Primary care physicians (PCPs) are incredibly frustrated. This level of frustration should be a wakeup call. The greatest frustration is “Time, time, time”- or more precisely, a lack of time. From in depth interviews with over 30 PCPs, everyone said lack of time was the greatest frustration of their practice (or was previously if they now were in a practice that limited the patient number to a manageable level.) Each knew that they could not give the time needed to give the level of care that they were capable of giving and that their patients deserved.
Stated somewhat differently, they said that it was very frustrating to always be focused on meeting overheads and trying to earn what they thought was a reasonable income because to do so meant less time with patients and a sense of frustration and perhaps even guilt. New practice patterns have meant not being readily available to patients, not visiting them at the hospital or ER, and no longer being the “captain of the ship.”
In a Daily Beast article, Dr D Drake wrote about how “being a doctor has become a miserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers…It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system.”
The complexity of the healthcare delivery system was a common frustration refrain in my interviews. In such a fragmented system, “I need to go an extra mile to communicate with my patients but there is not enough time to do it.”
Other frustrations were dealing with insurers for preauthorization of a test, procedure or referral; trying to figure out what drugs were or were not on an individual insurer’s formulary (and each has a different formulary) and in dealing with their reimbursement methodology. Some insurers are very slow to pay reimbursements which mean carrying high working capital – difficult for a small practice. One noted the amount of time required to arrange for something like home care which, if the insurer was logical, would actually prevent more expensive time in the ER, doctor’s office or nursing home. PCPs find it exceedingly frustrating to deal with non-medical people at the insurance company who deny tests or medications that the doctor feels are very much in the patient’s best interest.
So PCPs were frustrated by government and insurance regulations, polices and roadblocks to care; by the fragmentation of the system; and by many others things but the root problem that was most frustrating was the lack of time with each patient.
Kevin Pho MD, a primary care physician and founder of KevinMD.com a very popular blog, posted about physician frustration following Dr Drake’s article. “So it’s important to have the conversation on physician dissatisfaction. It’s important to discuss the cost of medical education, physician burnout, and the myriad of paperwork and bureaucratic mandates that obstruct doctors from giving the best care they can to patients. Left unchecked, the physician profession will become completely demoralized. Whether you care or not, it matters. Demoralized doctors are in no position to care for patients.”
What is very clear in this extremely dysfunctional healthcare delivery system is that the primary care physicians (and most other providers as well) are very frustrated that they cannot give the level of care that they believe they were trained to do and would like to do. Most of their frustrations come down to the lack of time.
They need to take back the time and give it to patients, perhaps via direct primary care or with other models that offer a higher reimbursement for a patient visit or per member per month. But medicine is a very conservative profession; change comes slowly. Doctors will make the switch to something better only if they feel comfortable that their patients will follow them and approve. Otherwise they will retire early or go work for the local hospital and medical students will continue to shun primary care as a career. If patients want to benefit from much better care, if they want a doctor that is not frustrated and can spend time with them listening, if they want their total costs of health care to decline rather than rise, then they will need to educate themselves and then to advocate – to legislators, to insurers and to doctors. Concerted patient action will force the issue and make change occur. When the PCP has more time, care gets better, frustrations come down, satisfaction goes up and costs come way down. Everybody wins.
Next time: The value of integrative medicine in primary care.