The American insurance based healthcare system is rife with problems, inefficiency, and matters are only getting worse. Imagine if everyone sent a claim to their car insurance company for every tire rotation, air filter replacement or oil change – premiums would skyrocket to cover all the expenses. The use of health insurance for every single healthcare need leads to inflated insurance premiums and healthcare prices (hospitals charging $16 per tablet of Tylenol) that contribute to worse health outcomes. Many patients delay or avoid care due to being unable to afford the cost of office visits, labwork, medications, support services, etc. Patients deserve high quality primary care that can only be achieved with dedicated time and attention, but the current fee-for-service insurance based healthcare model does not allow for that – it is a system that is flawed, driven by profit, and does not meet the needs of patients. Health insurance does not equal health care.
After working over eight years in the traditional insurance based model, I was frustrated with the status quo of 10-15 min visits. In order to spend more time with my patients, I accepted a large pay cut, but found that 20 mins was still inadequate to properly address complex medical issues within a background of complicated social factors. Our current healthcare model incentivizes quantity of visits over quality of visits. A primary care physician is expected to see at least 24-32 patients per day, and expected to care for a panel of at least 2,000 patients. I had patients in my panel that I never had a chance to meet, but I was expected to weigh in on their care. Most of the patients in my panel had difficulty getting an appointment with me within the same week, often having to book a month out. New patients wanting to establish care had a three month wait, leading them to use the urgent care or ER for routine primary care issues (ER visit for checking blood pressure and refilling Lisinopril), further contributing to the massive healthcare spending problem in America. Established patients had to resort to urgent care when our schedules were fully booked for weeks.
In addition to inadequate time with patients, factors such as increased administrative burden, unnecessary prior authorizations, and pointless insurance mandates cause physicians to spend several hours per night (after seeing patients all day) and on their days off on the computer, enslaved to a burgeoning inbasket – it is enough to drive anyone crazy! We are required to check off boxes deemed important by insurance companies (taking time away from actual patient care) in order for the clinic to get reimbursement for the work we put in. There was so much administrative bloat that the clinic needed an extra staff member whose job was to handle the work of generating, receiving, sorting, filing, and faxing documents for insurance, after physicians spent time outside of their work schedule filling out those documents. A study in the Journal of General Internal Medicine in July 2022 estimated that a primary care physician would need 26.7 hours per day to complete all of the clinical and administrative tasks in our current healthcare model.
I dedicated 11 years of education and training in order to improve the lives of patients, not to become a cog in the managed healthcare machine, churning out profits for an insurance based system that did not have my patients' best interests in mind. All too often, I found myself feeling like my hands were tied, apologizing to patients for the system failing them (insurance denials or insurance requiring extra hoops that patients and physicians had to jump through). I was fed up, disheartened, overworked and undervalued. I started planning my exit, ready to quit medicine altogether. Then I remembered the problem is not with me for being unable to tolerate it – the problem is with the system for forcing these conditions on us as patients and as physicians.
This is why direct primary care started over two decades ago – to eliminate the middleman, reduce out-of-pocket costs for patients, and restore the patient-physician relationship. While we cannot fix this broken, inefficient system by ourselves, we can join the Direct Primary Care movement that aims to address the problems that plague traditional American primary care. We can do better. We deserve better.