Sunday September 13, 2009 at 9:01
“Primary care clinicians routinely face unreasonable time pressures, a chaotic work pace, and bureaucratic impediments. Onerous paperwork requirements that obstruct patient care have to be reduced. And instead of the current system which encourages doctors to rush through as many office visits as possible, physicians who take the time to counsel, guide, and address all of their patients’ concerns should be rewarded. Better valuing the doctor-patient relationship will increase satisfaction, not only for physicians, but for their patients as well.
Such solutions, however, have been largely absent from the health reform conversation.”
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Why the doctor won’t see you now | KevinMD.com
So true, Kevin.
I used to think that I had to have payment reform before I could shift the practice paradigm and start really caring for my patients again, using the full scope of my training in comprehensive primary care.
It finally dawned on me that the paradigm shift started with accepting that I could start myself by putting my own house in order.
1: Radically reducing practice overhead through useful information technology got me off the hamster wheel.
2: Aggressive pursuit of comprehensive primary care:
- superb access: patients say “I can get care when and how I need it”
- relationship: superb continuity and the time we need to build trust
- comprehensiveness: learning how to support patients as they navigate the rough waters of complex behavior change
- care coordination: technology and processes in place to bridge the silos of health care
I did this while continuing to work with the insurance industry in my practice, which means that this work came at considerable financial cost to my practice as almost none of this work is valued by the insurance industry.
Because the insurance industry continues to offer only lip service instead of true support for this work, other colleagues of mine have chosen to step out of that paradigm and work directly for patients who recognize the worth of this kind of practice.
I yearn for the day when employers and the gov’t recognize the dramatic reduction in total cost (~30%) that comes from this kind of care. I yearn for the day when they will unleash the potential of primary care across the US and fully fund our work, but I’m no longer holding my breath.
The paradigm shift may be too radical for insurers, too radical for gov’t programs that are more interested in checking boxes than exploring fundamental change that gets the results they say they want.
The good news is that the patients get it. They know that this is better for them. We’ll continue to see docs shift to this new model of practice because it gets them off the hamster wheel, because it makes it possible to practice good medicine again, because it is the right thing to do for their patients.
It bothers me that the cost has to rest on the shoulders of the patients, but right now that’s where we’re finding real support for comprehensive primary care.
Groups like Qliance in Seattle and HealthAccess in Rhode Island and Hello Health in NYC are making this paradigm shift possible for a wider swath of the population and given the intransigence of the insurance industry, that’s where we’re going to see the most interesting advances in care delivery.
Right now primary care physicians have a choice: continue in the current paradigm (“50% of Primary care ready to throw in the towel”) or join the growing community of those who are taking our profession back, re-energized in our work, no longer marking time while waiting for retirement.
