Having moved back to Columbus, Ohio exactly a year ago, I was ready to start my new job. Wanting to use my new health insurance and get an annual check-up soon, I needed to get myself a new Primary Care Physician (PCP). Let’s examine what how my experience went….
*Calls nearest primary care clinic*
Receptionist: Hello welcome to ABC Primary Care, how may I help you?
Me: Hi, I just moved here. I’m looking for a new doctor and an annual check-up
Receptionist: Oh I’m sorry, none of our doctors are accepting new patients at this time, try calling the XYZ Clinic
*Calls XYZ Clinic, which is happens to be 30 minutes away*
Me: Hi, I just moved here. Is your clinic accepting new patients?
Receptionist: (Paraphrasing) Our best doctors aren’t but one of our foreign sounding named doctors are.
Me: Sure, I would like to have an annual check-up as a first visit.
Receptionist: Alrighty, let’s see here, it looks like the first opening is three months from now. Shall I go ahead and schedule it for you?
Me: *Smacks my head* That’ll be fine I guess…….
The sad thing is, when I showed up for my annual check-up, I waited and waited until a back-up physician told me the PCP I was supposed to see was too busy.
This happens to be just one of the issues I have with the primary care today. My opinion also, is that younger healthier people are not using primary care the way it should be if at all. The fact of the matter is, I have many reasons to believe that the primary care system needs to be overhauled. Here’s why:
Human Nature doesn’t mesh with the Primary Care System today
Depending on where you live, PCP appointments can be hard to come by. As a relatively healthy person, the human nature in me says I don’t need to see a doctor unless I absolutely have to and even then, I can wait perhaps the next day. If you were to tell me I have to wait weeks for a PCP visit about a health concern that I have, I would’ve probably forgotten about it by the time the visit comes up on my calendar. This is why for someone my age, I don’t bother seeing my PCP anymore except for maybe routine things like … an annual check-up. PCP’s are suppose to be the consultants in your health and provide expertise in preventative and cost effective treatment. Instead, the PCP/Patient relationship has become dysfunctional as a result of overcapacity in the system and limited consultations.
Primary Care Physicians are a Dying Breed
The incentives to become a PCP are not enough to shift the current supply/demand equilibrium. As a matter of fact, the number of PCPs are on the decline while the number of new doctors entering the field has remained steady for the past decade. Also, according to Wikipedia -
“The number of medical students entering family practice training dropped by 50% between 1997 and 2005. In 1998, half of internal medicine residents chose primary care, but by 2006, over 80% became specialists.”
Primary Care is Unattractive
PCP’s are overworked and underpaid, period. Salary and compensation levels remain much lower compared to their specialist counterparts. Many long-time PCP’s have been forced to sell their practice or get acquired by a health system due to rising overhead and unsustainably low incomes. In order for accountable care to function properly, primary care needs to be sustainable and incentives need to be in place to keep doctors happy.
Some Ideas for Change:
Reform Medical Education
This piece often gets overlooked in the national debate for healthcare reform. There’s a certain hypocrisy surrounding the medical education system today.
The AMA remains adamant about keeping things within their scope of practice yet they continue to limit the supply of primary care physicians.
The AMA needs to sanction more medical schools and revise the medical education system to accelerate the supply of doctors. Instead, they are keeping the PCP supply low to maintain higher demand which equates to higher salaries.
To put things in perspective, 1,054 college programs received accreditation in 2012 alone. There hasn’t been a medical school accredited since 2010, and that’s only 12 schools since the year 2000.
In addition, there is absolutely NO transparency in the medical education system today. A medical degree will somehow set someone back over $250,000. Early in my career, my dream was to become a doctor and I went as far as taking the MCAT. I eventually gave up that dream as reality sets in… I couldn’t afford it and I couldn’t afford to put my family through it. Where is that money going? and why does tuition raises seem to correlate a lot with an individual’s maximum borrowing limit?
(I’ll give you a hint: it has to do with maximizing profits)
Allow the Scope of Practice to be Encroached Upon by Innovation
Primary care is becoming less and less about the expertise of licensed doctors and more about innovative ways for preventative treatment. I envision it will evolve into a network of technology, mid-level practitioners and an engaged patient who can utilize the system more effectively. Things like telemedicine, crowd-sourced medicine and having nurse practitioners provide care should be embraced and not rejected in order to preserve a way of life. Again, the AMA is lobbying hard to keep innovation from encroaching on traditional practice and patients like you and I have suffered to endure this. The AMA needs to relinquish their scope of practice and allow others to fulfill a demand they simply cannot meet.
Primary Care should be De-coupled on the Insurance Side
What I mean is that primary care should be separated from other outpatient, inpatient care as far as insurance goes. If you’re looking for an explanation, then ask yourself the following. Do you currently buy car insurance? Well, does your car insurance cover oil changes and maintenance checks? Let’s go deeper. Why are dental and vision insurance relatively cheaper?
The thing is, primary care claims equates to twice as many filings, which equates to extra overhead, which contributes to the overall cost to the healthcare system. De-coupling primary care from insurance means that insurance companies can focus their actuarial efforts on managing high-ticket items or they can offer primary care insurance as a stand-alone product. In addition, this allows people who don’t utilize primary services a chance to opt-out.
We’ve already begun to see a few pioneer clinics break away from the insurance model and accept cash payments only. Everyone knows how bundling will lead to upcharges, just read the New York Times article that came out recently about how Anesthesiologists bundled their services with colonoscopies to essentially double the price of the procedure.
Congratulations, you have endured my first rant post on my blog! Thanks for reading.