Joseph R. Anticaglia MD
Medical Advisory Board
A new wave in medicine is rippling across the United States and many conclude it doesn’t bode well, neither for patients nor family doctors. A recent conversation with a family doctor demonstrates his concern about the future care of patients.
“There’s a new era in medicine. I’m not talking about medical breakthroughs like targeted therapies for cancer, robotic surgical techniques, stem cell advances or the latest image studies. I’m talking about the dying relationship between Primary Care Physicians (PCPs) — Family Doctors and their patients. Let me tell you what I mean.” Below is the heart of the conversation I had with the doctor.
Paperwork and Insurance
“We’re spending more time on paper work and less time with patients.” Doctors often need to hire an extra person to handle insurance forms and answer patients’ questions about their coverage. It seems that every day doctors are speaking with an insurance representative requesting permission to do a certain procedure. It would be helpful if insurance companies would agree upon a uniform insurance form.
Compared to many other specialties, Family Doctors put in more hours, see more patients, get less pay and spend more time away from their home and less time with their family. We’re overworked, underpaid and an increasing number of recent medical school graduates are opting to enter other specialties. Also, Primary Care Physicians are retiring sooner than previously anticipated because of burnout.
Hospital Employed Physicians
“Solo practices are going the way of the Model T Ford.” It took years for the model T to be replaced by other models. One model that’s forcing traditional family doctors to the side of the road is Hospital Acquired Physician Practices.
Hospitals are devouring solo and group family medical practices. Once the physician signs the contract, the office and everything in it belongs to the hospital. The physician and staff are now employees of the hospital. In short, the hospital is in charge of the practice — staffing, vacation time, salaries, ordering office supplies and much more.
Many doctors, especially young doctors, think it’s advantageous to work for the hospital for some of the following reasons:
- ‘No’ Debt: Young physicians earn a salary from day one after completing their residency training and can avoid the expense of starting their own solo practice.
- ‘No’ overhead: The hospital pays the salaries, the rent, supplies and, when needed, their representative orders new equipment.
- Insurance Hospitals negotiate better reimbursement contracts from insurers because of their size and expertise. They pay the doctor’s liability insurance.
- Lifestyle: Most hospital employed physicians feel they have more time to spend with family and friends.
Urgent Care Centers and Corporations
Physicians who work in Urgent Care Centers (UCCs) treat non — life threatening illnesses and injuries such as the flu, cuts and sprains that patients think require immediate care. The centers can administer IVs, provide X-rays; but if the problem is more severe, patients are usually referred to a hospital emergency room.
As reported in a Forbes magazine article in February 2018, Urgent Care Centers are an 18 billion dollar industry with 7639 centers, as of June, 2017. Walgreens has joined with United Health to open more UCCs and one can anticipate more such corporate partnerships among other players in the future.
Telemedicine is the use of modern technology’s audio and visual systems to diagnose and treat medical conditions without the need of you waiting in a doctor’s office. It’s an alternative to the traditional ‘one-on-one’ way of providing medical care between doctor and patient.
It recognizes that most visits to the PCP are of a non-emergency nature and can be managed using video consultation or consulting with a physician over the telephone. It provides non-urgent medical care that is available 24/7 — whether you’re at home or on vacation and it is gaining in popularity.
With the focus on patient access to reliable medical care, Telemedicine is steering patients away from doctors’ offices and offers an alternative avenue to drive down the cost of health care.
Nurse Practitioners and Physician Assistants
The growing shortage of Primary Care Physicians and cost considerations has increased the utilization of nurse practitioners and physician assistants. Ordinarily, they work under the supervision of physicians. They assist doctors by taking a history of what’s bothering the patient, perform a physical examination and formulate treatment plans.
These professionals are looking to expand their independence and take on more responsibility. The laws of each state dictate to a significant extent their autonomy and what they can or cannot do,
My conversation ended with the family doctor opining on a pet peeve of his.
“Medicine is becoming a numbers game with patients — a business. I’ve been in practice 38 years before I recently retired. Think of this: Doctors demand from patients a retainer fee of several thousand dollars per year (concierge medicine) for the privilege of sitting in their waiting rooms. Who knows what other fees may be added on? It’s a new world and I’m glad that I was part of that other world.”
“You don’t need a double-blind study to face reality. Patients are unhappy with the long waits in the doctor’s office, their family doctors not being available — in many instances, in the evenings or on weekends — co-payments — and the high cost of drugs which somehow patients blame the physicians. Telemedicine, Urgent Care Centers, Walk-In-Clinics, Immediate Care Facilities are meeting patient’s needs. The times are a changing.”
Joseph R. Anticaglia, MD; A Win- Win Game — Medicine Without Borders, Doctors Without Waiting Rooms; HC Smart, 2014
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.