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Where have all the doctors gone?

The outbreak of the novel coronavirus COVID-19 is revealing just how unprepared we were for such a crisis. Most of the news is focusing on our lack of personal protective equipment (PPE), hospital beds and ventilators. This is putting our health care workers in real danger which threatens the health of all Americans. Reports suggesting 15- 20% COVID cases are health care workers and we must consider what happens when doctors and nurses aren’t there to help the sick. I’m inspired by all the companies and individuals that are rallying to care for our health care workforce by creating more PPE and medical supplies to fight this virus.

This epidemic also highlights the house of cards created by our insurance-based, fee for service model. As our medical offices and hospitals shut down non-essential departments, doctors and nurses are being furloughed and forced to work without pay as there isn't enough money coming in to pay salaries. When primary care is tied to these large multispecialty groups and hospitals, Americans are at risk of losing their primary care as the house of cards starts to collapse.

Now where do the patients go? Urgent care centers are private institutions and can turn patients away without insurance. So what are patients supposed to do? Go to the Emergency Department? That is the last thing we want.

Independent primary care physicians are also at risk. If they don’t see people in the office, they don’t make money. Fee-for-service means doctors get paid to do things to you. They don’t get paid if you don’t come in. Until now, telemedicine was very difficult in an insurance based model. There were so many rules that most doctors found telehealth too cumbersome and instead just told patients to come in. Well, what if you have three kids under two at home and just have a simple question? What if you are homeschooling your children and trying to work from home? Wouldn’t it be so much easier to call on the phone or have a video conference session? Federal and state governments are lifting previous restrictions including allowing physicians to work across state lines. In addition to caring for my patients, I am covering telemedicine for several other states including Florida, New York, Arkansas, and Missouri. Many Americans are experiencing this telemedicine approach. What’s the verdict?

Actual patient’s responses

Why don’t all doctor’s offices do this?

Why are we just doing this now?

This is so much easier!

One group of independent primary care physicians transitioned to telemedicine without skipping a beat. This group is able to keep their offices open, clean and ready to care for their patients even through this crisis. These physicians continue their patients on their medications, talk them through the anxiety of the unknown and keep them out of the Emergency Departments. These primary care doctors work for their patients by using the direct primary care (DPC) model. They are not worried about insurance reimbursement and simply care for their patients and their families. I’ve never been so proud to be a DPC physician.

DPC means patient’s pay the doctor directly. Doctor’s charge a monthly membership that includes unlimited contact including face-to-face or via text/phone/video. They use HIPAA compliant software and document all encounters. We are your doctor and you can call us when you need us. When patient’s call, they can actually speak to their doctor. Most of the time, the doctor actually answers the phone. Imagine that!

This is whole family health care combining technology and old-fashioned service.

We build relationships with our patients. I know my patients and they know me. When you know your patients, you can very easily handle concerns with without a face-to-face visit.

Most DPC doctors are seeing patients through video and saving face-to-face visits for any visits that need an exam. We can monitor blood pressure and sugars and adjust medications as needed. Bluetooth monitors even connect directly to our electronic medical record. The patients and the doctors lower their risk and everyone stays safe. Many DPC doctors also dispense medications in their office. These can be shipped to the patient’s home so they don’t have to go the pharmacy.

DPC is the perfect primary care medical office model during a crisis. It’s consistent but malleable to the changing needs of its community. As it becomes safer, many of us will reincorporate group visits and home visits.

We have masks and gowns but since we are significantly lowering our traffic through our offices, we are conserving the PPE for hospitals. Centralized testing centers allow primary doctors to triage patients and guide them to the appropriate treatment safely without needing to use PPE leaving more supplies for higher acuity settings.

Primary care is too important to be tied up with expensive non-essential treatments especially during a crisis. Let's leave health insurance for the events we don’t expect to happen. We need to create a stable safety net of independent primary care physicians ready to support their community in times of trouble. If we continue to couple primary care with insurance, premiums will continue to rise and Americans will be left without care. When we value a personal relationship with a physician enough to distance it from insurance, primary care is accessible, stable and affordable.

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