The future of medicine is here, and it isn’t pretty.  yesterday’s New York Times piece, “The Disappearing Doctor: How Mega-Mergers Are Changingthe Business of Medical Care,” lays it out pretty nicely.  Corporate America is using mega-mergers, such as the CVS- Aetna merger to cut costs and increase profits. These urgent care centers connected to hospitals, pharmacies, or stores like Walmart are staffed with non-physician providers.  Not that these services don’t have a role, since most primary care physicians are not available after hours or on the weekends.  However, they are squeezing out the primary care physician (PCP), who is able to provider a more compreshensive and continuity experience. According to the article, almost half of all PCP’s are employed by hospitals. What this means is that the days of the 4-5 physicians in private practice that accept insurance are over.  Most PCP’s today practice in large groups owned by hospitals or insurance companies.  They have two to three thousand patients at a given time and see 25 patients a day.  Physicians in these practices are getting burned out.  Patients are also frustrated because it is impossible to get an appointment with their doctor, there are long waits in the waiting room, and during the brief encouter with the physician, the doctor is looking at the computer half the time in order to document, code, and bill.  It’s now wonder corporate urgent care services are becoming more popular.

However, there is a way out. Until the system changes, stop using insurance for primary care. Yes, health insurance premiums are at an all time high, and represent far too large of what families are spending their mony on.  However, those premiums are not going to the Internal Medicine and Family Medicine primary care providers.  They are going to the insurance companies, drug companies, hospitals, diagnostic companies and imaging companies.  You certainly need health insurance not only for every day medicine which an be very expensive, but for emergency surgeries or catastrophic illness.  However, day to day primary care needs can be met without insurance.  There are some physicians that have decided not to deal with the insurance companies, and instead provide excellent medical care at a reasonable price.  Prices and levels of service vary.  In my practice, we provide same day appointments, next day appointments, 24/7 phone access, email access, text message access, and longer appointments for about $4 a day.  That’s less than some people spend on coffee.

We are lucky to live in the United States that has some of the best health care services in the world.  However, the system is broken and the future of primary care isn’t looking very good.  If you are not happy with your current primary care provider, consider seeing a physician outside the insurance system.

Author Matthew L. Mintz, MD, FACP

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