Though this is not uniformly the case there are some very good reasons why the topic bears discussion particularly in the realm of Primary Care.
Working for a large corporation (like a hospital) or an insurance company subjects the physician to the vagaries of the profit motive filtered through that entities ambitions. These ‘third party’ players never have to look a patient directly in the eye and do not necessarily have the patient’s best interests in mind. Their focus may be a board of directors, stock holders, or quarterly profits among a myriad of other conflicts. As physicians we do have to look the patient in the eye and we are morally, ethically, and professionally obligated to do our absolute best for the lives we have taken the responsibility for. Any other agenda is a compromise. Daily we see how a series of compromises lead to bad outcomes for the people we have dedicated our lives to serve.
The physicians and other employees of these institutions lack the control they need to fully care for their patients. Recognition of their limitations combined with a lack of control leads to Physician Burnout and the further compromise of care. Empowering physicians with personal autonomy developed through novel payor models and collaborative networks can re-establish the crucial physician patient relationship that directly fosters health and decreases burnout.
A movement toward this end which is rapidly gaining momentum is called Direct Primary Care. This economic model eliminates the insurance industry from the equation and fosters a direct relationship between the physician and their patient. Patients pay a monthly fee to belong to and become a dedicated patient of the Physician or in some cases Midlevel Provider. Fees can range from fifty or sixty dollars per month to several hundred, dependent upon the level of service and relationship the Physician and patient are seeking. An analysis of the data for Medicare age patients followed under a Direct arrangement noted hospital admission rate seventy nine percent less likely than Medicare patients followed in a conventional fee for service practices. For those under sixty-five Directly followed patients were seventy one percent less likely to be admitted than fee for service patients. *
A large contributor to these improved outcomes is simply contact. Having eight to ten patients per day compared to thirty in fee for service models allows for more effective encounters. The model also eliminates another huge problem in Primary Care which is unreimbursed care. Insurance companies will not pay for simple conveniences like a phone call or text nor will they pay for crucial services like coordination of care. The Direct Primary Care model is inclusive of all these elements so important for a truly positive customer service experience.