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Many physicians are troubled by changes they view as turning their profession into a commodity. But now is the time for action, not worry.
One of the favorite parts of my job is traveling the country and talking to physicians. Over the past few years, I’ve noticed that increasingly I’m playing the role of sounding board - and even occasionally therapist.
The issue is, of course, healthcare reform and the tremendous confusion, uncertainty, anxiety and at times anger it is creating.
I want to stress that by and large most doctors are 100 percent behind a system that ensures access to quality healthcare for all Americans. The frustration I’m seeing covers both sides of the political aisle. It’s about what many see as a market - and yes a political process - that is diluting the traditional relationship between patients and those physicians that provide primary care; the very foundation of a quality healthcare system.
The feeling of many physicians was summed up in an e-mail I received from a physician in Massachusetts. I thought I’d share what he had to say:
I know we’ve talked about this often, and I wanted to share a recent experience that has me troubled. I was recently at a meeting at which the new Health Insurance Exchange in my state was discussed. The newly minted chief marketing officer of the statewide exchange discussed its focus, implementation, and planned rollout. The room was filled with physicians, principally primary care, expressing concerns from their perspective. One issue was conspicuously left unanswered, despite numerous inquiries. With the current shortage of primary care in our community, where will all of these newly insured patients receive their primary care?
Sure there were plenty of questions about compensation and Patient-Centered Medical Homes, each of which was deflected to the insurers (who were, by the way, conspicuously absent). One attendee, an internist, referenced the movement afoot to facilitate primary care through licensing of physician extenders to practice independently, something which reportedly was facilitated by the recent law passed in Massachusetts. Another noted that commercial outlets such as pharmacies will soon be deploying ‘primary care’ through the availability of such providers.
This is the practical reality primary-care physicians now face as the Affordable Care Act unfolds. With so many people entering the system, primary care will become another commodity. There is little regard for the expertise learned by primary-care physicians during traditional medical training, nor the wisdom gained from years of practice caring for patients, nor the value of an ongoing relationship with a person.
Unfortunately I think this view of primary care is doomed to propagate and with it quality will be negatively impacted and compensation for good quality care further limited. Oddly enough, patients understand the value of a trusted physician who knows them and their families and they continue to seek out the care of well-regarded primary-care physicians.
The e-mail went on to express his frustrations - ones many of you likely feel as well. In my response, I tried to be understanding and also hopeful. Yes, we are in the midst of a tremendous sea change and change is difficult. I told this physician that the nation needed a wide range of healthcare options; we shouldn’t have a "one size fits all" approach. Some patients want and can benefit from a quick trip to the drug store to see a nurse practitioner - some will be happy with a medical home and multiple providers - and some want more. The good news is that millions of patients will continue to want a real relationship with their primary-care physician. And that meant there are still many options for MDs.
I shared my opinion that many physicians are finding that concierge medicine - and especially hybrid models or those that enable physicians and patients to have choices - are giving a lot of physicians some important breathing room and hope. They are helping to offset the uncertainty of care with a practice model that allows them to return to medicine the way they were taught. Plus that private source of revenue helps to take away the current uncertainty with reimbursement and increasing overheads.
In short, my message is that concierge care is a model of delivery that will not only survive the changes in healthcare, but also one that will better serve the needs of patients who do not wish to be herded into institutional clinics. It’s the best model I know for patients who want to ask the advice of their physician before taking an immunization; for patients whose complex interlacing medical conditions necessitate the training of a physician rather than that of an extender.
I'm not saying the next few years will be simple and not saying we shouldn’t all keep a wary eye on Washington D.C. and our states’ governing actions and become active in finding ways to have our voices be heard. I am saying now is the time to move forward with making changes that will allow you to care for patients the way you think is best and in a way that enables you to have rewarding professional life.
Are you worried about the influx of new patients? What are you doing to adjust? Adding more extenders, changing office hours? Tell me below in the comments section.