The Nine Forces Converging On Primary Care: #3 Longer Workdays, Reduced Reimbursement and Failing Practices

In The Familiar Physician: Saving Your Doctor in the Era of Obamacare, I wrote that the looming possibility of financial failure changes everything. At the very least it focuses your attention. I was referring to my own experience at a particular point in my Family Medicine practice, but from what I read and hear directly, growing numbers of primary care physicians across America are struggling to make the business end of their practice work. That objective becomes even more important in light of the fact that many of them have already given up on the ability to fully enjoy their personal lives and families, take vacations and carry out a normal workday schedule.

Office staffs are harried and swamped with electronic documentation requirements, records, insurance forms, referrals, appointments, daily urgent call-ins, scheduling tests then reporting results, answering their correspondence – and patient care in the midst of all of it – that they barely have time to take a deep breath.

The cuts to physician payments are a steady sound from Washington and it is particularly difficult for physicians to continue seeing a growing rise in Medicare beneficiaries, especially in small or solo practices, with the constant threat of reimbursement reductions of 25% or more.

These financial difficulties coincide with a time in which as a nation, we are leaning hard on primary care medicine as a field and primary care doctors as a group to help guide us across a different health care landscape. In a dysfunctional payment system based on volume rather than value, many primary care practices have neither the incentive nor the time to follow up on patients the way they would like to or to provide more comprehensive medical management, especially when chronic conditions are involved.

Resources for management and overall care coordination are especially strained when older patients are seen by several different specialists.

When I was in active practice I worried about how I would be able to survive financially.  But most of all, I worried about the patients.  I still do.