Like characters in a Dickens novel health care in the US demonstrates the best of times and worst of times. We hear real horror stories and witness spots of brilliance. My heart is heavy as Dr E's light is extinguished but gladdened by Dr B's resurgent hope.
These anecdotes highlight both the urgent need to change and what that change might bring.
We are crushing primary care practices with payment policies that fail to account for much of the work we should do on behalf of those we serve. We exacerbate inadequate payment with unfunded mandates calling physicians away from their patients to address administrative trivia. We thwart effective care with denials, delays, and mind-numbing bureaucracy that sap the time and destroy the spirit of the primary care work force.
But some physicians have figured out how to work outside this toxic environment and deliver great care in vital and satisfying practices. They enjoy their work and the finances are lined up with doing right by their patients. They are professionally and personally satisfied and delivering care in a supportive environment.
The worst of times
I've known Dr. E for years. His soft caring voice and gentle manner must touch a lot of his patients. As a primary care physician with a long career he has deep relationships with the people he serves that give him great insight into the right treatment recommendations and the compassion that is core to our work.
Dr. E can't sustain his primary care practice any more. He's crushed by the administrative burden of the paperwork, the denials, the rejections that dog his every move to care for his patients.
The toxic policy environment takes down another good PCP and leaves a large number of people to seek care from strangers.
I enjoy practicing medicine. But I hate spending so much time and energy dealing with the barriers and controlling inequities that 3rd party payers impose on my time and energy. I am deciding to wind down over the next year or two, giving patients time to find other providers (I have a lot of Medicare pts who will not be happy about the task of searching for someone who accepts Medicare). I just this week, called our local free clinic and told them I would volunteer for an additional day each month (if I am going to provide free care to patients under the disguise of insurance companies who refuse to pay, I might as well avoid the hassles of dealing with them and up front, give care away ). I can do locums work for 6-8 days/ month and earn as much as I do now working 5 long days each week. What is wrong with this picture. Sorry to sound so discouraged.
The best of times
But not all environments are equally toxic and some have found ways to thrive.
I was basically inspired by Obama "to be the change" and somehow decided to risk everything on some vague notion I had on how to create a medical clinic. It was a bit of an experiment in some ways where I wanted to show that a Jr doctor with no name recognition, zero patients, no funding, and no media coverage could incorporate design into a medical environment and harness the power of social media to build a large and successful practice. After 13 months and starting with zero patients, we are now staffed and open 7 days a week with 4 doctors and have seen over 3,300 patient visits in a fee for service model. We have seen around 2,400 unique individuals and are averaging 7 new patients daily.
Here's the predominant tone of patient experience in his practice:
This is the way medicine used to be and this is a refreshing change to the managed care that medicine has become. He reminds me of my grandfather who was a physician in a small town in Kansas.
I think I just found my new primary care establishment. Right price, great service, and best of all, they value my time as much as their own.