Does your doctor recognize you when you come in? Or does he or she merely scan your file quickly before stepping into the exam room? My dog’s veterinarian knows her history mostly from memory, but I’m not convinced physicians in large cities can have that close a relationship with their patients. It’s a little too much to expect that level of relationship in my opinion. It isn’t necessarily bad if our doctors only remember us contextually. That is, at the office they remember our history when prompted with a file but would not recognize us at the mall without a prompt. Most of Americans no longer live in small towns where we have the same family doctor who delivered us at birth.
Kaiser Health News wrote about our changing relationship with our doctors.
Lucia Agajanian, a 25-year-old freelance film producer in Chicago, doesn’t have a specific primary care doctor, preferring the convenience of visiting a local clinic for flu shots or going online for video visits. “You say what you need, and there’s a 15-minute wait time,” she said, explaining how her appointments usually work. “I really liked that.”
I’m a firm believer that primary care physicians should seek out the type of practice that suits them, and that patients do likewise. I’ve written in the past about the time I called my physician’s office and was told he was out of town. His office referred me to a colleague who was covering for him. The colleague did not accept appointments, he only took walk-ins. It was first come, first served but the wait was only about 10 to 15 minutes. Also, he only took cash but prices were inexpensive since he didn’t have office staff and insurance billing.
But Olga Lucia Torres… misses her longtime primary care doctor, who kept tabs for two decades on her conditions, including lupus and rheumatoid arthritis, and made sure she was up to date on vaccines and screening tests. Two years ago, Torres received a letter informing her that he was changing to a “boutique practice” and would charge a retainer fee of $10,000 for her to stay on as a patient.
“I felt really sad and abandoned,” Torres said. “This was my PCP. I was like, ‘Dude, I thought we were in this together!’”
Ms. Torres’ doctor may have wanted to practice in a setting where he knows more about his patients and has more time to manage their care. Or maybe he cannot easily afford to practice alone in a setting where he serves a patient roster of 3,000 people, with a myriad of different insurance plans.
The two women reflect an ongoing reality: The primary care landscape is changing in ways that could shape patients’ access and quality of care now and for decades to come. A solid and enduring relationship with a primary care doctor — who knows a patient’s history and can monitor new problems — has long been regarded as the bedrock of a quality health care system. But investment in primary care in the U.S. lags that of other high-income countries, and America has a smaller share of primary care physicians than most of its European counterparts.
One-third of physicians in the United States work in primary care, although only about 12% are general practitioners. This is lower than in Germany (23%) and almost half in the Netherlands (45%). As a result, it’s often difficult to get an appointment without waiting weeks for an opening.
Another consideration that affects primary care practices is about half of physicians work in practices they do not own and therefore, do not necessarily control how the practice is run. The KHN article went on to say patients may be surprised to discover they don’t see the same doctor each visit, or their primary care provider may be a nurse practitioner or physician assistant rather than an MD or DO. Many physicians want to practice primary care and form close relationships with patients but change their mind. I met a physician who told me when he entered medical school, he specifically wanted to practice primary care. His instructors quickly told him no, he didn’t. He said the pressure to specialize came early. Like more than half of his colleagues, he chose to specialize at the urging of his instructors and mentors. It’s unfortunate schools that train physicians discourage the kind of doctors most of us need.
People with a regular primary care doctor or practice are more likely to get preventive care, such as cancer screenings or flu shots, studies show, and are less likely to die if they do suffer a heart attack.
Physicians who see patients regularly are better able to spot patterns of seemingly minor concerns that could add up to a serious health issue.
Most Americans are unlikely to have a doctor like Marcus Welby, M.D. as their primary care physician. That’s both good and bad. Younger people without chronic conditions appreciate the convenience of convenient care, retail clinics or walk-in clinics. People with chronic conditions are better served to find a physician with whom they can develop a relationship. That is increasingly hard to find and when found, it may involve paying extra for a direct primary care physician.