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Top Challenges 2021: #6 Increased competition

Medical Economics JournalMedical Economics January 2021
Volume 98
Issue 01

In late 2020, Medical Economics® asked our physician audience what they thought would be the most challenging issues they will face this year. This is what they told us.

Primary care doctors must adapt their practice to survive competitive pressure from every direction.

A primary care physician in many places can drive down the street and see competition on the rise, but it’s not from other doctors’ offices. Pharmacy chains and even some retailers are vying for the same patients but often have far more resources than the average primary care doctor. In addition, nonphysician providers are gaining increased independence, siphoning off low-acuity patients and their reimbursement.

In the past, nurse practitioners (NP) usually had to practice under a doctor’s supervision. Now, 29 states allow NPs to operate independently and the largest growth was in outpatient clinics. CMS reported that Medicare office visits provided by NPs and physician assistants rose from 4.6% to 12.3% between 2010 and 2017.

CVS Pharmacy, which already had more than 1,000 MinuteClinics focusing on basic care, is rolling out 1,500 HealthHUBs by 2021 that will focus on chronic disease management and blood draws. Amazon is testing clinics to provide care for its thousands of employees, Walgreens is planning to open more than 500 primary care clinics in its stores over the next five years, and Walmart is increasing its commitment to health care clinics in or near its stores.

Experts say that if a primary care practice wants to survive, it must adapt to the realities of this hypercompetitive market.

“Health care delivery in traditional clinics really is going to have to evolve to be quicker, better, cheaper and faster in order for people to be satisfied with it,” says Hajde.

Here are the key strategies experts recommend:


Patients don’t get sick only during business hours and offering a few Saturday appointments no longer caters to their busy lifestyles. With urgent cares and retail clinics offering extended hours daily, if a practice doesn’t adapt its schedule to its patients, they’ll get their care from a place that does.

Easy online appointment-setting

Patients don’t want to spend 15 minutes on hold to make an appointment. Practices need to offer online scheduling to make it easier for patients to book an appointment.

Minimized wait times

Patients expect the doctor to see them within about 15 minutes of their appointment time. Consider implementing a system that texts patients updates on wait times, allowing them to adjust their arrival to reflect the doctor’s current schedule.

Updated waiting rooms

Free Wi-Fi, coffee and water are the minimum. A modern design with comfortable furniture and natural lighting will put patients at ease and make them feel valued. A dingy room plastered with warnings and payment notices isn’t exactly customer friendly.

Streamlined paperwork
The more forms that can be filled out electronically and in advance, the better. No one wants to sit in a waiting room filling out forms on a clipboard that could easily have been done the night before. Checkout should be just as easy, with little or no time spent standing in line.

Quick responses to questions

Patients expect a response to questions posed via email or an EHR portal in 24 hours or less. This timeframe is basic business protocol established by the retail and service industry and medical practices must embrace it as well.

Transparent pricing

Patients expect guidance on how much services will cost, what will be covered by their insurance and what will not. If a referral is made, the patient should be informed whether it will be in network or out of network. Any bill sent by the office (or better yet, presented online), should be easy to read and understand.

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