Primary care doctors need financial independence
Nice article but it does miss one important point. I believe the way we pay for primary care causes the problems. Paying for a visit with a fixed price has so many unintended consequences that I do not believe the model can work. Our payment system encourages shorter visits. Our insurance companies place hurdles on spending. Those hurdles have a huge negative impact on the daily life of primary care physicians.
If we do not look at how we pay for primary care and develop a more logical system, we will continue to have flight from primary care. With apologies to many well meaning colleagues, the problem has nothing to do with training. The problem is the job and how we pay for the job.
Money is the answer, but just as important as how much we pay we must consider how we pay.
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Money is not the answer. Freedom is the answer. I envy the primary care docs, in that they have the potential to run their practices, and their lives, with at least a degree of freedom that I as a surgeon and other hospital-based docs do not have.
While the default position to the vast majority of office practices is to enroll as a “provider” with medicare, BC, and all the rest, that is easing the doc into a career of servitude, to the wrong master. The true master of your career should be the welfare of your patient. If I had to do it over again (I’m well into the 3rd decade of practice) I would open a cash based primary care practice. The models are out there- A doc, a nurse, maybe one other FTE to answer the phone, collect the money, pay the bills. I could build my own EMR with a $600 computer and $300 software. Do the books with Quickbooks or similar.
Overhead? Figure $3-5000 for rent, $10K for employee expenses. $2K for insurance. Another $2-3K per month for other expenses. Live very nicely, with fewer hassles, on the difference between Gross income and these expenses. Your practice will thrive, even attracting patients who have insurance, because you and your employees will be happy, the atmosphere in your office will be relaxed, and you will be serving the interests of your patients without worrying about bullet points, cpt codes, insurance and medicare audits, and the next adjustment to your reimbursement schedule.
Many (most?) are thinking- “That’s delusional- nobody could run a practice for that amount of money.” You are in the wrong city or state- very doable out here in flyover country.
I think a blended payment system is the answer – part per visit and part risk adjusted per member per month management fee. Some type of pay for performance/quality/patient satisfaction bonus could also be added if it can be figured out how best to do it. There needs to be an incentive and a margin to cover the mission for on call coverage, disease management, preauthorizations, etc., otherwise there is no incentive to keep providing good primary care instead of just working shift work at the urgent care center or ER.