Solutions to the Primary Care Problem

February 12, 2018

Primary care physicians have a time deficit.

They have too many patients, so they can’t spend as much quality time with each one to discover the root cause of every issue that walks in the door. They end up shuffling many patients off to specialists instead.

Primary care should be the backbone of our healthcare system, but it’s been damaged.

So, how do we fix the situation?

We’ve already outlined the bulk of the primary care problem in part one, which you can check out here if you haven’t already.

Let’s take a brief look at another issue plaguing our primary healthcare system and then we’ll dive into how we can fix it by means such as lowering the physician-to-patient ratio and using health insurance properly.

Overview of the problem

Physicians don’t have enough time to spend with their patients, especially those with multiple chronic illnesses such as high blood pressure, multiple sclerosis, and arthritis.

These are all incredibly common ailments among American patients. Some of that stems from an aging population. Most of it stems from our lifestyle choices.

We eat too much. We don’t sleep enough. We’re too stressed out. Twenty percent of the population still smokes tobacco.

With our fast food, high-sugar, high-salt diets and general inability to take care of ourselves properly, it should surprise no one that chronic issues like high cholesterol, type 2 diabetes, and cardiac complications are so common.

Throw in the high health insurance costs and difficulty getting insurance companies to pay up, as discussed in the previous article, and it should also surprise no one that primary care doctors are strapped for time and experiencing burn out.

Lower Physician-to-Patient Ratio

The number one thing we can do to ease the primary care problem is by lowering the physician-to-patient ratio. Of course, that’s much easier said than done.

The ideal ratio is somewhere between 1-to-500 and 1-to-800, depending on the age and overall health of the patients. Physicians who deal with older populations should ideally have a ratio even lower than 1-to-500. Most doctors are handling numbers much higher than that, though.

Case studies show that when physicians are able to work with a lower number of patients, the results are well worth it. Total costs plummet. The overall population is healthier. Patient satisfaction increases. Doctor frustration decreases.

A lower physician-to-patient ratio also means that doctors can focus more on health and wellness, as well as the patients with chronic conditions.

For example, AbsoluteCARE in Baltimore takes care of an older segment of the population. There’s more chronic illness among them, but they have a physician-to-patient ratio of 1-to-300. That means, each physician can spend much more time with each patient. Overall, the population has vastly improved health despite the chronic conditions many patients experience.

Using Health Insurance Properly

The main reason for the current high physician-to-patient ratio is that our reimbursement system has made it very expensive to treat patients. Doctors have to take on more new patients to meet the rising overhead costs.

We can’t just blame the insurance companies, though. Patient expectations have contributed to the problem.

Health insurance used to be more like car insurance. It was there if you needed it, but it was cheap because you expected to pay for small things out of pocket and only use the insurance for major medical care.

Today, we tend to treat our health insurance like pre-paid medical care. We expect it to cover everything, which means the prices go up and up.

If we can take the health insurance out of the equation in primary care, so that we’re using health insurance the way we use every other type of insurance, the costs can come way down.

Lower overhead costs in turn mean that physicians can afford to lower the number of patients they take on. As we described above, that’s a good outcome for everyone.

Conclusion

Primary care should be the backbone of our healthcare delivery system. But our primary care physicians are suffering from a time deficit and a population that doesn’t try very hard to take care of itself.

There’s no magic pill to fix the mess, but we can start to clean things up by lowering the physician-to-patient ratio wherever possible and using health insurance properly.

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This post is based on a podcast interview with Dr. Stephen C. Schimpff, author of Fixing the Primary Care Crisis: Reclaiming the patient-physician relationship and returning the healthcare decisions to you and your doctor. To hear this episode, and many more like it, you can subscribe to Healthcare Simplified.

If you don’t use iTunes, you can listen to every episode here.