The Return of the Primary Care Doctor
How First Primary Care is breaking up the specialist circus, and putting the focus back on the patient
If you’re like most people, you probably don’t really have a “family doctor.” You probably just head into Urgent Care or a Minute Clinic when something comes up, and take the referral to a specialist, if necessary.
You’re not alone: most people have no clue what their Primary Care Physician is for, other than a highly paid gatekeeper to the specialists they need to see.
True enough – That’s exactly how our current healthcare system operates.
In our fee-for-service model, where the insurance companies dictate healthcare and Primary Care Doctors must see an average of 20-25 patients per day – they don’t have time to do anything else.
So they’re happy to give you a referral and let the endocrinologist “do that.“
Or a rheumatologist handle it.
Or a cardiologist.
Along the way, you acquire a Rolodex full of specialists, all operating independently and treating their “piece” of the body.
But this model is the most dangerous thing in medicine right now.
“It’s no secret in the medical community that medical errors are the leading cause of death – just behind heart disease and cancer.”
Here’s a BIG reason why:
The “specialist circus” creates a hodgepodge of services where the right hand doesn’t know what the left hand is doing.
There is no longer a hub – a single doctor who is managing the full picture.
At worst, this can lead to life-threatening mistakes when prescriptions interact or medical histories are missed or misinterpreted.
At best? This leads to an incredibly expensive (and wasteful) care model.
No matter how you look at it, a rushed primary doctor is the most expensive entity in healthcare.
The truth is, most things can, be handled by a primary care physician.
They just don’t have the time.
Instead, they pass the buck to the specialist, and move on to the next patient, because they have a daily quota that they have to meet. (Sounds a little wrong, doesn’t it?)
This model not only diminishes the role of primary care, it drives costs through the roof and forces out a critical piece of the healthcare puzzle.
Every team needs a leader, and the same is true for your healthcare. Think about your last project at work…. Or coordinating your last family vacation…
Someone has to run point, or the outcomes aren’t often pretty. Without an engaged primary care physician overseeing and managing care, the same is true for your healthcare.
That’s supposed to be primary care’s role.
This is a systemic problem in the current fee for service model: a typical primary care physician doesn’t have time to work through the problem with you, educate you, and help you understand how that issue ties into your overall health.
But without your primary care doctor fully engaged, no one is looking at a patient’s “big picture.”
The Return of Primary Care
There are a growing number of physicians, myself included, working to change that model by breaking out of the insurance system and providing healthcare directly to consumers.
The key feature of direct primary care is that we don’t have daily patient quotas to hit…
Which means we can spend as much time as necessary with our patients.
That gives us the ability to manage care – and truly look out for our patients.
Sometimes that means taste-testing vegan protein powders, so we can recommend something that fits a patient’s lifestyle, nutrition requirements, AND doesn’t taste like cardboard (true story)…
Oftentimes it means helping them avoid thousands of dollars in unnecessary out of pocket expenses.
One of the biggest questions I get asked when people consider joining my practice is: “Ok, but what about all of my specialists?”
In my practice, I find the number of referrals we need to make are significantly less than “normal,” because we have time to address the patient as much as necessary.
If they have a challenging problem, or if a procedure is necessary, we go to a specialist.
Then we come back and manage their care in our practice, consulting with specialists as needed.
There’s a number of benefits to this:
1. There is ONE physician-led team managing your care and looking over the big picture for “what makes sense”
2. Any prescriptions—long term or short term – are prescribed from one place. That means patients aren’t running all over town seeing specialists for something as simple as a refill (the #1 reason most continue to see a specialist regularly for an otherwise well-managed condition)
When we do need to call in a specialist?
We can often do the initial consult over video conference so that everyone is included and on the same page about care. That means your primary doctor and your specialist have an actual working relationship to ensure nothing gets missed. And you have a primary care physician who is looking out for you.
When a member first joins our practice, we sit down and we start the education process.
Let’s understand what’s really going on.
Why their treatment plan is the way it is.
What are the things that we really need the specialist for?
Most of the time, they’re primarily going to their specialist for their refills or to keep tabs on a well-managed issue.
Once we start educating them, they realize “okay, I can manage these issues with you and I can get all my prescription refills from you…. I don’t need to drive across town for routine items like this.”
Their specialist roster starts to shrink, often times their prescription list starts to shrink, their quality of care goes up, and most of the time – their costs go down.
Saving thousands in out-of-pocket healthcare costs
A pretty typical scenario: I have a patient who was seeing a cardiologist for some heart issues. Every year, his cardiologist would bring him in, do an EKG on him, send him for a stress test, and then have an office visit with him.
Every year, this patient’s tests came back looking normal.
So when he came in for his patient onboarding at my practice, I asked him the questions I ask every patient when I see a pattern like this:
- Do you know why your cardiologist is ordering EKG’s and stress tests for you every year?
- Do you think you need them?
- Is this changing in any way how you manage your health?
- What do you do differently after your cardiologist visit?
And like many patients I’ve worked with over the years, he wasn’t really sure how to answer. Because every year, he’d go and have these tests done, the doctor would tell him he looked good, and there were no follow-up items… Just a bill for $1500 or so, every time.
He was just doing what his doctor told him to do.
So I asked him to talk to his cardiologist next time and ask, “Why are we doing this stress test every year when they are coming back normal and I’ve been stable over the last four years? Do we need to do them every year?”
In unnecessary bills, every year
His cardiologist’s response: “You know what, I think we can do these every three years instead.”
Just asking that question put $3,000 in out-of-pocket expenses back in his wallet over the next two years.
But how would anybody know to challenge their cardiologist? Or to ask those kinds of questions? Why would they even think to do that?
Most wouldn’t unless they have a doctor in the family. And it’s one of the reasons I say that a rushed primary care doctor is the most expensive link in healthcare.
Centralizing care, and putting hours back into the day
Even for patients who have more intensive healthcare needs, that care doesn’t have to be siloed with their respective specialists. Having a primary care doctor who can centralize and coordinate care has a tremendous payoff in quality of care, prescription costs (and numbers), and time savings.
Another patient of mine specifically sought out our practice for this reason.
Before coming to our practice, she would regularly spend half a day on specialist appointments and a small fortune on regular bloodwork screenings.
But most of those specialist appointments were actually for prescription refills…
I’ll let her tell her story:
Before I joined First Primary Care, managing my health and doctor’s appointments truly felt like a full-time job. No matter what the appointment was for, I would lose half a day between driving to appointments, waiting to be seen, and actually spending time in the appointment itself. And if I needed something urgently, there was the wait time to get an appointment (or the inconvenience of squeezing into my specialist’s only available last-minute opening).
It was not the healthcare experience I wanted, to be sure.
I came to Dr. Goyal specifically because I wanted someone to manage my care, and have oversight because I knew that each of my specialists was operating in their own ‘bubble.’
The time savings has been so immense.
Most of the time, we can meet over video chat to discuss any concerns I have, so I don’t have to drive to his office every whipstitch. Dr. Goyal coordinates and fills my prescriptions for me, so I don’t need a separate appointment for that. I can have blood drawn right in his office, when that is more convenient for me.
And he coordinates with my specialists. I still have access to them, but I don’t “need” them as much now.
But what still catches me off guard is that working with Dr. Goyal really is like working together as a team. He’ll ask “well what do you think?”
I’d never had a doctor actually ask – and value – my opinion before.
So I know, that when he’s helping me make decisions about my care, he truly understands my values, he knows my story, and he knows my preferences… And I can trust his recommendations when I’m not sure how to proceed.
I share this to show you – there are many ways that the current specialist-centric model is costing people. In safety; in fees; and in time.
And there are just as many ways to “save” by finding a primary care physician who can actually engage with you and your care.
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