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Poor access to primary care is a real problem

This article highlights an important quote about the importance of primary care to the quality of healthcare:

“A solid and enduring relationship with a primary care doctor - who knows a patient's history and can monitor new problems - has long been regarded as the bedrock of quality healthcare systems.”

The authors go on to illustrate that “enduring relationships” between patients and physicians are virtually extinct in the US. That doesn't mean doctors and patients don’t desire those relationships. Just look at the trend and growth of concierge medicine. This model of care allows for an “enduring relationship” between the patient and the physician. Just ask any patient or physician in a concierge practice if they love it. They do. The only way to get this model of care is to pay $3,500 annually (above insurance premiums) to the physician to make it economically possible to have such a relationship and yet, just about anyone who can afford it buys concierge medicine. Unfortunately, that price tag limits access to less than one percent of the US.

So what does everyone else do? They go to urgent care for access. The article notes that growth in urgent retail clinics has grown 200% over the last five years. These urgent care chains are being set up in national retail pharmacies like CVS. These clinics do offer affordable and accessible care. However, these also are a nice model for promoting prescription sales. Finally, they are seldom connected to the patient's other healthcare providers and consequently promote fragmented healthcare.

Another unfortunate trend identified in the article was the acquisition of primary care practices by corporations. It noted that 48% of primary care practices are no longer owned by the physicians in the practice. The largest owner of these practices is now private equity firms, according to the article. Somehow I do not see private equity firms promoting “enduring relationships.” Unfortunately, primary care physicians are frustrated with the risk and complexity of private practice and have sought refuge in these corporations.

These trends are not good for US healthcare. Sadly, the article did not offer any solutions to these problems. Everyone should have access to concierge medicine without the surcharge. It would improve quality and reduce health costs. If you would like to learn more about the causes and potential solutions to these challenges, I would recommend my new book The Journey’s End.

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