It doesn’t take a rocket scientist to see that primary care faces more challenges than it’s ever faced before. Not the least of which is being one of the lowest paid medical professions with rising medical school prices which encourages more doctors to choose specialty medicine and eschew primary care. What’s astounding is that this trend stands in stark contrast to what patients want from primary care. Patients want more convenience while the medical establishment is turning out fewer primary care doctors which creates a shortage of doctors and long wait times for primary care visits.
As Lydia Ramsey notes in her tweet below, urgent care offices are popping up everywhere. Combine that with retail clinics and the future of primary care is facing a lot of serious questions.
New one: I dug into the urgent care market, whose offices are seemingly turning up in every neighborhood in the US. The move toward convenience is making everyone from hospitals to health insurers pay attentionhttps://t.co/FWwYMYHYjJ
— Lydia Ramsey (@lydiaramsey125) December 4, 2018
The reality is that most patients don’t want to go to urgent care or retail clinics. They’d much rather go to their PCP. Why don’t they go? The simple answer is convenience.
It’s much more convenient to hit the urgent care or retail clinic than it is to go to their primary care doctor. Some of this has to do with a shortage of primary care doctors which means long wait times to be seen. In other cases, it’s the really poor experience patients have had visiting their doctor in the past. I don’t need to list off the litany of bad patient experiences that we’ve all had when visting doctors. It’s like a universal PTSD experience that everyone has gone through.
Dave Chase offered his take on the rise of urgent care:
Rise of urgent care is driven by two main items 1)Bandaid after devastation of primary care 2)Response to hospital ER profiteering. If there’s proper primary care in a community and ethical hospitals, there’s no need for separate urgent care. https://t.co/d2LSKiEiyB
— Dave Chase (@chasedave) December 5, 2018
I’m not sure about his reference to the “devastation of primary care.” I’d be interested to hear why he thinks primary care has been “devastated.” Is he referring to over-regulation and underpayment? Is he referring to the shortage of docs I mention above? Is he referring to the rubber stamp PCP visits that are required to see a specialist in many insurance plans and in many ways ruined the PCP visit?
No doubt, primary care has been one of the least appreciated medical professions. However, primary care doctors didn’t do themselves any favors either. In many ways it reminds me of what Uber and Lyft have done to the taxi industry. Taxis could have embraced all the conveniences that Uber and Lyft provide, but they chose not to do so. Why not? Because they felt like they didn’t need to change since they had a virtually monopoly on the industry. Would I rather get a taxi? Yes, but I don’t because Lyft is more convenient. Sounds a lot like PCPs, doesn’t it? We’d rather go to a PCP, but an urgent care or retail clinic is more convenient.
Going back to Dave Chase’s comment that “If there’s proper primary care in a community and ethical hospitals, there’s no need for separate urgent care.” I might agree if he’d say there was less need for a separate urgent care. Urgent care does some really great work in off hours. However, the real problem is defining what he calls “proper primary care.”
I do think that if PCPs would have embraced better patient experiences, urgent cares and retail clinics would be much smaller. That said, does anyone think we can put that genie back in the bottle? I don’t think so. I believe our future healthcare system is going to have urgent care, retail clinics, and primary care.
The real question is what can PCPs do to make sure they thrive in this new mixed environment? I’d suggest that the first place to start is convenience.