You wait for over an hour to see your doctor, only to be rushed out of his office in a few minutes. Why is this? House Call Doctor explains the 5 reasons behind the flawed primary care system in the U.S.
Some primary care doctors are leaving their jobs in pursuit of something you may have heard of called “concierge medicine.” In this kind of practice, the doctor doesn’t accept health insurance of any kind and cares for fewer patients. Each patient pays a flat monthly fee (determined by the doctor or clinic) in exchange for unlimited access to their doctor.
In this type of practice, you may have to pay out of pocket for any tests, imaging, or medications (which may be quite costly), but you will have a much longer appointment slot, shorter wait times, and unprecedented access to your doctor (even via phone and text).
I think it’s a brilliant idea – it works for some patients and some doctors really well. But it’s not for everyone. Some patients simply cannot afford this and some areas of the country don’t yet have these types of clinics. But it is an alternative.
Reason #3: Access of Care
How fast do you want to see your doctor? Do you want to be able to see them the same day if you all of a sudden feel sick, or are you OK with waiting 6 weeks?
The average primary care doctor manages between 1,500 and 2,300 patients, depending on the practice. So the access to your doctor is often one reason appointment slots must be shorter. The more patients a doctor is responsible for, the fewer time he or she can spend with each individual patient.
This is why doctor tardiness is not improved in an HMO system in the U.S. because appointment durations must still be 20 minutes long in order to allow for this “access.”
If we increase interest in primary care amongst medical students, and there an increase in U.S. primary care residency programs to match that interest, it may be a different story one day.
Reason #4: Scheduler Limitations
For those rare, lucky doctors who have the opportunity to vary the time templates for their patients, it may still not be enough. Why? Because the person scheduling the appointment on the phone often does not have medical training. This means he or she will likely not be able to accurately gauge the complexity of the reasons for the patient’s visit and thus, not allocate the appropriate amount of time for the appointment.
I gave an example of just such a case in my previous episode, Why Is My Doctor Always Late? Check out Ms. Sadness, one of the last patients of the morning.
Reason #5: Unpredictability
Medicine, like people, isn’t always predictable. Sometimes a patient may be scheduled for a simple pap smear, but you discover that their blood pressure is incidentally 186/95 on the day of their appointment.
Or a patient comes in with flu symptoms, but their last blood test for diabetes was over a year ago (and off the charts uncontrolled). Or just as the doctor is completing the visit, the patient says, “By the way, I’ve been feeling chest pain for the past few weeks. Why do you think this is, doc?”
What can you do as a physician? Ignore the elevated blood pressure, blood sugars, and chest pain just because the patient came in for something entirely different? No, that would be unethical.
So now you see how complex and interconnected this issue is. The fact is that doctors don’t like running late just as much as the patients don’t like waiting, but there are numerous forces acting beyond our control…or are they?
Tune in next week when I provide suggestions for what both doctors and patients can do to improve the situation.
Incidentally, I want to say that even given everything I know about the primary care profession, I would still choose it if I had to do it all over again. There’s absolutely nothing like building a relationship with my patients and helping them to live a healthier life.
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Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.