It’s hard to get a doctor’s appointment — primary care or specialist. We wrote about this recently, offering suggestions for individuals wanting to get an appointment. But are there bigger, global solutions to the problem?
The situation seems to have been caused by a doctor shortage and several other factors — resulting in long waits for surgery or even primary care appointments for garden-variety issues. The specialist appointments are easier to get than primary care, according to reports — pointing to a bigger problem, since the primary care appointment usually precedes a referral to a specialist.
But what can be done system-wide to address the problem? Some solutions are coming to the fore, but they may not work quickly, or may not be available to all.
No end in sight
Dr. Guy Culpepper, a family medicine practitioner who is C.E.O. of the Jefferson Physician Group independent physician association, is passionate on this topic. He wrote in an email: “the shortage of primary care in particular will be a huge topic for the next few decades.”
“It takes 11 years of college and post-graduate training to become a family physician,” he added. “So even if today students were suddenly given a dramatic incentive to become family physicians, it will take another 5-10 years to just begin to increase the number of family physicians.
“And then, like most professionals, it will take another decade of experience for each physician to become excellent.
“Presently there is no compelling reason (beyond the ministry of it) to choose primary care if you rank high in your med school class.
“Most specialists can make double the primary care salary, so if you have debt you have to choose a better-paying specialty.
“This creates a national P.C.P. pool that is not made up of the top of the class.
“It also creates P.C.P.’s who were not talented enough to get into their preferred specialty and settle on being family physicians … with dissatisfaction.
“Primary care should consist of the best physicians possible and paid enough to encourage the best physicians to dedicate their lives to this noble profession.
“The delay in getting an appointment with a primary care physician will be much worse for the foreseeable future. Impossible in some areas.
“I need family physician partners myself, so we could help even more patients, but I can’t find one.
“And I can’t afford, on these low P.C.P. fee schedules, to compete with the hospital recruiters.
“I’ve been trying to warn Americans, but most won’t know what they’ve got until it’s gone.”
Employer solutions
But wait, there are things that can be done. Some employers have set up direct primary care clinics or have given access to such clinics to their employees.
Clay Elder of Premise Health, a leader in employer-based onsite health center management, wrote: “Also noting that there is an important nuance within the context of ‘direct primary care.’ There are shared/ network [direct primary care] models and then, for larger employers, there are dedicated on-site (behind security) or dedicated nearsite (outside of security to allow dependent access but still dedicated to one employer).
“For larger employers, taking control of primary care access and quality is a main driver to that dedicated model. As is total cost of care savings.
“It is an absolute solution for primary care access. Again, for larger/ more concentrated employers, public sector entities and unions.” He said companies offering such options include Fortune 1000 companies, and some public sector employers — brands like Google, AT&T and Goldman, but also lesser known brands like the poultry processor Fieldale Farms.
“Almost zero wait time (even for walk-ins) and incredible access for appointment availability,” he added. “Not [fee for service] so not rushing — focusing on real, holistic lifestyle medicine-driven primary care. The way primary care used to be.”
Expanding on model
Dave Chase, co-founder and C.E.O. of Health Rosetta, a public benefit corporation focusing on improving models of health benefits, wrote: “I’d like to build on Clay’s observation about ‘dedicated nearsite clinics (outside security to allow dependent access but still dedicated to one employer).’ Recent developments show nearsite clinics are evolving to address broader healthcare challenges beyond serving only large employers.” He added that it’s something of a trend among employers who have used the services of such companies as Apree (formerly Vera Whole Health), People One Health, Crossover Health and Premise Health, offering employers the opportunity to take part in near-site primary care clinics for their employees.
“Organizations like Vera Whole Health have pioneered a collaborative model allowing employees to use clinics sponsored by different employers,” he explained. “In Seattle, while the Gates Foundation clinic remains behind security, facilities built for Trident Seafood, City of Kirkland, Expedia and Seattle Children’s Hospital welcome employees and families from any participating organization. This practical approach recognizes that an Expedia employee’s family living in Kirkland benefits from accessing a nearby clinic rather than traveling to the Seattle waterfront.
“Based on public statements from nearsite clinic providers, their footprint could serve 20-30 million members. Combined with the 2-3 million members in Direct Primary Care practices, we’re making significant progress rebuilding our weakened primary care infrastructure—creating better options for both patients and physicians outside the fee-for-service hellscape.”
How would an employer gain access? “At this point, it’s limited to employers that work with forward-looking benefits advisors (there are some that aren’t with Health Rosetta),” he wrote. “Historically, the onsite/nearsite folks have just dealt with jumbo employers so it tended to be the big consulting shops. That is extending to the mid-market. Our advisors most commonly work with [direct primary care] providers and there are networks of DPC clinics that aren’t all held by one company but provide a point of aggregation.
“There’s two ways to go there. There’s orgs like Hint Health that have a network of D.P.C. providers — see https://connect.hint.com/. There are also specific D.P.C. orgs who have aggregated their own affiliates like https://nexterahealthcare.com/locations/. As you can tell, there’s a lot of activity.”
