In May of this year, Medical Economics published an article about independent physicians. For the first time, employed physicians outnumbered independent physicians. The American Medical Association conducted the Physician Benchmark Survey to analyze the ways physicians practice medicine and function within the healthcare infrastructure. The survey confirmed the increase in employed physicians but also hinted that the pendulum may be shifting back towards physician-owned practices. Doctors prefer autonomy. But, like everyone else, they want financial security. The uncertainty in the healthcare market lead to a variety of new, novel models of healthcare delivery. Some doctors converted their practices from insurance-based payment to direct-primary care models. Patients pay a monthly fee for access for their primary care needs. While this might seem ideal for both the doctor (who gets a guaranteed monthly revenue stream in the form of membership fees) and for patients (who can get immediate access and telemedicine appointments that fit their lifestyle) it lacks the finer fundamentals for most people and makes medical care more like a fast-food franchise: prices listed on the menu board for ordering. While Google and WebMD make medicine seem more and more like a D.I.Y. venture, most people still need a professional to sift through the science and help them make good choices about their care.
Most patients get their health coverage through their employers, so they need to use their insurance for health care access. Many patients do not have the expendable income for membership medical care. Having a direct primary care model practices also tends to limit population diversity and can lead to a very generic patient profile group. The heart of primary care is taking care of patients from cradle to grave, womb-to-tomb, and dealing with all manner of medical, psychological and social problems. And seeing patients from all walks of life. A patient’s community plays a role in their health and wellnes. For example, if a community loses a large employer (think West Virginia and the loss of coal mines or Detroit and the loss of auto manufacturing), then that whole community suffers that loss economically. And the impact is widespread: schools, churches, civic organizations, municipal tax revenue, hospital admissions…everything. Being a doctor for such a community means you feel those impacts, too. Converting to a direct primary care model will not insulate your practice from the economy.
It might alleviate the headaches of the insurance industry and all it manifestations of “cost-containment”: prior authorizations, formularies, approvals and referrals. But, the spirit of much of those components are well-intended. How can the insurance company help people be healthier while also managing cost? Sure, it can be frustrating, but the designed intent is to be HELPFUL for the patient. If primary care doctors want to be advocates for their patients, they work within these systems, but it is most efficient when the patient and their provider’s office work in a collaborative manner.
In the last 7 years, many primary care doctors elected to sell their practices to corporations or hospitals. Indeed, many specialists have, too. They become employees of a hospital corporation or a venture equity firm. Doctors (and their patients and the billings associated with their medical care) are now viewed as a speculative investment. Patients and their care are converted into the modern equivalent of a widget on a factory floor. Should patients be informed that their provider and the care they deliver is held by an equity firm? It is a new prospect that treats medical delivery as a venture capital endeavor. But, has the patient given consent for that? Should patients be asked if they consent to participate in that process?
At Primary Care Physicians, we believe in the value of independent, physician-owned practices. Our obligation is to our own Hippocratic Oath and to the pateints who have entrusted to us their health, wellness and care. The only risk in that relationship is between me and the patient: can they get an appointment today? Can I get them referred to the specialist they need? Can I get approval for that test or prescription we’ve agreed that they need to take every day? Any other model risks a conflict of interest. If I am owned or employeed by a hospital, then my mission gets rolled into the profitability of the hospital. If I am associated with a particular insurance company, then they want me to focus on cost-cutting measures that save THEM money, potentially at the expense of patients. My oath and my vocation is to a patient – A PERSON. It is a relationship. I serve as their advocate, their liaison, their caregiver. It is a trust thing.
Sure, we have a business to run. We have staff and payroll and overhead just like any other small business. But people aren’t widgets; their illnesses and fears should not become the new conveyor belts for profit margins. We must remember the care, compassion and respect each patient deserves and strive to be avaiable for them in those moments of need.