The Problem with Primary Care
February 2, 2018
For primary care physicians, time is not on their side.
Once, they had the time to really listen to patients and get to the heart of the issue without needing to run dozens of tests or send the patient on to a specialist.
That kind of time is less common now, and it’s causing serious havoc for doctors and patients alike.
Let’s take a look at an example of two similar patients to spell out the current problem with primary care, so we can look deeper at the cause and effect.
A Tale of Two Patients
Imagine two different patients with two different primary care physicians. They have the same symptoms: an uncomfortable pain in the side of the chest, running down towards the abdomen. They are both worried that it may be something heart-related.
For the first patient, the primary care physician can only spend 12 minutes with each patient that he sees. He checks her background and suggests an electrocardiogram. When nothing seems strange there, he says it’s probably nothing to worry about, but just to be safe, he can recommend her to a cardiologist.
She goes to the cardiologist who likewise finds nothing worrisome, but because the pain extends toward her abdomen, she suggests visiting a gastroenterologist.
Nothing is found there, either, but she is referred to another specialist. Then another.
Finally, she sees another physician who suggests the discomfort could be a sign of anxiety.
It takes four months and thousands of dollars to reach this diagnosis.
For the second patient, the physician can spend 30 minutes with each patient. He takes an electrocardiogram and no other tests. It shows there are no physical complications. After talking a bit more, the physician figures out that the pain is likely a sign of anxiety.
It takes one visit and a few dollars.
It’s the same symptoms, but one patient goes through several specialists while the other needs just one visit.
Why is there such a discrepancy between these two scenarios?
The discrepancy has nothing to do with the skill or training of the primary care physicians or the desire to help their patients or the worry about potential lawsuits for not catching something that could be dangerous.
The difference between them is time. The second physician can spend more time with his patients.
Rising overhead costs mean that most physicians are forced to take on too many patients. If they work an 8-hour day and schedule 24 patients, that’s 3 patients per hour, which means each patient gets to see the doctor for 20 minutes.
Except that it’s not really a 20-minute visit because the physician has to move from one room to another, familiarize him or herself with the patient background, file paperwork, etc.
In reality, 12 minutes, or less, is much more accurate.
A lot of the rising costs are related to health insurance. Physicians have to follow a variety of rules, regulations, and requirements for health insurance providers to pay out the funds necessary to keep the practice running. And, each insurance provider tends to have a different set of rules.
It’s a lot to keep up with.
To combat the costs, primary care physicians take on more and more patients. This limits the amount of time they can spend with each one.
For simple issues, 12 minutes may be plenty of time. But, for elderly patients, or those with chronic conditions, who have multiple prescriptions and may need things to be explained more clearly, 12 minutes is rather sub-par. Even if the solution or diagnosis turns out to be something simple—as with our example above—it may not be obvious right away.
Overworked doctors simply don’t have the time to spend getting to the root of an issue when there is no obvious solution.
At the same time, they don’t want to endanger anyone with a quick dismissal, so they’re more likely to recommend the patient to a specialist even if that isn’t really necessary. Unnecessary specialist visits place a higher burden on patients and tend to heap on healthcare costs.
The overwhelming overhead costs and lack of time also contribute to doctor burnout. Approximately 55% of physicians have measurable, objective signs of burnout.
The current prevailing system isn’t good for the doctors and it isn’t good for the patients.
The problem with primary care is that rising overhead costs and an unhelpful reimbursement system have cause a time deficit. Physicians simply don’t have enough time to spend with each patient.
This post is based on a podcast interview with Dr. Stephen C. Schimpff, author of Fixing the Primary Care Crisis: Reclaiming the patient-physician relationship and returning the healthcare decisions to you and your doctor. To hear this episode, and many more like it, you can subscribe to Healthcare Simplified.
If you don’t use iTunes, you can listen to every episode here.