If you wonder why you can’t find a primary care physician anymore, read this article from yesterday’s New York Times. Solo family practice, pediatrics and general internists are becoming an endangered species. The starry-eyed physician who just “wants to help people” soon finds him or herself mired in debt, having to see 30+ patients a day to meet the ever-increasing overhead of insurance requirements, and quickly losing that spark that made him/her enter medicine in the first place. These doctors find that their practice, both clinically and administratively, is dictated by the government, insurance companies, and Pharma. It has become impossible for the solo primary care practitioner to financially survive in the current medical climate. As the article states, most doctors are now working for large corporations so that they can have a life, but more importantly, make a living. Witness the increase in physicians taking their services to the people in concierge or boutique practices in an effort to remain financially viable and still control their own destiny. This type of practice strives to provide the service of the “family doctor” while leaving much of the acute and traumatic care to the hospitals and emergency rooms. Services frequently focus on preventive medicine and getting healthy(services not reimbursable by insurance) as opposed to treating symptoms and managing disease to quickly clear the waiting room. However, access to services can vary and it’s not a perfect system. People have to pay out of their pocket for most services but for many, it can provide access to a doctor that schedules 30 min to 1 hour appts, does not have a packed waiting room and is available for email and telephone consult. So, physicians setting up these alternative practice systems is about much more than money. It is an effort to hang on to what we love the most: meaningful interaction with our patients and a desire to help people.
This post was prompted by a Facebook post that said, “Does anyone know how to get bio identical hormones without selling a kidney?” To this I say, “the best things in life are neither free nor easy, and where there is a will, there is a way”.