I remember being part of a group of young physicians in 1982 that was told by a consultant, “You’ve got to be pretty bad to screw up this business opportunity. It’s just too easy to make money because people want your product. Basically anyone can survive in business as a doctor.”
It sounded good, but we received virtually no training for how to run our practices and make them successful from an administrative standpoint.
In my last post, I talked about the great divide between clinical providers and system administrators. These two entities—clinical medicine and healthcare administration—both want to deliver care to patients. But there’s constant friction between their goals and approach.
We’ve all contributed to the problem, and most of us have put little effort into finding common ground. With healthcare (and primary care in particular) at a unique juncture in our nation’s economic, political and social landscape, it’s impossible to ignore the chasm any longer. A good starting point for providers is to recognize our faulty understanding of good business practices and examine what needs to change.
It’s a matter of time
Doctors in the 60s, 70s and 80s didn’t really have to worry about being efficient to survive. When I was told in the early 80s that barring miserable failure in medicine I’d have no trouble achieving financial success, all of the industry’s emphasis was placed on good clinical performance. The assumption was that everything else would simply work itself out.
This belief fostered poor habits and a dysfunctional business model in primary care that set us up for failure. For example, time consciousness in the exam room was considered a lack of patient focus. In other words, if you weren’t providing unlimited attention to your patients, you weren’t giving them a good product (healthcare). This and other poor habits have persisted for decades, and now we’re experiencing the consequences.
As I’ve worked with practices and systems across the US over the last five years, I’ve observed hundreds of primary care providers at work. Very seldom have I seen one who’s able to limit his or her time for the sake of maintaining a viable business model that offers the convenient, same-day access patients need.
One internist told me last year, “If a patient needs me to stay in the exam room for an hour, I’ll stay in the room for an hour.”
At first blush, this commitment sounds admirable. But when style is considered more valuable than efficiency, it ultimately leads to underperformance. Unlimited time for one patient destroys access for another. Patients who can’t be seen by a primary care provider end up at the ER or an urgent care center and generate significant expense, due to unnecessary testing and an emergency level of care for what should have been a routine visit.
The root of this problem is the belief that time boundaries in the exam room aren’t important. This single issue is probably the number one reason primary care doesn’t have the impact it should—and could—have on our healthcare system. That lack of time-consciousness has helped create our current poor access to primary care, which has led to excessive costs across the healthcare industry.
Think about this issue in contrast to notoriously time-conscious lawyers. Lawyers know their business can’t survive without billing clients for any work performed on their behalf. While that approach can certainly be exploited, the principle holds true: viability is threatened by giving away your product without boundaries on time.
Make a move
The point of this critique isn’t to cause offense, but to call attention to poor habits. If you’re like me, I wasn’t aware of my dysfunction in the exam room until I was forced to re-examine my entire delivery model. And while not all the blame rests with providers, we have to acknowledge how we’ve contributed to the problem by not viewing our work with a business-oriented perspective.
The ACA reflects how healthcare is coming to grips with the fact that we can’t spend whatever we want on patient care if the economy is going to survive. Providers must begin to think in the same terms in order for costs to come down. We can’t bridge the gap without protecting critical elements of good clinical care and sustainable business. Both are needed for healthcare to thrive.
Don’t miss the third and final post of this series, where we’ll take a look at how providers and administrators can better work as a team to build self-sustaining businesses with convenient access.