Top challenges of 2022, No. 4: Increased competition

Medical Economics Journal, Medical Economics January 2022, Volume 99, Issue 1

Editor's Note: The past year has been one of the most challenging on record for U.S. physicians. After the lockdowns and telehealth surge of 2020, the year 2021 has been strange. Although things went back to “normal” in that most practices resumed seeing patients in person, the COVID-19 pandemic and its challenges remain. As we do each year, Medical Economics® surveyed our audience to find out what the big challenges were. By far, the top answer was “administrative burdens” including staffing, prior authorizations and electronic health records (EHRs). We decided to take a closer look at what these burdens entail, to help physicians get ready for whatever challenges 2022 will bring. Here's number four.

Physicians are not the only option when it comes to primary care services. As venture capital firms, giant tech corporations and pharmacy chains jump into the retail, urgent and primary care space, it is becoming more challenging for traditional practices to stand out.

The competitive landscape is changing quickly. In October, for example, Walgreens announced it was investing $5.2 billion in VillageMD to open primary care clinics in its retail pharmacies. It does not stop there. CVS has MinuteClinic and HealthHUB primary care services in thousands of locations in the United States. Amazon and Walmart have been exploring the landscape as well.

This trend has been exacerbated by the COVID-19 pandemic and patients’ increased comfortability with telehealth services. Although the use of telehealth has fallen in 2021 compared to its 2020 highs, patients know what to expect from these services. Physicians will likely have to deal with growing competition from telehealth-only providers. For example, UnitedHealthcare announced earlier this year it is launching a “virtual first” health plan in which a patient is encouraged to choose an online doctor who acts as a first point of contact for most primary care and referral services.

It leaves primary care physicians in a bind. Not only do retail and other alternative care settings steal patients away, but they take mostly the lower-complexity cases, depriving practices of easier revenue and leaving physicians to deal with more complex, difficult cases.

“The expectations on primary care are so overwhelming,” says David Boles, D.O., a family physician in Clarksville, Tennessee. “Then you throw on top of that a walk-in clinic right down the street that doesn’t deal with any of those things and sees this person for a minor problem and gets paid similar to what we do for an office visit. They get the icing, and the real meat of the issue is left to us.”

How can physicians in traditional practices compete? Here are some strategies.

You know telehealth — use it

Patients want convenient services. Telehealth is one way to meet patients when, how and where they want to see their physician. It is something most physicians have had lots of practice with since the pandemic began. If your virtual care program has gone dormant as your practice opened to in-person appointments, dust off the cobwebs and get going again.

Be available

Patients do not get sick only during business hours; offering a few Saturday appointments no longer caters to their busy lifestyles. With urgent care centers and retail clinics offering extended hours daily, if a practice does not adapt its schedule to its patients, they will seek care from a place that does.

Make it easy — and do not make them wait

Patients do not want to spend 15 minutes on hold with your front desk to make an appointment. Practices need to offer online scheduling to make it easier for patients to book an appointment.

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

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. Medical practices must embrace it as well.