Family practice should be the heart of medical care, but in recent years the field has found itself in crisis. Rather than providing the bulk of patient care, more people are getting basic treatment at urgent care centers or walk-in clinics. Ultimately, it’s a numbers problem; not enough young physicians are going into primary care and while some have argued PAs and NPs could fill the gap, the reality is that burdensome healthcare costs stem in large part from a lack of preventative care. What can the medical profession do about the shortage of family practice physicians? It could be that the problem is fundamentally a management problem. Family practice is viewed as an unprofitable hassle, particularly compared to the specialties and subspecialties that dominate medicine today. Changing how we manage and market family practice could draw more young physicians to the field, but the shift needs to start at the top.
Consolidation: Pro Or Con?
Consolidation has been changing our healthcare landscape over the last several years. Some of these have been enormous, such as the merger of Aetna and CVS, and could significantly drive up consumer costs. Other acquisitions, though, have helped keep smaller operations in business under a new heading or helped to prevent cuts. Hospitals routinely cut behavioral health and patient education programs, for example, because they simply aren’t profitable, even though they’re critical to overall wellness. Because of the profit incentive, a significant proportion of physicians expect their practice to be impacted by consolidation or acquisition in the coming years. For primary care providers, this could be good news. Connecting with more profitable operations subsidizes basic care. The family practice Supro Direct supplements their basic care offerings with concierge medicine, chronic pain management, IV therapies, and an in-house lab, among other offerings. Other primary care offices are linking up with hospitals, allowing them to charge facility fees on top of typical charges and increasing the profit margin.
Too Much To Do, Too Little Time
While finances are one major management-level issue impacting family practice, money is hardly the only issue impacting the field. Another concern is that of burnout and the heavy load of responsibilities that primary care physicians carry. In two studies evaluating primary care tasks, researchers found that doctors would need an 18-hour workday to address both prevention and chronic disease management. If you’ve ever heard patients complain about 15-minute appointments and being rushed out the door, it’s clear that primary care providers just don’t have enough time. What can management do to address the time crunch facing physicians? One approach would be to better integrate the multiple services that are supplanting and supplementing primary care today. That includes coordinating the implementation of telehealth services, onboarding geriatricians who care for aging individuals, and developing collaborative programs that include social workers and community healthcare workers whose efforts address the social determinants of health – issues that are often too great to address during office visits. Primary care isn’t what it used to be and that isn’t just because there’s a shortage of care providers; people don’t have the type of relationships with their family physician that they once did. Our doctors aren’t anchors in the community in the same way, and it shows at a utilization level.
Finally, and unsurprisingly, insurance plays a major role in the problems primary providers face today. Overhead costs are outpacing insurance pacing and doctors need a slate of 2500-3000 patients to stay afloat. That’s unsustainable from a professional standpoint and it isn’t good for patients. Building a retainer-based, concierge style practice and heavily advertising services allows doctors to reduce their load to 500 to 800 patients and means those patients receive more comprehensive care, but it also means refusing insurance. That’s a barrier for a lot of patients who rely on insurance to subsidize their care. Great managers can help primary care practices gain leverage when negotiating with insurance companies, but getting the upper hand is almost always about volume. That means that primary care practices need to either partner with hospitals or specialists, or they need to band together. A large enough group of primary care physicians, especially when the group includes pediatricians and geriatricians, can grab back power from insurers, especially if they’re providing top quality preventative care and can prove their value by saving insurers’ money. If you remember your family doctor from years ago or read accounts of the physicians who saw patients from birth well into adulthood, then you understand what an enormous impact these providers can have on a community. Back then, primary care providers didn’t need all kinds of management interventions because insurance was less complicated and community word-of-mouth was all the advertising they needed. Today, of course, there’s no going it alone. Management can make or break a primary care practice at every decision point and administrative staff need to take responsibility and rebuild primary care so that it serves patients the way it once did.