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For the second time in the last six months, a Northern Light Health provider, frustrated with the overall state of the health care system, is leaving the organization to open a direct primary care practice in Presque Isle.
Judi Pimental, a family nurse practitioner at Northern Light’s Presque Isle walk-in care facility and former primary care provider at the health care giant’s office in Fort Fairfield, is set to open Trinity Direct Primary Care at 167 Academy St. on Jan. 5.
It’s another example of how the insurance-free, subscription-based direct primary care model has exploded in Maine and across the U.S. in recent years as patients and providers alike become disillusioned with the state of health care.
“The way that the system is set up, I don’t think that it’s really patient-centered,” Pimental said. “I’m excited about being a patient-centered clinic.”
Direct primary care is built around that patient-first ideal. The model sells itself on longer visits and greater access to your primary care provider, who is not strapped with the quotas and rigid schedules that burden traditional providers.
That’s because most practices, like Pimental’s, do not bill insurance. Patients instead pay a flat monthly fee for access to most things typically offered under the primary care umbrella without the surcharges added in the traditional “fee-for-service” model. For Trinity DPC, that fee will be $89 a month for individuals or $159 for couples.
“I don’t think anyone was hindering me at my employer’s, but red tape hinders you when they’ve got a quota to meet and the insurance companies have their bottom line,” Pimental said. “I’m looking forward to cutting loose from that bottom line and actually making sure I’m worried about what [the patient] needs.”
It’s a reality she said is not always possible under traditional primary care.
A patient may have a 20-minute appointment. Of that, 8 to 12 minutes is spent with the nurse, leaving the provider 8 to 12 minutes with the patient, which isn’t enough time to deal with chronic conditions. And people have to wait so long to see their providers that they have a list, she said.
“When you don’t have the time to really dissect what’s going on with the patient, it’s not just frustrating for the patient, it’s frustrating for the provider as well,” Pimental said. “I left primary care because I felt like I wasn’t able to do the job that I really wanted to do.”
Pimental calls primary care her passion. But those issues caused her to leave it after five years in Fort Fairfield to become the director of the Mi’kmaq Family Health Clinic in Presque Isle. She rejoined Northern Light on its walk-in care team in 2024, but primary care still called her.
In September, she decided to pursue her own practice. Three months later, Trinity DPC is preparing to open its doors. Pimental will accept around 400 patients, she said, and has already seen healthy preenrollment. Her practice will be for adults 18 or older, a contrast to the pediatric-based Lionheart DPC, Presque Isle’s first direct primary care clinic that opened in September.
Maria Rutmann, Lionheart’s owner and provider, also left Northern Light to open her practice and has helped Pimental as she launches her clinic.
“She’s mentored me a tremendous amount throughout this whole process,” Pimental said. “As soon as she heard that the bug was in my ear, she’s been like ‘You’ve got to do it.’”
Trinity will be the third direct primary care practice in Aroostook County, alongside Lionheart and Phoenix Direct Care in Caribou, which opened in 2018. There are at least 30 practices in Maine and there were more than 2,600 in the U.S. by the end of 2024, according to an estimate by online resource hub DPC Frontier. That’s an increase of at least 500 from the previous July.
The service, its providers emphasize, does not replace insurance, which is still needed for emergency care and prescription medicine. They hope rising interest in direct primary care will force insurance companies to offer more catastrophic insurance, which covers those missing pieces and lowers premiums versus typical health insurance.
But in the meantime, Pimental — who uses direct primary care herself — believes the model still makes sense financially.
“If you’re visiting the urgent care center, even if you have great insurance, there’s usually at least a $50 copay associated with that,” Pimental said. “A primary care membership is $89 a month. If you — God forbid — visit urgent care twice in a month, that’s $100.”
And with easier access to primary, preventive care, she hopes her patients will avoid many issues before they become emergencies.
“If I don’t know the answer, I will be very honest and tell you, ‘You know what? I don’t know, but we’re going to find out together,’” Pimental said. “I think that’s a huge strength, but you don’t have the time to do that in traditional medicine in my opinion right now.”