Health Reform Makes New Demands on Physicians

I was talking to my hairdresser today about health care. She told me that she had to cancel her annual visit with her OB/GYN, and when she tried to reschedule, the receptionist informed her that the next appointment wouldn't be available for another nine months. Wanting to take advantage of her insurance company's free wellness benefit, my hairdresser looked around for a primary-care provider. She told me that numerous phone calls to area offices revealed multiple providers who are no longer accepting new patients, in part, she was told, because of healthcare reform.

I am not sure how to explain her difficulty finding a physician and was happy to hear that my clinic was able to provide her a timely appointment. However, my own primary-care physician acknowledged to me recently that she's had to change her appointment templates and scheduling rules to accommodate changing patient demands. As physicians try to find work-life balance, it's important to consider that our work is not static. As healthcare evolves and the manner in which it is provided and reimbursed continues to change, physicians will be required to rethink many aspects of their workday.

I've noticed, like my own family physician, an increased patient demand for "wellness" or physical exam appointments, yet those same patients balk at coming in for follow-up visits. If your experience has been like mine, your patients are not only expecting to have preventive-health topics covered at wellness visits, but also a comprehensive review of their chronic diseases, and assessment of acute concerns. Tempering my response to these requests is the patient satisfaction questionnaire each of my patients receive after their visit (upon which a portion of my compensation is based); my understanding that as preventive health services are increasingly being covered, deductibles and costs for nonpreventive healthcare are growing for patients (and own family as well); and my desire to accommodate the patient by jamming a visit with as much care as I can.

My clinic schedule and work flow is still set up like "Marcus Welby, MD," to a large extent. I have a series of scheduled patients and my nursing staff interrupts me in-between patients with all kinds of requests and questions. However, very few of my appointments are actually for a simple strep throat or an ankle sprain. Most are a combination of preventive, acute, and chronic disease care. Since chronic disease care is a team sport, I can't shoulder the burden of the work associated with these visits alone, and my clinic is not set up to help me to the degree I need.

I suspect that my hairdresser's experience is the tip of an iceberg that we may not be expecting. More is changing in healthcare delivery than just an increase in the number of insured patients. As healthcare reform continues to evolve, our entire way of providing care must change in order to manage what we are being asked to do, what insurers are paying for, and what patients demand.