Primary Care is NOT Dead

I recently read a nicely written article called Rest in Peace, Primary Care on KevinMD.com. Unfortunately there are many sad yet true facts and these points are well made by the author, Dr. Gopal. In case you don’t get a chance to read it, I’ll highlight some of these points. She points out how the “corporation of medicine has destroyed primary care as a specialty.” It talks about how administrations without any clinical background unfortunately call the shots for the way practices are run. All the while, the primary care doctor bears the frustrations from the patients who may at times assume the primary care physicians just spend as little time as possible with their patients in order to see as many people as they can in one day to be rich. Unfortunately these rules are made by these admins who decide number of patients need to be seen to make profit for them.

This is very true. I recall that as I was interviewing for a fee for service primary care job, I very vividly recall the hospital administration giving me the tour saying I’d need to see about 30 patients a day to break even for them. I was very very fortunate in that in the following weeks I discovered the existence of direct primary care (DPC) and saved myself before being sucked into this corporation of medicine that manipulates PCPs into being hamsters running their wheels to churn out patients in and out. What do you do when you get 7 minutes with a patient? Do you get to educate on healthier lifestyles? No. What ends up happening is the doctor throws medicine at every single problem, tries to band aid problems, refills meds, hopes he or she can catch up to the next patient already waiting an hour do the same 25-30 more times by 6pm, then finishes notes, does coding for insurance, fills papers faxed to their office. Maybe they get home before their kids go to bed.

The author is right in fearing for the future of healthcare in the country. Yet, I will argue that Primary Care is not dead. It is being revived across the country by more than 1200 primary care physicians who have refused to be manipulated by this so-called corporation of medicine. They are using the model called direct care model to bring primary care back to life. Not only is this bringing primary care back to life, it’s working, running, and thriving. This movement is bringing primary care back to how it used to be by placing primary care back into the patients’ and their doctors’ hands without letting any third parties in between. Patients using such clinics are loving them. Their healths are improving. They are starting to feel like their doctor is a part of their family. Doctors are saying that for the first time in years they can finally feel like they can practice medicine for the reason they went to medical school. It’s saving doctors from being burned out.

Why is it only such a small number of doctors who do this? It is challenging. Giving up everything and starting from a practice from scratch with 0 patients and ask patients to jump on board with something different from what they’ve been seeing the past 20 years. They ask, “ wait, I should have insurance or something like it [medical cost sharing community] but I shouldn’t use it for primary care?”  Exactly. I do exactly this. I tell my loved ones to do this. I tell my patients and everyone I care about to do this. When was the last time you tried to use your car insurance for your maintenance visit? Why aren’t more doctors doing this? More and more doctors are starting to do this. I assure you. However, it will take time. I’m not going to lie. It is very challenging to start it up. Starting a zero panel means you’re starting with a salary of zero all the while a mountain of $200 to $300K medical school loans that’s ever growing with interest staring down on you. Then, you have to market yourself. You have to do a lot of things yourself to get this off the ground. You have to educate people to let them know about this model of care in which everyone is healthier and wealthier (with the exception of health insurance CEOs).  Then  they have to keep on going and not give up and realize this takes at least several years to build a successful panel and to change what’s unfortunately been engraved in our minds- that healthcare means insurance and that healthcare isn’t possible without insurance. Not everyone will get it right away. Just when you’re having a great day as 2 new patients have signed up, a patient you’ve cared for in hardest of times will call letting you know they’re cancelling because they now have a job providing health insurance. Like I said, not everyone will get it. But you have to keep on pushing. The beauty of it is, we as physicians are trained to keep on pushing to get through our long years of education and training. Therefore you will for sure see more doctors step out and take this step for the better of their patients and themselves. And more patients will opt for this model of care that allows better care for them and actively support their docs. It’s almost like the scene in the Matrix where the protagonist takes the truth pill to step out and really see what’s going on.

When a patient goes to their primary care doctor using the direct primary care model, their physician gets to spend more time with them, build a trusting relationship and cover crucial topics such as lifestyle modification in detail. Not just throw Band-Aids. With increased accessibility direct primary care prevents urgent care and ER visits. Most importantly it helps get in front of the chronic diseases, which are ever increasing in the insurance ran primary care world of our country, and help manage them better if not cure them. A dpc doctor is not forced to do paper work for insurance, their coding work, prior authorizations, pre-certifications or see 30 people. Direct primary care model benefits everybody. It helps patients save their health. It helps them save their money. It helps small businesses save their businesses not only allowing them to have healthier employees but also saving them significant amount of money that’s otherwise going into the pockets for the self-serving or insurance serving brokers.

What can you do to help save your health and your loved ones’ health? Tell them about this model of primary care called direct primary care. Tell your neighbors about direct primary care. Tell other small businesses owners and their employees about direct primary care. Tell your legislators about direct primary care. Telling more people never hurt anyone. Less than 1 out of every 1000 people know about this model. Share with everybody this gem of care, this movement that is saving primary care.After all primary care saves lives.

Until next time.

Best,

Dr. Efe Sahinoglu

 

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