Last week, a patient with severe gastroparesis came in for an unexpected visit. She seemed very upset, on the verge of tears. Instead of asking her why she was in, I asked her why she was so sad.
“My hematologist just retired; I was her last patient. I don’t know who will take care of me like she did. And she wasn’t even old enough to retire,” she said. This took me back to a phone call I had a few weeks ago with a good friend and pediatrician, who also mentioned that her practice was closing shop, and she planned to work for an urgent care center. It turns out that both these medical practices had not turned in a take-home salary for their respective owner physicians for over a year.
The next day, my first two patients were husband and wife, who receive their primary care from a very busy medical practice. At the end of their visit, they asked me hesitantly, “Doctor, can you recommend a good family doctor for us? Our doctor just doesn’t seem to have time for us.” My first patient the following day, was a new patient who found me via an internet search. This patient too had a very busy and successful internist as his PCP. Immediately after his first visit me, he asked me the same question as the couple mentioned earlier, for the same reason.
These interactions with my patients made me think about why caring and dedicated physicians are being driven out of medicine. And why do those doctors we perceive as successful, not have enough time for their patients? There is something seriously wrong with this picture! The only explanation in my mind is the perverse economics of medical practice. We are paid for actions third parties consider valuable, but we know are worthless for patients, and not paid for what we know will help and patients consider of high value. I also realized that many “successful” practices were those that contracted with every insurance plan in the region, resulting in massive costs associated with compliance with such plans. This leads to overbooking and ultra-short interaction time between physician and patient. This is what I explained to my patients, this backward system, as the main reason their doctors do not have enough time for them.
So how do we as a society, decide where our health care dollars go? How do we as a medical profession decide where our loyalties should be? These are difficult questions, if we believe that third parties can determine the best value for the health care dollar. These are easy questions if we come to the decision that patients should make the value judgment.
The people that can truly upend this perverse economic model are indeed patients armed with proper knowledge about health insurance and the free enterprise system. We physicians can help them regain control of their health care dollar by spending a few minutes educating them, the health care consumer, one patient at a time. We can also educate our patients’ employers on how to purchase health care at a higher value than the current perverse methods. We physicians can innovate and create our own models that provide high-value care for our patients and their employers, such as what my local (endocrine and nutrition) colleagues and I have done. I know that patients and employers are waiting for better options.
The challenge to my colleagues is, are you up to the task?
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