Revisiting An LA Times Article From Last Year

The byline of last year’s LA Times article reads as follows: “Some physicians in solo practice, frustrated by long hours and less time with patients, opt for so-called concierge medicine. Critics say it could reduce access to care.” We’ve heard this argument before, and although it’s not entirely invalid, it does require a sweeping generalization, something theorists in academia do, or a teacher does when illuminating students to a mathematical law. And in doing so, it positions our field as more of a problem than a solution. They summarize direct primary care as follows: “The model is simple: Doctors charge their patients an annual fee and in turn, give them more time and attention.” While true, this overview is suspect, making us sound like we’re advocating a two-tiered system.

The article continues with a quote from The American Medical Association, as of October 2012, saying, “[Concierge medicine] practices raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care.” The guidelines continue, asking that physicians don’t abandon their patients.

This feels like a vaguely pathos-driven argument, as if by giving people high-quality care, we somehow become bad guys that are leaving people out to dry. THIS IS SO BLATANTLY offensive given that insurance-based primary care physicians only had to start seeing 2,000 patients because if not, THEY WOULD GO BANKRUPT.

These arguments are endlessly infuriating because doctors didn’t become doctors to work at a patient factory. That defies logic. Go to school for a decade to work ridiculously long hours doing something you MIGHT get paid for? Such was the case when a certain doctor never received payment from Anthem Blue Shield on bogus charges that his paperwork was not completed correctly. The argument that direct care exacerbates the healthcare dilemma needs to be nipped in the bud. We’re not saying that direct care is America’s healthcare panacea. In fact, it’s not. But it is one way to provide a legitimate service and incentivize an increase in the supply of said service. Although, we know that getting more doctors in the field is grueling uphill battle, and will take an educational zeitgeist.

The article also includes the story of Dr. Saltman who said he didn’t become a concierge doctor to increase his income. He’s quoted as saying, “I did it to continue to do something I love without being resentful.” A patient of his, Mitch Waks, mentioned several health issues that included blood pressure and high cholesterol. Then nine months later, he claims to have lost 60 pounds, lowered his cholesterol and brought his blood pressure to normal ranges. He attributes his improved health to Saltman’s personalized care.

The LA Times article also includes a statement from AAFP President Glen Stream dating back to October 2012: “The American Academy of Family Physicians doesn’t consider concierge medicine the ideal model for primary care.” However, Stream admitted that it was understandable why physicians had made the switch. “It is an adaptation to a dysfunctional healthcare environment,” he said. “We recognize people’s need to adapt, to be able to provide services to their patients. As long as they are providing good-quality care, then it is something we understand.”

Looking back on his position got us thinking about the root of a doctor shortage. Is direct primary care really to blame? Sure, if every doctor refused to take insurance tomorrow, and formed a union with exorbitant prices, only serving the elite and wealthy, then yes, things would grind to a halt. But this is an absurdity, and not a reflection of reality. In fact, one culprit of lost man-hours in primary care is actually paperwork, which accounts for 22% of doctor’s work as of 2012. This is equal to ~165,000 full-time doctors, a substantial amount of labor.

Our thinking led us to this article going over research conducted in 2012 and published by none other than the AAFP. Here are the story highlights.

1.) Physicians are practicing fewer hours and seeing fewer patients than they have in past, posing a direct threat to patient access to care, says a new study conducted by the physician consulting firm Merritt Hawkins.

2.) In the next one to three years, more than 50 percent of physicians “plan to cut back on patients, work part-time, switch to concierge medicine, retire or take other steps that would reduce patient access to services,” says the study.

3.) The study also documents sagging physician morale, finding, for example, that more than 77 percent of physicians are “somewhat pessimistic or very pessimistic about the future of the medical profession.”

After reading this, it’s worth mentioning that pointing the finger at direct care as a main culprit seems borderline immoral. Doctors are admitting to quitting the profession outright. How is this not a worse outcome than a doctor switching to direct primary care? On top of that, the majority of doctors expressing pessimism about their job IS DEFINITELY a problem. We don’t want to be labeled an adversary in the fight against a broken healthcare system. Even if we’re not the end-all be-all, branding us as villains only secures the dominance of those currently in power, an over-eager government and massive insurance companies who have the power lobby Congress. And wouldn’t you know, that’s probably what they want everyone to think.

More Reading
“Annual retainer fee buys patients more time with their doctors” | Los Angeles Times

“’Silent Exodus’ From Medicine Threatens Patient Access to Care, Study Says” | Academy of American Primary Physicians

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