Have been a PCP for 25 years, and am a big fan of Health Affairs.. but think they missed the mark on this recent article: No More Lip Service; It’s Time We Fixed Primary Care
In this article, the authors argue for doubling down on our current Primary care system by "making more primary care docs" and "paying them more". Others arguments from the comment section are "let the NPs" do it. Folks- that is like saying Blockbuster just needed to open some more stores to be a little closer to everyone!
In other words, this argument is missing the forest for the trees...big time! As I've mentioned before, We don't have a shortage of PCPs, we just have a shortage of using them efficiently. Every other industry has figured this out- online banking, shopping, travel, and media. Look at the market cap of Amazon and Netflix vs. any brick and mortar company (hint Amazon hit over $1 Trillion in 2018, making it worth more than 21 other major retailers, combined – from Walmart to Costco)
The world has changed, and people want convenient, cost-effective care via web and mobile, just like every other part of their lives. We need to look at the vast majority of routine care and figure out how to delegate routine workflows like refills and pre-visit planning (see healthfinch) and virtualize routine care like minor urgent issues, stable chronic care and preventive checkups (see MDLIVE). And automation needs to be a big part of all this- from expert rules to run workflows to intelligent interviews to triage out the more difficult cases to be seen in the offices.
Primary care needs to be virtual first- with automated triage to the right level of care, and an online provider to deal with the majority of issues. Fortunately no one will go out of business (except maybe the overly ubiquitous urgent care centers) as healthcare is big enough that both "Blockbuster" stores and Netflix can easily co-exist... with the good news is that the combination will be able to take our current number of providers and ensure great care for all in the time and place they want it.
By 2025, it's estimated that over 50% of all care will be delivered online, and that the number of office visits will go down.. but the ones who go into the office will be the ones who really need it. In other words, we need to "un-democratize" healthcare and embrace the fact that not everyone needs to go into the office - we still treat a 22yo with a sinus infection like a 72yo with CHF... but they don't want or deserve the same 15 minute office visit! Let's break that artificial construct (the quote that comes to mind is what Don Berwick referred to as the "Tyranny of the office visit"). Our future will be automation based triage with majority of care being handled online, and then the "Office visit will be Plan B" as detailed by Dr. Tom Lee in NEJM (Jan, 2018).
Viva la (Online) Primary Care!
