Why primary care is due for a renaissance

At a time when half of primary care doctors say they’d leave medicine if they had an alternative and the NY Times reports on a family physician who can’t give away his practice this hardly seems like the obvious time to claim that primary care is positioned for a renaissance. However, if there’s one thing savvy investors have demonstrated, when everyone says to invest in something that is usually the time to get out. Conversely, when the conventional wisdom is to avoid something, that’s often the time savvy investors jump in.

For my money, if I could invest in family medicine residency programs right now, I would. As the national conference for family medicine residents and medical students takes place this week, they should feel emboldened that they have made the right decision. Hats off to them for following their passion and bucking conventional wisdom when people told them to avoid family medicine.

The following reasons are why I believe primary care is due for a renaissance:

  1. Some of the most successful entrepreneurs and venture capitalists of the last 20 years are investing in primary care based practices. Benchmark Capital is one of the most well regarded venture capitalists with investments in organizations such as eBay and Twitter. They have been a major backer of One Medical Group which has had great success with their primary care model. The founders of Amazon, Dell and Expedia have backed Qliance, one of the pioneers of the direct primary care model. These investors know about disrupting the status quo. Whereas traditional practices have been slow to adopt technology, these organizations are using technology as a point of differentiation.
  2. The rise of onsite clinics that have primary care as their foundation continues to create more demand for primary care doctors. Dissatisfaction by purchasers of healthcare will continue to expand the onsite clinic trend.
  3. Retainer-based direct primary care is exploding around the country providing an alternative for primary care physicians to the insurance bureaucracy laden model most practice in. Earlier Brian Forrest’s Direct Pay Health was profiled on KevinMD. Separately, I called Samir Qamar’s MedLion the most important organization in Silicon Valley no one had heard about. They’ve proven a model that is affordable and effective while providing primary care physicians with a much improved professional experience.
  4. Simple laws of supply and demand. There’s already a shortage of primary care. Look to Massachusetts to see the further demands expanding coverage has put on primary care.  While one can argue the merits of that health reform, it’s indisputable that it has created more demands on primary care. Analysts believe a core reason CIGNA and Humana have bought onsite clinic businesses is to ensure they have a supply of primary care physicians as demand increases for primary care.
  5. In the so-called “Pharma 3.0″ trend, pharmaceutical companies are repositioning themselves as “health outcomes” companies. Major players I’ve spoken with are putting primary care as central focus areas which is a shift from where many of them have focused. In one case, they are already delivering primary care themselves.
  6. As the Chief Technology Officer of the U.S. outlined in this video on market opportunities in healthcare innovation, the reimbursement model is radically shifting. With Patient Centered Medical Home (PCMH) pilots consistently showing positive return on investment, the PCMH pilots coming out of the federal reform set up a major shift in reimbursement as outlined in the video segment. If they show, as they have virtually everywhere else, that there’s a positive ROI, Medicare reimbursement can shift without any congressional action. With Medicare reimbursement driving overall reimbursement, the impact of that would be massive.
  7. Studies such as IBM’s global study on the $2B they spend annually on healthcare have produced a consistent conclusion. That is, the formula is quite simple. The countries with the highest proportion of primary care have the healthiest populations and spend lower per capita on healthcare. Every government and business is budget constrained and these findings will be hard to ignore.

The knee-jerk reaction to the predicted renaissance of primary care is to believe it will come at the expense of specialists. As I commented in an earlier piece on Direct Primary Care, that potential zero-sum-game is the elephant in the room, but the biggest fat in the system is burdening day-to-day healthcare with insurance bureaucracy. Physicians would be well advised to address that rather than fight amongst themselves in my opinion.

No renaissance comes without some bumps in the road, but I’d argue that the next twenty years of primary care will be far better than the last twenty.

Dave Chase is CEO of Avado.com, a Patient Relationship Management software company, previously founded Microsoft’s Health business and was a consultant with Accenture’s Healthcare Practice.  He can be found on Twitter @chasedave.

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  • Anonymous

    What’s stopping you from investing in family practice residencies? Just an off the cuff idea — Offer to subsidize salaries or pay back student loans in return for a percentage of future income if you think they are going to make money. Offer to set up practices similarly. Contrarian investing is great, when it works but the guy that built the last buggy-whip factory thought those stupid automobiles would never last.

    99% of what a family practice doctor does can be done more cheaply by NP/PAs and while individuals may buy the argument that they do not do so at the same quality, the government is quite happy to get 80% of the quality for 50% of the price ESPECIALLY when they have defined quality as ability to comply with guidelines.

  • Anonymous

    The current patient centered care model promoted by the AAFP will see the NP/PA takeover of primary care.  If I called my doctor today for an urgent need, I would see the NP.  I only see my physician for my yearly physicial/medication refill, something the NP could do as efficiently and effectively.  While my doctor supposedly looks over the NP’s shoulder, I have never had the diagnosis and treatment of the NP questioned by the doctor, even when it was wrong.

    My husband was recently hospitalized and he saw plenty of physicians assistants.  He was in the hospital for 12 hours before we met the doctor in charge of his care.  We saw a doctor again at his release from the hospital…not the same one, of course.  I predict primary care will follow this model.  Clinics will hire physicians to oversee the work of NP/PA’s…interaction with the patient-optional.

    Direct pay may work for those financially solvent enough to pay the extra income.  Catastrophic health care plans still contract with providers, driving administrative costs up for providers.  A true direct pay would not involve an insurance company at all.  If money is tight, do I want to spent all that money on primary care and not have it count toward my deductible?  And what about a direct pay nurse practitioner?  50% less seems a lot more affordable for that standard medication refill appointment.

  • A Patrick Jonas

    Dave, thanks for your optimism. The response from e-patient seems to have a better vision of what’s really going to happen.  Time will tell.
    APJonas, MD

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