The short version: A medical system that forces me to have very short appointments and thereby provide low quality care goes against my sense of duty and removes the meaning from my work.
Look it sounds cheesy but I want to be the doctor YOU need. I want to be available when YOU need me. I want to spend my time talking to YOU about your health and educating you about how to improve it.
Not the doctor that the insurance companies or big healthcare business want me to be, i.e. a rapid visit low quality care doctor. Not available 4-6 weeks after you need help. Not spending my time feeding the charting software what it needs so the clinic can get paid.
Direct Primary Care lets me do that. It gets billing and insurance out of the way so I can focus on what you need. When any primary care physician has adequate time, they can handle 80-90% of what walks in the door. When we have 5-7 minutes with each patient (this is what I was told to aim for in residency) you end of differing most or all of the topics that need a longer appointment and place a referral for a specialist to manage.
If I could do all that through the traditional insurance based model, trust me I would choose that instead. There is some significant risks going against the grain in healthcare. Not to mention that as soon as you sign a contact with an insurance company you are nearly guaranteed to fill up your panel.
I’m not alone either, many of my colleagues are burning out and struggling under the current model. We NEED to find another way to treat patients that doesn’t go against our sense of ethics and morality. Did you know the rate of medical student suicide is 3 times that of the general population, or that 2 in 5 physicians meet criteria for diagnosis of depression (according to the American Medical Association).
STORY TIME
Mrs Jones (a 27 year old mother of 1) comes into the clinic. This is my first appointment of the afternoon, I had to work through lunch because my morning clinic ran long because Ms Thompson was demanding I increase her pain medication because it’s not working at this dose anymore. Anyways, Mrs Jones has been struggling to get her weight back down since the birth of her child who’s now 2 years old. She’s hoping to address 3 concerns today because it took her 6 weeks to get into see me and my clinic only lets patient schedule one appointment at a time. My nurse has already prompted her that we will probably only have time to address one or maybe two issues. She’s complaining of some vaginal discharge and odor and thinks she’s getting another episode of bacterial vaginosis (“BV” is a bacterial overgrowth in the vaginal canal). This is her fourth episode this year and she’s frustrated because she doesn’t know why this keeps happening. Also she’s hoping to ask for some nutritional advise for weight loss and wants get her right knee pain evaluated because it’s been keeping her from walking and she’s noticed this has made her put on more weight recently.
All 3 of these issues are going to take time to address properly. She’s probably doing some things feminine hygiene-wise that’s contributing to the BV but that alone is a 15 min conversation. Digging into diet always take a long time. And her knee pain is effecting her weight too. I have a choice to make. I look down at my watch and think, “I’m already an hour behind, what can I manage without putting myself too much more behind. I told Lys I would be home for dinner tonight”… “Okay, Mrs Jones, I don’t want to short change you addressing any of these complaints. I think we’re only going to have time to address your vaginal concerns but we’ll see if we have any time left after we’re done with that concern. Tell me about your feminine hygiene habits.” … “well unfortunately we couldn’t get to those other 2 concerns but I think we got a handle on the BV, hopefully it’s a while before you get another episode.” I look down at my watch and think “ugh, hour and a half behind now. Maybe if I rush through my notes I’ll make it home before the Jackson’s asleep.”
Some days I made a choice to spend more time than I had with my patient, sacrificing family time, other days I chose family time. Every time I chose myself or my family, I felt like I was betraying my patients and my conscience, Maybe I shouldn’t but I did. Physicians don’t have a burn out problem because they are weak people. They are burned out because the medical system abuses them until they’ve compromised their ideals. There are some providers I’ve met that manage to thrive in this environment (providers who can triple book their patients and manage not to get burned out) but I’m not built for it.