The shortage of physicians caused by the implementation of the Affordable Care Act in the next five years will drive a massive increase in the popularity of Concierge Medicine in the US.
As the typical healthcare organization adapts to the coming tidal wave of newly insured patients it will become very difficult for you to see your doctor when you are ill, impossible to see them for routine care and make the typical experience of getting a checkup feel like being dropped into a “patient mill”.
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5 years from now, If you want to have a personal physician see you for all your healthcare needs, you will need to pay for the privilege.
One popular way to do this is “concierge medicine” where you pay a monthly or annual premium directly to your doctor and, in return, they become your own personal physician, taking direct responsibility for your healthcare needs. The good news is that concierge medicine is no longer a privilege of the rich. Premiums are becoming much more affordable – as low as $200/year – and if you enjoy seeing “my doctor” and not being rushed, you will feel the additional money for a concierge medicine doctor is well spent.
Concierge medicine popularity will also be driven by the primary care doctors themselves. Those who want to continue to have a personal relationship with their patients will find it very difficult to be satisfied with the typical high volume practice.
Why Concierge Medicine and why now?
The Association of American Medical Colleges estimates that there will be a shortage of 91,500 doctors by 2020 as the Obamacare insurance coverage provisions are implemented and 30 million Americans become eligible for health insurance coverage.
This tidal wave of newly insured patients has to be served somehow and US Medical Schools and Residency Programs cannot supply anywhere near these numbers of new physicians in this short of a time frame. There is no hope whatsoever to cover the shortfall with newly minted US Residency graduates … none.
The Fork in the Road
How will healthcare markets respond – especially with regards to primary care? As the shortage of primary care providers worsens it will literally create a fork in the road for patients and doctors, driving the structure of their practices into two completely different tracks.
– Each is a distinct and logical response to the massive patient overload
– The two models produce dramatically different experiences for both the patients and doctors
– And each will expose gaping holes in a physician’s medical education that must be addressed.
Track 1)
Volume Driven: Doctor as apex of a care pyramid
In the more traditional practice structure, the physician will be come the leader of a care team supervising a number of Nurse Practitioners and Physician Assistants who provide the majority of the hands-on care. The skill and experience of the physician will be saved for the more complicated and severe cases seen that day. The majority of the doctor’s activity will be devoted to leading and coordinating the care provided by the pyramid of N.P’s and P.A.’s who are their direct reports.
This model is invisibly driven by a financial reality – the very high overhead of the practice. The only solution for these groups will be to maximize patient volume. All the front line providers will see 20-30 patients a day, most likely with 15 minute time slots for each visit. It will look and feel like a “patient mill” with everyone doing their best to maximize patient satisfaction and outcomes under extreme time pressure.
As a patient in this model you will only see your doctor on rare occasion and only when you are very ill. Your primary relationship with be with a P.A. or N.P. This may come as a bit of a shock if you are used to seeing “my doctor” whenever you are sick or need a routine checkup.
In 5 years we will learn to accept this as the “normal practice of medicine” in America. All corporate forces in healthcare are leading in this direction at the moment and it seems clear that volume driven care will become the new normal for the majority of patients and medical practices.
For the physician, the challenge of this model is the complete absence of functional leadership skills training in most medical school and residency programs. 30-50% of these physician’s time will likely be spend in leadership and management activities for which they are not prepared on graduation. Office team leadership training should be a popular CME topic in the years ahead.
Track 2)
Service Driven: Concierge medicine / direct care model
As the typical patient begins to notice they are only seen by a physician on rare occasion, a certain percentage will become willing to pay for that privilege. I suspect this will quickly grow to a substantial wave of new demand for concierge medicine services especially as premiums continue to fall and more concierge medicine practices are available.
The surplus of patients means a shortage of doctors. As the shortage worsens, a larger and larger segment of our population will become willing to pay to continue to see their doctor as they do today, especially if your alternative is the high volume patient mill practice I described above.
The huge popularity of the concierge medicine model will have another important driving force – the doctors. The office duties of the physician here are exactly the opposite of those in example #1 above. Here the physician is often seeing less than 15 patients a day, providing direct patient care and continuing to have meaningful personal relationships with their patients. And the dramatically lower overhead of the concierge medicine model means they can make the same amount of income as the volume driven doctors without having to see all those patients or supervise a team of mid-level providers.
As a patient, you will continue to see your doctor whenever you are ill or in for routine care. The doctor will most likely be practicing solo in a small office and will have much more time available for your visit.
As a physician, the challenge of this model is the absence of business training – and specifically marketing training – in most medical education programs. The concierge medicine model is inherently entrepreneurial and will always involve a fairly sophisticated marketing program to be successful. For the first time the doctor must enroll their own patients who pay with their own money for this direct relationship. Acquiring these skills is not an insurmountable obstacle and I have yet to meet a newly board certified MD who understands the essentials of marketing.
What’s a patient to do?
If you would like to continue to have direct access to your doctor in the years ahead, I encourage you to investigate concierge medicine services in your area and ask your current doctor if they have considered a concierge medicine practice. If you google “concierge medicine (your city here)”, you will most likely find a practice nearby. They would be happy to meet you and introduce you to the practice at no charge.
What’s a doctor to do?
If you are a primary care physician with 10 or more years of practice ahead of you, I suggest you look at the various concierge medicine business models and get ready to be met by the fork in the road.
Will you choose to lead a team or build your concierge medicine practice? If you are leaning in one direction or the other, I suggest you get started building your missing skill set – be that leadership or marketing. The wave of newly insured patients is coming.