Many readers know that I co-authored an Annals of Internal Medicine article on retainer medicine. The article has received (as expected) mixed reviews, because the concept causes angst for some physicians.
I believe (and I will not speak in this rant for my co-author) that retainer medicine emerged because of the current payment system. Retainer medicine is a response to burnout. Yes, many retainer physicians are making more money. Is that a crime?
I pose this question for opponents. Where is the professionalism of having to see patients in 15 minute blocks? Where is the professionalism of seeing too many patients in one day?
Some critics want data. I would argue that even if we had presented data (which are available), they would argue that the data are tainted.
We are unlikely to get universal agreement on this issue.
We tried to explain (given a limited word count) that retainer medicine is ethical and may represent a better practice model. I doubt that anyone believes that you can provide quality care of complex patients in 15 minute blocks. I believe that every good physician will admit that more time equals better care (up to some limit).
Primary care (which I do not do any more) is in crisis. The crisis has emerged from the combination of payment structures and every increasing overhead.
If we do not learn from the retainer medicine movement then we are ostriches. Perhaps some observers enjoy suggesting that a growing number of physicians are practicing unethical medicine. That opinion carries a world view that I find narrow.
Talk with physicians considering the switch to retainer medicine. Talk with practicing physicians and understand their frustrations. Learn from a bottom up movement. Perhaps through an understanding of why physicians and patients find this movement attractive we can all understand how we must restructure our health care system. Our current payment system is badly broken, we should look for ideas for a new payment system from every successful experiment.
Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.
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