Work described in this story was made possible in part by federal funding supported by taxpayers. At Harvard Medical School, the future of efforts like this - done in service to humanity - now hangs in the balance due to the government's decision to terminate large numbers of federally funded grants and contracts across Harvard University.
- By JAKE MILLER
Burned-out primary care physicians are increasingly seeking safe haven in concierge care and other free-market models of practice. This has resulted in an exodus from traditional primary care practices and exacerbated an already acute shortage of primary care physicians. These alternative models also give patients more personalized care and attention. But for the rest of people who get their primary care from traditional practices, the already pressing shortage of primary care doctors often gets worse.
But this evolution toward the free market has pros and cons for doctors and patients alike, highlighting an urgency to strengthen traditional forms of primary care, according to a recent perspective in NEJM, co-authored by Harvard Medical School researcher Zirui Song.
To find out what this trend portends for primary care, Harvard Medicine News spoke with Song, who is an associate professor of health care policy in the Blavatnik Institute at HMS and a primary care doctor at Massachusetts General Hospital. He co-authored the piece with Jane M. Zhu, a primary care physician and associate professor of medicine at Oregon Health & Science University.
HMNews: Why is the persistent shortage of primary care doctors such a grave concern?
Song: Not only is good primary care a trusted first stop for patients, it's a safety blanket that follows you through life. It knows you, prevents disease, and anticipates needs. As the population gets older, medicine more sophisticated, and the health care system more complex, having good primary care doctors available for the people of this country is a necessity, not a luxury.
Unfortunately, primary care is becoming increasingly hard to get. Over 30 percent of U.S. adults now don't have a regular source of primary care.
HMNews: What drives this shortage?
A lot of primary care physicians are close to retirement, and there aren't enough trainees to fill the gap.
Burnout, income disparities between PCPs and specialists, and the loss of autonomy in practices owned by health systems have contributed to primary care doctors leaving medicine. Meanwhile, physicians in training, with medical school debt averaging over $200,000, generally look to other specialties when choosing careers in the United States.
HMNews: You and your colleagues have found that concierge care and direct-pay care, two alternative models of primary care, are growing. Why?
Song: Concierge practices offer personalized care and exclusive access, including same-day or next-day appointments, home visits, and sometimes accompanied visits to specialists. Doctors still bill insurance. Membership fees can range from thousands to tens of thousands of dollars a year. Direct primary care ("DPC") does not deal with insurance. So, patients avoid premiums and co-pays for primary care, instead paying for its services and common prescription drugs out-of-pocket, often at reduced, bulk-purchasing prices. Membership fees are often several hundred to thousands of dollars a year. Some practices have features of both concierge and DPC.
For doctors, these models can restore their autonomy and joys of practicing medicine, with less paperwork, less administrative burden, smaller caseloads, and more face time with patients - all while earning higher incomes. This can extend careers. Patients get shorter wait times, their doctor's cell phone number, and personalized attention, provided they can afford it.
