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Is there a crisis in primary care?

Created date

December 18th, 2015

doctor and patient

Today, many primary care offices are busy places. Waiting rooms tend to be crowded, and you might wait 30 minutes or more to see your doctor who may then spend only 10 minutes with you in the exam room. 

Why have things changed? “You can blame crowded, busy doctors’ offices partly on Medicare and today’s private insurance reimbursement structures,” explains Stephen C. Schimpff, M.D., professor of medicine at the University of Maryland Medical School and former CEO of the University of Maryland Medical Center. “Like everyone else, doctors need to make a living and low reimbursement rates make that difficult, especially for primary care providers.”

Doctors have to pack their schedules with patients in order to meet overhead costs and pay their staff members’ salaries. “Primary care doctors earn about what they used to but have to see about twice as many patients per day to do so,” Schimpff says.

Shortchanged on health care

Young, healthy patients may have their health care concerns sufficiently addressed in a 10-to-15-minute time slot, but Schimpff says seniors are unlikely to receive adequate attention in that period of time. “Seniors typically have at least two or three chronic medical conditions and are taking five or more medications,” he says. “That type of information necessitates a careful and thorough examination.”

Older adults have additional issues that should be addressed during a visit. “Primary care is supposed to focus on prevention, wellness, and care coordination. Doctors need to take care of problems that arise, but they must also be proactive in order to prevent further problems,” Schimpff explains. 

Some preventive care issues include vision, hearing, and cognitive assessments; flu or pneumococcal vaccines; discussions about advance directives; and balance and falls assessments. While many can be taken care of at an annual physical, some—such as cognitive and balance assessments—may need to be evaluated more often when a patient comes in.

A controversial solution

One of Schimpff’s answers to the primary care crisis—direct primary care—is bound to spark some lively discussions. “In the direct primary care model, patients pay their doctors directly for service,” he explains. 

Patients who choose direct primary care can pay for visits on an hourly basis, or pay a retainer-based amount monthly or yearly. “Using this model, physicians can limit the number of patients they see, and thus offer truly outstanding care for episodic issues as well as complex chronic illnesses,” Schimpff says. “Communication is simple—you have your doctor’s cell phone number and email. If you forget a question or develop a new problem, you can have it answered right away.”

Schimpff suggests several other ways to improve primary care delivery. “Employers could pay for physicians’ annual fees; insurers and capitated insurance programs could agree to a higher reimbursement for primary care; and Medicare could make changes based on data that shows high-quality primary care will ultimately reduce total costs.” 

Until the problem is solved

“Not everyone can afford direct primary care, but for those with high deductible insurance policies, costs are quite reasonable,” Schimpff says. “Some direct primary care physicians make generic medications available at wholesale prices and laboratory tests at far below market prices.”

Until a solution is found for time-pressed doctors, seniors, of course, still need quality health care. If you move or your doctor retires, you might find yourself having to find a new provider, and you need to know what to look for.

When you first call an office, you should receive a prompt answer and courteous treatment from office staff. If you can’t get an appointment in a reasonable amount of time, it might be a sign of an overly busy practice. When you arrive, you can observe the office staff to see if they seem impatient or act unprofessionally.

But the rubber really meets the road once you meet your doctor. “If a doctor takes time to listen to all of your concerns, that’s a good sign,” says Myla Carpenter, M.D., senior medical director at

It’s best to find a primary care doctor who treats mostly seniors. “They will be familiar with your needs and understand how to coordinate your care with other specialists,” Carpenter says. “Your doctor should also be knowledgeable about community resources.” 

“The goal of direct primary care is to revitalize the patient-doctor relationship,” Schimpff says. “All primary care doctors should have sufficient time to provide top-notch, quality care for all of their patients without interference from third-party payers.”

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In Fixing the Primary Care Crisis, Dr. Stephen C. Schimpff gives compelling evidence about how government and third-party payers have a negative effect on health care delivery. He explains in great detail his well-researched solutions for what has truly become a primary care crisis in this country.


 

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