Let’s Take Back Primary Care
As a primary care physician in the community, I have seen many of my brethren have to call solo practice quits. Their large overheads combined with poor third-party reimbursements and bad debt have forced many to seek employment within large hospital systems or retire early from healthcare. Primary care physicians are looked at by for-profit entities as a way to attract patients to these physician employers only to generate more money for these for-profit entities or hospital systems. By employing primary care, this feeds into these hospital systems where more testing and high-end referrals to specialists that are also employed by “the system”. The irony in all this is that hospital based primary care clinics are at best break-even propositions or loss leaders for the system. To think that insurance companies or Medicare will pay much more for this primary care network is a “pipe dream”. The overhead in these clinics is astronomical but subsidized by hospital systems.
The bottom line is that the providers are mere employees and told how many patients to see and must hold to these outrageous “quality initiative” standards or else they will not get their bonus. Quality family time comes at a premium and being told what days you can have off can be somewhat humiliating. It is no surprise the physician “burnout” is at an all time high, upwards of 80% in some surveys.
Taking back our primary care livelihood is possible and necessary. Our communities need good primary care providers that listen and incorporate sound medical advice that keeps patients healthy and saves the system money. By spending more time with patients and listening, proper diagnosis can be given, and cost-effective healthcare can take place.
Solo practice is starting to make a comeback within the micropractice environment. Doctors are taking their lives back by minimizing overhead and incorporating multiple payor models. To see only 10 patients/day and make just as much or more than our employed brethren is all too common. No need to keep up with crazy quality initiatives and spending more quality time with family are common themes in these practice settings.
To bring back the “old days” of primary care where the physician is in charge and able to deliver the care people deserve is very possible. There is no risk taking here, primary care is needed everywhere and as long as overhead is kept to a minimum, more and more medical students will opt for this lifestyle. Trust me, I have lived it and helped others achieve this goal.