Two topics that have been flooding everyone’s timeline and twitter feed over the past few weeks: COVID-19 and remote work–or for our health care folks, virtual care. I won’t touch too much on COVID-19. There are tons of experts doing amazing work to help spread accurate public information, and I thank you all for everything that you’re doing.
As someone who has spent the majority of their health care career working remotely, and managing virtual care teams all over the world, I’ve learned a lot about communication, trust, and preparedness. What it has also taught me is the value of having access to that one person that is always up to date on your health, the health of the team, and the health status for the environment the team is operating in.
In the Navy and Marine Corps, we call these people “Docs.” A Doc can be a physician, a nurse, a physician’s assistant, or a hospital corpsman. Ultimately, they are responsible for ensuring mission readiness, but more importantly, they are responsible for the well-being of the entire team. In the Navy, I was this person, often traveling with bags full of medications, health records, medical supplies to ensure mission readiness. Spending hours researching local health reports on issues such as dengue fever, malaria, or SARS. Then I would go back to my team, provide a comprehensive report on what I learned, and allow them an opportunity to ask questions directly.
What’s interesting about my training and experience is that it essentially was the role of a primary care physician. A role that has since been declining in the United States and in multiple countries throughout the world. According to a JAMA Internal Medicine article, U.S. adults with a primary care physician fell from 77 percent in 2002 to 75 percent in 2015. Among 30-year-olds, the proportion dropped from 71 percent to 64 percent in that same period. To highlight the impact of decline over this time period, it would roughly represent the entire state of New Jersey. That’s almost 9 million Americans without a primary care physician.
So why the sudden decline in primary care, and how did we end up transitioning from a society with primary care physicians, to a society without primary care physicians? Well, what happened is the primary care physician was replaced by retail urgent care centers, telehealth chatbots, gig-economy telemedicine marketplaces, and other digital health engagement tools. What used to be the norm had eventually become so big it consumed itself, forcing a mass merger and acquisition wave that swept the nation. And If you weren’t caught by the M&A wave, you fell prey to market effects. Whereas those operating traditional medical practice models over-prioritized the operations and not the patient–leaving the backdoor open for pseudo primary care offerings to steal their patient’s hearts, minds, and wallets.
Now here we are, the coronavirus (COVID-19) has patients scared, nervous, under-prepared, with no one to trust or communicate with. Remember all those important things I talked about earlier? Those things that make a primary care physician valuable? They were reduced once we stopped utilizing them and accepted their replacements as viable alternatives. These are the consequences we are all experiencing in real-time. But let’s not overlook the fact that there are telehealth companies now offering online assessments to help keep low-risk patients from clogging up hospitals and other health care systems. Nonetheless, I like to keep it real and ask the hard questions. What would our experience be like right now if we all had access to a primary care physician? What would be the nation’s reaction, and would we be better prepared than we are now? Will the coronavirus make primary care physicians cool again?
For the sake of humanity and for the sake of the United States of America. I hope so.
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