Editor's Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Stephen C. Schimpff, MD, a quasi-retired internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center, and author. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
It’s about time—time to recognize that primary care physicians (PCPs) need more time with their patients.
PCPs have no time because they need to see too many patients per day to cover rising overhead costs. Short visits, often 15 minutes with even less face time, mean more difficult issues solvable by the PCP get referred to a specialist or lead to a prescription when lifestyle changes could have been appropriate.
Certainly, 15 minutes is not enough time for an elderly patient with impaired vision, hearing or cognition nor for the patient with multiple chronic illnesses and on multiple prescription medications now presenting with a new problem. It is not enough time for a person whose problem is underlying anxiety who needs empathetic listening. It is not enough time to develop and maintain a trusting relationship—the essential ingredient of the doctor-patient interaction.
It’s about time to appreciate that primary care is not just the simple stuff like a sore throat or a sprained ankle, but includes wellness, health maintenance, prevention, management of complex chronic illnesses like heart failure and diabetes and care coordination among various providers. When the PCP has the time to give such truly comprehensive care, the costs of primary care do go up, but the total costs of care come down substantially as demonstrated by multiple reports. It’s a good return on the financial investment, reduces physician frustrations, increases patient satisfaction, and of course, means higher quality care all around.
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It’s about time for insurers to recognize that their combined approach of using price controls on reimbursement and of constantly adding extraneous work requirements has led to a serious conundrum. PCPs now see two times as many patients per day but earn the same income (inflation adjusted) as decades ago. But that means short appointments. That’s not adequate. So it’s time for insurers to look at new models, models that grant more time to each patient.