MSNBC has been making some noise recently about primary care physicians going off the grid to provide better care for patients who pay directly for services:
Patients face bitter choice: Pay up or lose care
Clinic with two doors, a symbol of two-tier care
Opinion: ‘Concierge’ is another word for bribe
The statements are stark and harsh:
- Getting a doc's time and attention shouldn't require a premium fee
- No one should have to pay more to get decent, unhurried and attentive care
- The whole system of primary care has broken down
I couldn't agree more. It infuriates me that the choice offered most physicians is between maintaining the status quo of low quality high volume care or exacerbating the physician shortage by downsizing, charging premium fees to deliver high quality to the few.
I've spent years studying the medical office practices and lead a national demonstration project showing how far we can go in delivery excellent care. The results are everything we want and need - high quality, terrific experience of care & bending the cost curve.
The problem is that this work is not valued in our current system. Docs who deliver high quality care, docs who provide decent, unhurried & attentive care are punished financially and end up losing their practices as they re-enter the indentured servitude of industrial medicine.
I've spent years trying to get the payers to provide the resources necessary to achieve & maintain high quality care. Everyone professes interest but pay only lip service. What makes me want to tear my hair out is that the extra primary care funding results in total costs substantially lower than maintaining the status quo.
I hate that we're forced into this dilemma:
Maintain the status quo while study after study demonstrate bad outcomes, lousy experience of care and outrageous high costs. Maintain the status quo that creates a prison-like atmosphere for primary care with docs in such abject misery that few medical students choose to enter primary care. Maintain the status quo that is the very root cause of the primary care shortage.
or
Do what we can now to deliver high quality care.
I know there's always a middle course, but right now I applaud those doctors who choose a path of quality in the face of misinformed accusations of unethical behavior. These practices are not holding their breath for health care reform that gets it all right. Many have taken the less traveled path to demonstrate that:
- High quality can be achieved now
- Primary care can be an excellent career choice
- Physicians can get out of jail and control their professional lives
Health care reform is a messy process during which we will see good ideas with unintended consequences. These docs are choosing to serve fewer people well & Congress is choosing to continue to leave millions of Americans out in the cold with no health coverage. Rather than lashing out let us work together to bridge these gaps so that we can live up to Dr. Cohen's comment:
The truth is, we all deserve the kind of attention from our doctors that our grandparents routinely expected and their doctors routinely supplied.
Amen to that.
Let's get back to a place where the doc didn't have to spend hours every day feeding the administrative trivia beast, playing 'prior authorization' and 'billing and coding jeopardy.' Let's get docs off the hamster wheel and give them the breathing room they need for decent, unhurried and attentive care.
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