Todays issue of the Boston Globe had a great article in the Business Section on the Rise of Retail Clinics and how they are rising to meet the needs of patients. The article is below for those who wish to read it and please read the comments, as they are always fantastic when it comes to articles on our healthcare system.
The main question I ask in this blog entry is: Why are these clinics popping up everywhere and having success? It is actually a very simple answer- they are filling the void that our fractured, third-party based healthcare system has left in its path of destruction of the physician-patient relationship. They are the callus on the fracture, but they are not the cast that will keep it fixed for good!
Patients used to have access to their OWN doctor or nurse when and if they needed them, even if it were for a simple question. Now, because of a warped third party payment system and corporate run healthcare, patients feel as if they are nothing more than a number on a list. They would rather go see a doctor or NP that knows nothing about them at a pharmacy than their “in-network listed ‘PCP’ “. Why? Because they do not want to listen to a 5 minute list of menu options on a phone; they do not want to be on hold for ten; they do not want to wait to have their problem addressed for hours to days, especially when ill; they do not want to pay a copay or deductible for a rash that could be diagnosed with a picture; and most importantly they do not want to be rushed in and out in 10 minutes after waiting for 45! So do I begrudge companies like CVS for opening these clinics and do I begrudge patients for going to them? Absolutely not!
So whom do I have issue with? I have issue with a system that has been perpetuated for long enough to allow this fracture and pseudo-callus to form. The reason I call it a “pseudo-callus”- and this is in no way to be disparaging to the doctors and NPs who work at these clinics- is because they are not the patients OWN doctor. Are the “providers” at these clinics going to be there when that simple cough turns into a lung mass or emphysema? Are they going to be there when that simple UTI is actually a bladder cancer? No matter how excellent the quick care is, I ultimately believe that people still crave their OWN doctor. DPC not only fills this void, it is the cast that will allow this broken system to heal once and for all. And not only do you not have to “check with your insurer about coverage”, my monthly fee is cheaper than the visits to these clinics. See here: CVS Minute Clinic Prices
It is time doctors and patients look for the cast rather than the band-aid.
Today, July 15, is a really important day to me- for both happy and sad reasons. This day in 1993 is when I physically lost my best friend. My grandmother, Bella, was and is a large part of who I am as a person. She taught me about hard work, determination, unconditional love, and empathy. She is also the main reason why I not only became a Family Physician, but also why I left the insurance-based system behind for this new endeavor of Direct Primary Care. I knew people deserved better because I knew she always deserved better.
My grandmother was stricken by early onset dementia at the age of 62 and rapidly declined over the course of my high school years until her death in the summer of 1993 following my graduation. Although her death was a finality, it was also a blessing. She never wanted to live her life the way she was at that time, nor did she want to be a burden on anyone. My family struggled to get her approved for Medicaid after she worked her entire life. As a result, we were unable to get her coverage for a nursing home. We cared for her at home until it was simply unsustainable. As awful as it was, it taught me what people deserve when they are ill. It taught me that we treat our animals better than we do our loved ones. The system was screwed up even back then. So she lived in the nursing home until her money ran out after which she died peacefully in her own home with me by her side.
I have always used this experience to guide me through college, medical school, residency, and now my career. I miss her guidance and love every single day, but I know that I am finally happy as a physician because of her. I will always look back at her and my relationship with her, but I will never look back at a system that prevents doctors and physicians from caring for each other and does nothing to secure the sanctity of the physician-patient relationship. Is that not what medicine was based on in the first place? Hopefully she is fully resting in peace knowing that her only grandchild is happily doing the right thing and being the doctor she knew I could be.
How does DPC help patients in the hospital? You can ask my patient quoted below or ask the Hospitalist who took care of him, but I would also like to comment on this.
There are many benefits to Hospital-based doctors (aka Hospitalists)- they are intelligent, well trained doctors and NP/PA’s and they provide 24/7 coverage if something goes wrong when you are admitted. We as primary care doctors used to practice hospital medicine as well as outpatient/office medicine, but for many reasons which is beyond the scope of this blog post, most if not all primary care doctors solely see patients in the office setting now. And there are many negatives to this which most patients who have been admitted to the hospital at some point can attest to:
As good and caring as these doctors and NP/PAs are, they don’t know the patient like we do.
Hospitalists often have a minimum of 10-12 patients on their census at a time some of whom may be very ill. That is a lot to manage.
As a result of #2 and the amount of documentation and computerized order entry that goes along with it, hospitalists have very little time to call and/or email the Primary Care Physician with updates on their patients.
This contributes to more fragmentation of care and increased costs to the system as a whole.
Lastly, which is the worst in my opinion, is scared and confused patients.
So what does DPC do to help this? :
We can actually come visit our patients periodically to check in and see how the hospital stay is going. The patient- like the one quoted below- gets to see their own doctor and be reassured that we are “in the loop.”
We have more time to communicate with the Hospitalists regarding our patients histories, medication lists, social situations etc. This allows us to work in a collaborative way to ensure the patient gets the best care possible.
I believe Hospitalists would appreciate this involvement rather than look at as us “stepping on toes.” We can provide information that the patient may not be capable of communicating or that they may not think is vital to their hospitalization.
The end result is what healthcare should be about- BETTER OVERALL PATIENT CARE.
So here is my patients quote/review: “If U haven’t yet signed up with Gold Direct Medical Services, U R surely walking in the wrong direction! I recently had a several day hospitalization and was actually visited by Dr. Jeff Gold, and was also privy to a conference between him and the hospital doctor, to say nothing of the several daily direct calls to me in my hospital room from him. WHEN WAS THE LAST TIME YOUR DOCTOR VISITED U IN THE HOSPITAL?”
For all of you who are in the enrollment period for employer-based insurance, including town employees, we can help answer your many questions. We offer free one hour consultations to help look over your insurance benefits. We also show you how Gold Direct Care can complement your insurance in a way which accomplishes two main goals:
1) Provide you with better access to primary care (AKA better quality care) with a doctor that is available to you when you need them. Appointments guaranteed within 24 hours and no insurance hassles.
2) Lower your cost. By combining our aged-based monthly fee with a lower premium/higher deductible plan we can get you to either break even for better value or, best case scenario, we can save you money all the while keeping you protected medically and financially.
We understand how complex insurance options can be. We are here to help you become a better consumer and navigate these complexities, so you and your family are protected; all the while getting the best value for their dollar. Please contact us for any inquires and to set up a time to talk at email@example.com or 781-842-3961.
We also have knowledgeable insurance consultants as well whom we can direct you to if needed.
So today I spent an hour speaking about Direct Primary Care to 1st and 2nd year medical students at Tufts University that are interested in Family Medicine or Primary Care in general. It was a great experience to see students engaged and interested in pursuing a field of medicine that desperately needs young, bright, and energetic minds. They asked intelligent questions and hopefully learned that there is hope on the horizon for primary care. There is a currently a shortage of good primary care physicians across the country, but especially here in Massachusetts. We need to fix this and the only way to do so is to make Family Medicine palatable, financially rewarding, and most importantly gratifying by focusing on patient care. Read this article from 2013 for more information: http://www.beckershospitalreview.com/hospital-physician-relationships/primary-care-shortage-dire-in-massachusetts.html
Direct Primary Care, in my opinion, is a way to build off the positives of our healthcare system and simultaneously remove the bureaucracy and red tape of insurance that does nothing to help patients or control costs. We have a solid foundation to work off of, but we have to modify it without scrapping the whole construct. DPC does this. It allows insurance to be used the way it was intended to be used- for catastrophic, high cost events or illnesses.
In my hour with them today, I hope I was able to show the students that if we keep fighting the good fight and do the right thing, maybe someday DPC will become the norm rather than the exception. I hope the more than 200 patients we have enrolled already can attest to the value and quality of this old, yet new, model of primary care.
As Albert Einstein once said the definition of insanity is doing the same thing over and over again and expecting a different result.