in 2014.

After graduating residency from Mayo Clinic in Rochester, Minnesota, Dr. Gentile was on staff there for two years while her husband finished his surgical residency. She says of her time there, “I was doing general primary care in the outpatient setting as well as inpatient medicine and teaching residents. It was a wonderful experience, but it in 2019, when my husband was done with training, it was time to move back home to Pittsburgh. I was offered jobs at the big box medical centers in the city, and something just didn’t feel right. My mentor and program director at Mayo pulled me aside one day and said, ‘I don’t think you’ll be happy doing general primary care at those places. You spend time with patients, they have your cell phone number. You need a setting to really practice Lifestyle Medicine and you won’t get that seeing patients every 10 minutes. Have you heard of direct primary care?’”

At that time, she hadn’t heard of it. Never through medical school, residency, or attending life had she been introduced to any other model of delivering medicine than the traditional, insurance-based approach. Dr. Gentile attended a direct primary care (DPC) conference not long thereafter and she was immediately sold. “I had met my people,” she says fondly. That simple question from her mentor sparked a passion and led Dr. Gentile on a journey that culminated in co-founding Direct Care Physicians of Pittsburgh and later founding Rebel Wellness, her medical practice and wellness studio located here in Pittsburgh.

Image: Janine Essey

Direct primary care is quickly gaining popularity in the United States. According to the study “Trends in Direct Primary Care” from Hint Health, DPC memberships are seeing an average annual growth of 36%, reaching a total growth rate of 241% from 2017-2021. However, it is still a model many are unfamiliar with. What sets direct care apart from a traditional medical practice is that DPC removes insurance from the equation completely. Patients pay a low monthly membership fee (in most cases less than $100 per month) and benefit from extended time and comprehensive evaluations with their doctor; direct access to their physician and often same-day or next-day appointments; no copays; greatly discounted medications, lab work, and radiology; continuity of care; and intensive lifestyle coaching. It is quite literally a direct relationship between patients and physicians.

No third party is dictating how often and for how long the physician can see the patient. Since it does not involve insurance, DPC doctors don’t turn a patient away at the door depending on what type of insurance they have. Sometimes confused with concierge medicine, DPC is different in that with concierge services, the (usually much higher) fees only get you in the door. DPC monthly fees include visits as well as the care provided.  As the website for Direct Care Physicians of Pittsburgh proclaims, direct care is “healthcare without the hassle.”

“What I always like to point out to people is that health insurance does not equal health assurance,” remarks Dr. Gentile. “It’s a prevalent thought in our society that as long as you have an insurance card, you’ll be okay. But oftentimes insurance dictates whether you can receive care at all – when the insurance company doesn’t know you, your history, or anything else about your specific situation. That is something that only a close relationship with a physician can achieve.”

That’s not to say patients should forego health insurance completely; it can and should be used for what it is intended: catastrophic health events, hospitalizations, surgeries, and the like. Dr. Gentile explains it as such: “If you think about car insurance, you use it for accidents or if your car needs extensive repairs. But you wouldn’t use it for an oil change or to buy gas.  That’s exactly what’s happening when you use health insurance for things like preventative care, small procedures, and routine exams.”

DPC is not only beneficial for the patient; physicians also see advantages in this model. “It’s so appealing to me because it allows true autonomy for the physician. And through the long visits with patients and the continuity over time, it gives patients true agency in their health. Autonomy and agency are lost in the traditional healthcare system. If you are practicing Family Medicine and Lifestyle Medicine in their truest sense, DPC is currently the only way to do that in this country.”

Family Medicine physicians are trained to do a large number of things including acute care, chronic disease management, preventive medicine, sexual health, mental health, dermatology, home visits, inpatient care, many different in-office procedures, and more. For a family doctor to really stay adept, as well as know their limits, ideally they need time and continuity with patients.

“When you are churning patients through in an insurance-based primary care clinic, the time is very limited. This means you aren’t regularly practicing those skill sets consistently. Also lost is the continuity, as most clinics these days are set up in a ‘team-based’ model where patients see whoever they can get an appointment with. Access is very limited and wait times can be 3-6 months. Lastly, the focus in these big box healthcare systems is making money. That pressure trickles down to the clinic to do the things that will bring in money, which in primary care include seeing as many patients as possible per day, billing for sick care as opposed to preventive care, and ordering more testing for the patient to have done within that same healthcare system” states Dr. Gentile.

On the contrary, in DPC, there is no “churn.” With visits lasting up to an hour if needed, a lot can be addressed.

Images: Janine Essey

The direct care model feels at once cutting edge and old school. While appearing to be the way of the future in order for patients to receive truly individualized care, it also has the nostalgic appeal of the family physician of decades past who made house calls and had a trusting relationship with every member of the family. This level of professional intimacy is certainly shaking things up in the healthcare industry during a time when widespread mistrust of the medical field is at an all-time high.

Disrupting the status quo in order to re-establish that trust and help patients achieve their healthcare goals is at the core of everything Dr. Gentile does. To say that her office is simply a medical practice would be a vast understatement. In addition to housing her medical office, the expansive space is home to Rebel Wellness, which includes a state-of-the-art learning kitchen where Dr. Gentile teaches how to prepare plant-based meals, and a large open studio where she leads group and 1-on-1 fitness and mindfulness classes.

“In my medical practice, I found myself showing patients how to do certain exercise moves and giving them personalized dietary advice – so including space to do that on a bigger scale was important when thinking about expanding my practice. So many times, folks have the experience of going to the doctor and being told they need to ‘eat healthier and exercise more’ without really getting any advice on how to incorporate that into their daily lives. I wanted to rebel against that experience and provide the community with a valuable service.”

“Rebel” is a word that came up time and again when speaking with Dr. Gentile and seems to be almost a mantra in her practice and her life. “I would definitely say that I am a rebel in a lot of ways, but rebel is also a verb, an action word. To rebel against something takes work.”

And work she does. Inside and outside the office, Dr. Gentile is an active member of the community. She is a Walk at Home program instructor, a board member of Plant Based PGH, and has led the Highland Park chapter of “Walk with a Doc” since 2020. “My goal has always been to make health education more easily accessible to the community. It can feel intimidating to ask questions in the exam room; there’s the ‘white coat’ effect that some people experience when talking to a doctor. That’s why programs like Walk with a Doc are so valuable. Just getting out of the office and walking and talking with people can change the conversation completely and open them up to asking more questions and learning about things we otherwise wouldn’t have a chat about.”

Opening up conversations around health and wellness also occurs on Dr. Gentile’s social media channels, where she often shares advice, recipes, fitness tips, and personal anecdotes about her life as a physician, business owner, wife, and mother. There is a level of vulnerability displayed that is not always seen from medical professionals. “I think being vulnerable and authentic with the world is important because it shows the human side of healthcare. So many times, patients view their doctors as not having the same struggles or issues in their lives. I am here to say, ‘this is really hard sometimes!’ As a doctor I’m not here to judge but rather to encourage and educate.”

Direct Care Physicians of Pittsburgh has several locations around the city. You can find more information about the practice at directcarepgh.com

Dr. Natalie Gentile’s office, as well as the
Rebel Wellness facility, is located at
201 South Highland Avenue, Pittsburgh 15206
and can be found online at rebelsinwellness.com

Follow Dr. Gentile on Instagram @nataliegentilemd