How physicians can avoid becoming a boiled frog

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.

The work of primary care has changed. What was once mostly minor acute care with patients only going to their doctor when they were sick with one problem has become much more complex. Today, primary care physicians are expected to provide comprehensive preventive services, manage a variety of chronic diseases and provide counseling for patients suffering from stress at home or at work. On top of that, the coding and documentation of patient visits now takes up half the time of a busy physician’s schedule.

The problem is that nobody changed the schedule! Primary care doctors are still expected to do their work in brief visits and care for the same large panel of patients as yesteryear. No wonder the burnout rate among primary care physicians is approaching 50 percent, according to various studies, and U.S. medical students are avoiding primary care specialties. 

The fable of the boiling frog is widely known. The premise is that if you put a frog into boiling water it will jump out. If you put a frog in water and you slowly turn up the heat it will just sit there and boil. Most primary care physicians today are boiling frogs. Some commit suicide, many retire early, and brave ones go into new models such as direct primary care.

Primary care is vitally important to any rational healthcare system. Primary care physicians manage 75 to 85 percent or more of the reasons a person should see a doctor. When primary care is used, populations are healthier and have lower overall healthcare costs. For that, in the U.S., primary care physicians receive about 8 percent of the healthcare insurance premium dollar. (All physicians receive nearly 16 percent of the healthcare dollar.) Primary care has been in great trouble for some time and needs to change.

There must be a national effort to rethink how primary care is practiced. Quality primary care takes time with patients to do the complex work, even with teams providing the effort, and the panel sizes per physician needs to match the work required. There are new models of primary care emerging such as concierge medicine, direct primary care, and franchise models such as Iora Health. These all provide insights into what works well.

It is time for a revolution throughout primary care voicing the words of Howard Beale played by Peter Finch in the 1976 film Network, “I’m mad as hell and I’m not going to take it anymore.” 

The healthcare system would grind to a halt of primary care physicians stopped and demanded proper working conditions, with appropriate payment from health plans and health systems. Let’s do that before we boil away.

Joseph E. Scherger, MD, MPH, is vice president for primary care and Marie E. Pinizzotto, MD, Chair of Academic Affairs at Eisenhower Medical Center in Rancho Mirage, Calif. He is also a member of the Medical Economics editorial advisory board.