Putting patients first by letting patients go

Like many primary care physicians in this health care marketplace, I found myself operating on a hamster wheel of volume care, seeing more and more patients and spending less and less time with them.  The pressure on my practice, my patients and my staff was unsustainable.  With new regulations and declining reimbursements, there was no way to provide the levels of support and service that are so important, especially to older patients or my more vulnerable patients who juggle complex situations.

My patients wanted more from my staff and me, and as their physician, I wanted to ensure their needs were met. That’s why five years ago, I started my hybrid concierge program.  A hybrid concierge program is different than more commonly known concierge programs in that it allowed me to offer concierge service to those patients who join, while continuing to care for my traditional patients.  It gave me breathing room in my schedule. For at least part of my day, I could take a step back and practice at a slower pace, to provide the counsel and care coordination that, in traditional practices, there just isn’t time for anymore.

I didn’t know what to expect.  I was devoted to my patients, and I didn’t want them to feel pressured to join my concierge program, but I did want them to know that more time with me was possible, if they felt they needed it.  The results were overwhelming.  My hybrid program was filled immediately and remained full, with a waiting list.

It became clear to me that as much as primary care physicians like me were struggling under the immense pressure put on the health system, patients were struggling too. The population is getting older.  Baby boomers are entering retirement.  Adult children are moving away from home leaving aging parents to navigate a complex, often digital, health system entirely on their own.  This hasn’t been easy for anyone.  It hasn’t been easy for me to provide a senior with a list of referrals to a specialist and not help them secure that appointment. It isn’t easy for an elderly patient to sort through a complicated phone bank and then wait on hold just to make an appointment.  It hasn’t been easy for me as I worry about whether that patient is scheduling the follow-up appointment I insisted upon. And I know it isn’t easy for my busy patients to take off work and spend extended time waiting for their appointment to start.

During concierge hours, I didn’t have to worry as much, and neither did my patients.  Because of the limited nature of the program, I had the time to personally follow up with patients, to make sure my staff helped them schedule appointments with specialists. I was able to have telephone consultations with out-of-state family members who manage the care of their parents. Patients with medical concerns were able to reach me directly, even after hours. They knew that when they came in for their appointments, they would always see me—not another provider in my group. Caring for patients in this manner was the way I dreamed of practicing when I was a student. I wanted to be the community doctor that helped not just with prescriptions, but with prevention. I wanted to be there for my patients when they needed me most.

As the months turned into years, demand for my concierge services increased.  I let my hybrid program grow a bit.  Then a bit more.  I had to stop accepting new patients—there was no choice.  And then I finally had to make the hard decision to end my traditional practice altogether.  This was a tough decision to make, but turning away patients who needed the extra services my concierge program offered was also difficult.  I couldn’t juggle it all and be the doctor I wanted to be.

The real story here is not me. It’s the patients.  Why would so many patients be willing to pay an annual membership fee to be seen by a primary care doctor, in an era where urgent care clinics and minute clinics abound?

It’s because good health is personal, and there aren’t enough doctors in my area to care for each patient with the attention and support they deserve.  It’s because people are aging, and it’s important for doctors to be able to see the nuance in their patients — not just in their blood pressure, but in their attitude.  How could a doctor who doesn’t know a patient tell if the patient looks worn out?  Pale?  Depressed?  There is no substitute for a doctor who knows you.  There is no substitute for a doctor who has time to encourage you and motivate you to stick with a medication or treatment plan, a weight loss program, to nurse you through a challenging break up, the death of a loved one.  For adult children with full-time jobs and families of their own, there is no substitute for the ability to send a quick email to mom’s doctor asking if sore muscles is a side effect of the new medication, or to let the doctor know she’s feeling better and her appetite is back.

The health care marketplace is trying to make quality health care accessible to patients by adding providers at a multitude of levels and locations.  There are minute-clinics at drug stores, urgent care clinics for everything from pediatrics to orthopedics. But to merely have access to medical care isn’t the only thing that’s important to good health.  Patients need peace of mind, compassion, care coordination, and coaching.  They need to know they are getting advice from a person they trust.  And that’s why my practice was able to successfully introduce a hybrid concierge program and why we made the transition to full concierge.  These choices aren’t easy for patients to make, but concierge medicine isn’t a luxury anymore.  And practicing medicine in this volume care climate isn’t easy for physicians either.

Cynthia Williams is an internal medicine physician.

Image credit: Shutterstock.com

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