FAMILY PHYSICIANS ESSENTIAL TO HEALTH CARE SYSTEM

Family physicians are “the front door for people seeking health and healing, and connection…” That “hallowed role….has been relegated to the position of weathered doormats for a system bent on optimizing its ability to deliver and be paid for commodities…..primary care is a common good that benefits and is deserved by everyone….our system has….not invested in  supporting family physicians who provided the majority of the care people need.” We have not prioritized the relationship with the family doctor the patient can call on in time of need. 

To summarize and clarify the previous paragraph, family physicians have allowed their role and position in the medical system to be minimized and denigrated to the point that they are currently only triage officers. Their responsibility is to send patients in the direction that best suits their situation. Thus they are partially responsible for our uncaring and inefficient healthcare system. The “system” has done nothing to redefine and strengthen the family physician’s role and re-establish the strong physician-patient relationship. 

The system has created a situation where “the most complex task in medicine—integrating, personalizing, and prioritizing care for whole people—[is] cram[med] into 10 minutes….and pay those doing the work less than those providing minimally technical care.” In the name of “fiscal responsibility” and “quality care,” payment for complex evaluation and management services is so abysmal that to sustain their business, family physicians must see patients every ten minutes or less. 

This cannot continue. The American public will not tolerate being rushed, ignored, and treated as unimportant. And Physicians cannot remain in practice losing money on every patient. Illness is a time of great anxiety and discomfort and having one’s concerns brushed aside or minimized does not sit well with most people. Patients want the doctor to pay attention to them, listen, and show some understanding. When they don’t, patients get upset. 

Kurt C. Strange, MD, PhD of Case Western Reserve Medical School thinks it’s the system as it has evolved and physicians are complicit in perpetuating its dysfunction. He says physicians have bought into shoddy, rushed, incomplete medical care that shortchanges patients leaving them angry and confused. He says instead family physicians should “insist on and create practice situations that….use[ing] their full skills to meet the needs of their patients and communities” and become “the foundation for a functional health care system of tomorrow.” The more of us who can work in practices and systems that allow us to shine, the sooner a high level generalist personal doctor becomes the valued norm for everyone.” 

His point is physicians need to fix “a broken system” by providing services that restore value to the patient and by taking their responsibility seriously. Physicians need to invest themselves in health-promoting relationships with their patients and communities. In other words, they must change their attitudes and become personal doctors, again. He feels if more family doctors begin practicing in the manner in which they were trained, ie. providing full medical services, the system will correct itself and attract greater numbers of medical graduates into its ranks. To me that is untenable and delusional because reimbursement amounts are fixed, physicians can’t change that, and a practice can’t sustain itself when it’s paid inadequately. You have to pay the light bill. You’re not going to be paid one cent more than Medicare allows regardless of how thorough is your exam.

The only means by which the private practice of medicine can survive is through bypassing Medicare and commercial payers and adopting a direct primary care system called the concierge practice model. (See Concierge Model blog) When the physician is adequately compensated, his schedule is freer to permit adequate time to evaluate problems and delve into the patient’s psyche. Spending quality time with, and being available to, a patient, restores the faith and trust patients have in their physician, and good medical care is re-established. This is the dream scenario for every family physician, but the healthcare bureaucracy disagrees. Their focus is equity and inclusion. It is absolutely essential to the functioning of the health care system that the current system be replaced by a more efficient, patient-centered, family-physician-dominant model.

Reference: Strange KC. Time for Family Medicine to Stop Enabling a Dysfunctional Health Care System. Ann Fam Med 2023 May/June;21(3):202-203.