Part 1: What’s Wrong with Your Employees’ Primary Care?

This is Part 1 of a 4 part series by Stephen C Schimpff, MD covering the important topic of Healthcare in the US, that will be available each Friday in the month of June.

There is a crisis in the provision of primary care in America. The crisis means that Americans do not get the level or quality of health care that they deserve and need. This crisis is the major reason that health care in total is so expensive and why costs keep rising. This crisis needs to be fixed and fixed as quickly as possible. As a small business owner, CEO or other senior leader you may be surprised to know that there is much you can do, now. In this four part series, I will explain the crisis, its origins and how it can be fixed with special emphasis on what small companies scan do.

The fundamental problem is that primary care doctors (PCPs) care for too many patients and as a result do not have the time they need to give the highest level of care that they are capable. They need time – time to listen, time to think, time to give quality preventive care and time to coordinate care for those with complex chronic illnesses. Absent enough time they are quick to refer to specialists, order tests or imaging or prescribe an expensive drug. This drives up costs.

This crisis means that PCPs are highly frustrated, feel they are on a never ending treadmill, are leaving private practice or retiring early. It means that patients are equally frustrated at the long waits, short visits, high costs and no sense of being listened to, of not being actually cared for. The crisis means that there are not enough primary care doctors today and it will only get worse because students in medical school see the impact of the crisis and so choose not to enter primary care.

Why the crisis? Fundamentally it arose because insurance reimbursements are too low and office costs are always rising. This means that in order to maintain income yet cover overheads, the PCP must see more and more patients per day. Most PCPs have more than 2500 patients and well more than 20 patient visits per day. A visit is often only 15 to 20 minutes and the actual “face time” with the doctor is about 8-12 minutes. This is long enough for a simple problem but much too short for someone with a complex issue, or someone with multiple chronic diseases and taking multiple prescriptions. And not long enough for an elderly person with impaired vision, hearing or cognition. Doctors tend to interrupt their patients within 20 seconds and rarely let the patient tell their full story. There is no time for compassion, to build trust or to do true healing. Since there is too little time, the tendency is to send the patient off for tests or to a specialist when a bit more time with the history would give the answer. There is not enough time to discuss life style changes so it is easier to just write a prescription. It is these steps that are the major cause of higher and higher medical care costs in America –unnecessary referrals, unnecessary tests, unnecessary X-rays and unnecessary prescriptions. And with it has come the loss of the close doctor-patient trusting relationship and the lack of true healing.

When PCPs do have time, they can develop a trusting relationship and then give superb preventive care. This reduces serious chronic illnesses in the future – just the diseases that today account for 75-85% of all medical costs. When they do have time, PCPs can treat the vast majority of issues brought to them by their patients without the need for specialist referrals or excessive testing. When PCPs do have time, they can coordinate the care of those patients that truly do need to be referred, ensuring high levels of quality at a reasonable cost. When PCPs do have the time, they can appreciate the underlying stress and anxieties that propel so many illnesses and trips to the doctor. When PCPs do have time, they can give truly proactive preventive care by reaching out now rather than waiting for the patient to arrive with a problem.

What to do? Just tinkering with the current system will not lead to real improvement. It is time to start from scratch. Patients and PCPs will need to take charge and change the paradigm of primary care. Government will not do it. Insurers have been slow at best although a few have made useful efforts. A few enlightened employers are beginning to step up. Today it is mostly PCPs and to a less degree patients who are forcing the issue. Patients need to demand the time they deserve. PCPs need to insist that they will give the time. But if you as a business leader recognize the problem, you can definitely drive the charge to a new paradigm. This can save your company significant dollars while improving your staff’s health.

Next time – Part 2: The Transformation of Primary Care

Stephen C Schimpff, MD is a quasi-retired internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center, senior advisor to Sage Growth Partners and is the author of The Future of Health Care Delivery- Why It Must Change and How It Will Affect You

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