Current and Future Doctors Seek Solutions to Primary Care Crisis

There's a crisis in primary care. Patients say they can't get an appointment with a doctor when they need one; primary care practitioners are closing their doors; and medical school students are shunning primary care as an avocation. It's healthcare's answer to the perfect storm.

There’s a crisis in primary care. Patients say they can’t get an appointment with a doctor when they need one; primary care practitioners are closing their doors; and medical school students are shunning primary care as an avocation. It’s healthcare’s answer to the perfect storm.

In Boston, the situation has become so desperate that the city’s health department recently initiated a telephone referral service that links individuals with primary care physicians who are accepting new patients. The goal is to improve primary care service to city residents at a time when the local administration believes there are too many patients and not enough doctors.

But, as one New York City start-up observes, that’s not necessarily the case.

Primary care connection

One year ago, Cyrus Massoumi and Oliver Kharraz launched NYC-based ZocDoc, an online service that helps connect consumers with doctors, including primary care physicians. Patients can search for doctors by location, sort by doctors that are in-network for their insurance, read patient reviews, and book an available appointment online. The service, which is currently available in Manhattan and Brooklyn, is free to both consumers and primary care physicians, and is based on the concept that at any given time, there are doctors with open appointments.

“There are doctors who have open availability, but the problem is finding them,” says Massoumi, the company’s CEO. “In every big city in this country, there is an oversupply of practitioners in many specialties.”

ZocDoc has built integrations into the practice management systems used by many physicians, so the company is able to “pull” a physician’s availability directly to its website. Consumers can find a physician who matches up with their insurance coverage and is available on short notice, and schedule the appointment immediately online. Physicians also like the online appointment scheduling, says Massoumi, because it’s more convenient for their existing patient population that doesn’t have to wait on hold when calling in during busy times.

“There are waiting lists in certain parts of Manhattan for practitioners to come on board,” says Massoumi. “It’s likely that we will expand to another east coast city some time in the next 12 months.”

Practice options

Erik Goldman, editor of the trade publication Holistic Primary Care: News for Health & Healing, is the co-founder of a new tradeshow, Heal Thy Practice. The conference, which will be held Oct. 31 — Nov. 2 in Tucson, Arizona, addresses how physicians can increase their profits and improve patient care by adopting new business models.

“I don’t think [primary care] is dead,” says Goldman. “I think it’s an important piece of healthcare. If physicians want to thrive, they’re going to have to get back to the direct doctor-patient relationship, which has been mediated to death by the insurance companies. There are [physician practice] models available to do that.”

As an example, Goldman points to fee-for-service models which are often viewed as elitist. However, he tells the story of a physician who has a fee-for-service practice in a working class, rural mountain town in North Carolina. No insurance, no Medicare, no Medicaid. No billing clerks, no one doing coding. “He has his overhead so low he can do a $45 office visit, and he can give patients 50 minutes out of that hour. He says his expenses are paid on the first four visits of the day.”

Goldman says the conference examines all different forms of practice models, from fee-for-service and concierge models to medical spas and integrated clinics. “Most of our speakers are practicing doctors who are [succeeding] one way or another. We’re not saying any one of these models is the perfect be-all and end-all answer to primary care’s woes. Physicians have to assess what’s best for them. But these [practice models] are steps in the right direction.”

Back to school

The American Medical Student Association is hosting its 10th annual National Primary Care Week Oct. 6-10. With many medical school students opting out of a career in primary care, the goal of the event is to begin to reverse that trend.

“We want to educate medical school students around the country—and not just medical students, but all health professional students,” explains event chairman Ryan Van Ramshorst, a medical school student at Baylor University. “We’re working with other health professional student associations, including nursing and physician assistant students, to educate them about the [primary care] crisis.”

One event on the week-long agenda is called a direct day of action, where students will be encouraged to call local members of Congress to thank them for supporting the National Health Service Corps, a government program run by HHS that offers scholarships and loan forgiveness as a way to encourage students to go into primary care. AMSA is also working with the Kaiser Family Foundation to web broadcast speakers in the field of primary care.

“I just don’t think primary care is on the minds of as many physicians-in-training as it used to be,” says Van Ramshorst. “Our focus is to get primary care back on the radar.”

Ed Rabinowitz is a veteran healthcare reporter and writer. He welcomes comments at edwardr@frontiernet.net.