It's about time PCPs say enough is enough

Editor's Note: Welcome to Medical Economics' blog section 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 Medical Economics or UBM Medica.

It’s about time-time to recognize that primary care physicians (PCPs) need more time with their patients.  

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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.

Next: Time for a real change

It’s about time for employers to realize that superb primary care means better health, less lost work days, greater satisfaction, greater productivity and a significant drop in the employers’ total health care costs. What to do? Support clinics that assign limited numbers of patients (employees) to each PCP or place dollars in an HSA account that can be used by the individual to buy retainer/membership of a direct primary care physician.

It’s about time for patients to realize that high quality primary care is worth the price. We are used to the concept that insurance “pays for everything.” But with high-deductible policies, we will pay for primary care out of pocket anyway. So get rid of the insurer middle man and select a PCP who will give you the time you need.

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It’s about time for PCPs to individually decide that “I’m not going to take it any longer” and make the switch to a practice that pays as well but allows the time necessary with each patient. Reducing from 2,500 to 3,000 or more patients to 500 to 700 allows reducing the patients seen per day from 24 to 30 down to about 10 to 12. Called direct pay, direct primary care, membership, retainer-based or concierge, the concept is to offer each patient same or next day appointments lasting as long as needed, extensive wellness and preventive care, use of email and access to the PCP’s personal cell phone 24/7.  

It is about time for primary care physicians to understand that no one else will force the changes needed so that they must work together through organizations like Primary Care Progress to advocate for change.

It about time for medical students to realize that they actually can have a satisfying career in primary care provided they opt for a practice model that allots the time needed for each patient yet earns them a similar income.

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It’s about time patients need doctors that offer enough time. PCPs need time: time to listen, to think, to treat, to prevent. Absent such time, the United States will continue to experience a crisis in primary care-a crisis that means frustrated PCPs, dissatisfied patients, less-than-ideal care and an increasing shortage of PCPs, and with all of this, a continued increase in the rapidly growing cost of care.

It’s about time for a change.