You may have come across my article on why doctor’s run late, which has also appeared on Business Insider. Why does this topic strike a cord with all of us, whether we are in the health-care field or not?
One of the reasons the piece has certainly gone viral is because it does depict an accurate and typical day and struggle in the life of the primary-care office. Many physicians, providers, and staff empathize with these challenges that primary care clinics have endured for many years. Most are exhausted yet feel powerless to bring about significant change alone.
Second, it also strikes a cord with the patients who are frustrated with the same faulty system that has left them as victims. It’s easy to blame physicians for these struggles, but they too are victims of the same challenges the system has created, which include high volume and pressure.
Understanding the public reaction to this article has made me realize the numerous misconceptions about primary-care physicians.
I have attempted to describe the real reasons why your primary-care doctor is unable to spend more time with you, in response to suggestions made by many of you to increase patient appointment slots to try to solve this national dilemma. And then I described the ways in which we all do have in our control currently to help improve the situation as a team (patients, physicians, and clinics together) temporarily, prior to implementing more permanent change. I even illustrated 6 tips for physicians and supporting staff to do to improve this situation of national proportions.
Yet these myths and misconceptions still remain. So, today I would like to attempt to dispel some of these as best I can. The health-care system in this country is very complex, so it’s not an easy task to dissect.
Here are nine things you may not know about your primary-care physician:
1. They Have Salaried Incomes: Most primary-care physicians in this country are salaried. They are not paid per patient appointment. That means that they work for an employer, which is nowadays most commonly a large medical group. And with time these employers are growing in size, forming even larger and larger medical groups, forcing solo practices to become a thing of the past.
Attempt an Internet search for private solo primary care physicians in your community: there aren’t many. That is because they cannot financial succeed, have steadily closed their doors, and have instead signed on with these larger, stronger medical groups.
2. They’re Leaving for Concierge Medicine: Others have left the typical primary care model altogether, refusing to take part in this madness. They have instead opened private “concierge” medicine clinics, in which they no longer accept insurance plans of any kind, charge a flat monthly fee but take care of a much smaller panel of patients who have greater access to them. So instead of seeing 11 patients a half day, they may see 5, and hence spend more time with each patient. They can make this work financially because they have eliminated the middle payer (health insurance plans) and have now become their own decision makers in regards to setting costs (along with other decisions).
The problem with this model for some patients is cost; it’s not cheap. And if you are ill, you will need to pay for tests, studies, and hospital stays out of pocket. But it works well for those primary-care docs who are simply fed up with our current health-care model and its associated stressors, and for patients with relatively low utilization of our healthcare system and/or ability to pay for higher access of care. This is the new trend for some docs searching for an escape route.
But it’s not right for everyone.
3. They Don’t Control Their Schedules: Most primary care physicians do not have control over how their schedules are devised. It would appear as though we would, though. When patients schedule their appointments, it’s with the doctor they are scheduling it. When they sign in at the front desk, it’s their name they sign in for. It would seem as though we have control. But we absolutely do not in most circumstances.
These larger groups that employ us dictate how long each appointment slot will be, and are typically standard within the group. They also decide how many patients we see each day. Most primary-care physicians do not have negotiation room in how these scheduling elements are determined. If you join a group, you accept their rules.
However, having worked in three various settings myself, everything from public health to a large HMO group and a large private non-profit medical group, I can tell you that this has remained unchanged in all three environments. Is there a reason for this consistency? Is my employer greedy? No. They have to shorten our visits and increase the number we see in order to survive.
Our employers are also not to blame. It’s a system-wide issue.
4. They Have Extreme Overhead: There’s immense overhead to keep a primary-care clinic running—plus the seriously poor reimbursement rates by insurance companies for the primary care physician’s time. Mind you, the primary care doctor is often the most accessed physician by most patients, the physician you see the most recurrently and get to know in your lifetime. Yet we are the least reimbursed by insurance companies for our time, lowest on the totem pole. Hence, the shorter time slots and greater frustrations experienced by both patients and physicians alike.
5. There Are Issues with Access: Of note, increasing patient time slots also causes diminished access. If your doctor’s appointment slots all switch from 15 minutes to 30 minutes, then you may not be able to get in to see your doctor as quickly the next time around. It could take up to months.
This leads me to the next point, because part of the reason for diminished access is …
6. There Is a Shortage of Primary-Care Doctors: If you haven’t heard, there’s a huge primary care shortage in this country. U.S. residencies are having to fill numerous open spots with foreign medical school graduates. Why would U.S. medical students choose this career in primary care when they can specialize, spend more time with each patient, and get higher reimbursement for that time as a result?
Mind you, specialists, such as psychiatry, have a higher reimbursement rate for their time. So they may be able to spend 30 or 60 min with you. Specialists may even double, triple, or quadruple their salary with specialization. Primary care is a different ball game. We only wish we could spend 60 or even 30 minutes with each patient.
7. They’re Being Double Booked: Of note, the three clinical groups I have worked for mentioned above, none have routinely “double-booked.” This is a major patient misconception: not all clinics do this. But, the ones that do have good reason to. And it is not typically a pervasive or even daily occurrence, but one that may be necessary on occasion due to extenuating circumstance or urgency. After all, we are dealing with human lives, our most prized possessions. So please keep in mind that this is very complex and requires more compassion, understanding, and flexibility. We are not running an airline. It’s human life we are dealing with here.
8. Their Schooling Takes 11+ Years: After completing high school, physicians complete 4 years of college, then 4 years of medical school, and then a minimum of 3 years of residency in order to start finally earning a paycheck. That’s 11 extra years of schooling minimum. If you specialize, it’s another 1-5 years on top of that depending on the specialty. We spend our entire youth in class, often giving up opportunities for travel, starting families, spending time with our loved ones, missing important life events, etc. Not that we are complaining, because we actually do enjoy this process and chose it for good reason. But we don’t go through it for money either.
9. They Have Huge Debt, Which Can Take Decades to Pay Off: Medical school tuition and fees average at about 40K a year, and this is not including cost of living expenses. Not including the college tuition debt acquired from prior to medical school, most medical school grads leave with about 200 to 250K debt that takes decades to pay off. By the time we pay this debt, it is likely double to triple in cost. Most of us repay this debt sometime between age 40 to 50, and for some of us, even later.
And there you have it, 9 misconceptions about your primary care physician, debunked.
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.