Primary Care Physicians Who Got it Right - Fixing The Primary Care Crisis

Primary care today is a production line approach akin to the famous I Love Lucy segment where Lucy and Ethyl are wrapping chocolates on a conveyor line: they wrapped as fast as they could and pretended to keep up, even though they couldn't. With a fast moving conveyor, the job cannot be done properly. Slowing down the conveyor leads to much better quality. It may cost more initially but there are fewer chocolates improperly wrapped or just falling on the floor.

I have argued in the Washington Times as well as in this book that paying the PCP directly is better for everyone, but most of all for patients.

Some of the best attempts to improve our current dysfunctional delivery system have been accomplished by primary care physicians who have opted for a new, better system rather than waiting for others to come up with a solution.

The concept with direct primary care is to remove the insurance provider as the payer for primary care and replace it with a payment model that has patients paying their PCP directly while allowing the PCP to reduce the number of patients cared for from 2500-3000+ to a more manageable 500-800.With fewer patients, each gets longer visit times, easy access and comprehensive primary care. This basic model comes with many variations and might be called a membership model, a retainer-based model or concierge model. Despite the various names, they all have certain characteristics in common; most importantly is more time with the doctor.

Often regarded as being only for the "one percent," direct primary care/membership/retainer/concierge practices can be of quite affordable and believe it or not, a good choice for those with modest incomes. Many of these practices offer reduced cost laboratory testing and wholesale priced generic medications; the savings can often be more than the cost of the membership. With a limited number of patients, the doctor can offer same day appointments, visits as long as necessary, 24/7 access via his or her personal cell phone, real preventive and chronic illness care, along with thorough coordination of specialist care when needed. All offer thorough comprehensive primary care.

Studies of direct primary care practices, detailed in the book, have shown that quality markers rise, total costs (as a result, for example, of less hospitalizations and ER visits) go down substantially and satisfaction by both patient and doctor go up dramatically. It is a win-win.



Copyright (c) Stephen C. Schimpff, MD