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9 Things You Don't Know About Your Primary-Care Doctor

Many myths and misconceptions remain in regards to why your primary-care physician runs late, a topic that strikes a cord with all physicians, staff, and patients. Here are nine things you may not known about your primary-care physician or their office.

By
Sanaz Majd, MD,
September 28, 2017
Episode #213

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You may have come across my article on why doctor’s run late, which has also appeared on Business Insider. Why does this topic strike a cord with all of us, whether we are in the health-care field or not? 

One of the reasons the piece has certainly gone viral is because it does depict an accurate and typical day and struggle in the life of the primary-care office. Many physicians, providers, and staff empathize with these challenges that primary care clinics have endured for many years. Most are exhausted yet feel powerless to bring about significant change alone. 

Second, it also strikes a cord with the patients who are frustrated with the same faulty system that has left them as victims. It’s easy to blame physicians for these struggles, but they too are victims of the same challenges the system has created, which include high volume and pressure.

Understanding the public reaction to this article has made me realize the numerous misconceptions about primary-care physicians. 

I have attempted to describe the real reasons why your primary-care doctor is unable to spend more time with you, in response to suggestions made by many of you to increase patient appointment slots to try to solve this national dilemma. And then I described the ways in which we all do have in our control currently to help improve the situation as a team (patients, physicians, and clinics together) temporarily, prior to implementing more permanent change. I even illustrated 6 tips for physicians and supporting staff to do to improve this situation of national proportions.

Yet these myths and misconceptions still remain. So, today I would like to attempt to dispel some of these as best I can. The health-care system in this country is very complex, so it’s not an easy task to dissect. 

Here are nine things you may not know about your primary-care physician:

1. They Have Salaried Incomes:  Most primary-care physicians in this country are salaried. They are not paid per patient appointment. That means that they work for an employer, which is nowadays most commonly a large medical group. And with time these employers are growing in size, forming even larger and larger medical groups, forcing solo practices to become a thing of the past.

Attempt an Internet search for private solo primary care physicians in your community: there aren’t many. That is because they cannot financial succeed, have steadily closed their doors, and have instead signed on with these larger, stronger medical groups.

2. They're Leaving for Concierge Medicine:  Others have left the typical primary care model altogether, refusing to take part in this madness. They have instead opened private “concierge” medicine clinics, in which they no longer accept insurance plans of any kind, charge a flat monthly fee but take care of a much smaller panel of patients who have greater access to them. So instead of seeing 11 patients a half day, they may see 5, and hence spend more time with each patient.  They can make this work financially because they have eliminated the middle payer (health insurance plans) and have now become their own decision makers in regards to setting costs (along with other decisions).

The problem with this model for some patients is cost; it’s not cheap. And if you are ill, you will need to pay for tests, studies, and hospital stays out of pocket. But it works well for those primary-care docs who are simply fed up with our current health-care model and its associated stressors, and for patients with relatively low utilization of our healthcare system and/or ability to pay for higher access of care.  This is the new trend for some docs searching for an escape route.

But it's not right for everyone.

3. They Don't Control Their Schedules:  Most primary care physicians do not have control over how their schedules are devised.  It would appear as though we would, though. When patients schedule their appointments, it’s with the doctor they are scheduling it. When they sign in at the front desk, it’s their name they sign in for. It would seem as though we have control. But we absolutely do not in most circumstances.

These larger groups that employ us dictate how long each appointment slot will be, and are typically standard within the group. They also decide how many patients we see each day. Most primary-care physicians do not have negotiation room in how these scheduling elements are determined. If you join a group, you accept their rules.

However, having worked in three various settings myself, everything from public health to a large HMO group and a large private non-profit medical group, I can tell you that this has remained unchanged in all three environments. Is there a reason for this consistency? Is my employer greedy? No. They have to shorten our visits and increase the number we see in order to survive. 

Our employers are also not to blame. It's a system-wide issue.

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