Since the day I began training as a Family Doctor I had one goal- to make a difference in the lives of my patients. I soon realized that I had my greatest impact in the context of relationships with my patients. The better I knew the patient as a person, the more accurate my diagnosis was. Further, when they viewed me as a person, they were more likely to follow through with the treatment plan I recommended. With this in mind I have spent the last 20 years trying to build relationships with my patients. I am wondering if those days may be disappearing.
Building relationships takes time and many patients aren’t staying with their doctor long enough for a relationship to develop. This is not something they are choosing. Most patients have insurance through their employer or ObamaCare and employers, insurers and the government do not care which doctor the patient sees. They simply want affordable coverage. As a result many patients are seeing their insurance provider change every one to two years. Often they are switched to a plan that does not include their doctor. When this happens they are forced to switch to a new doctor as seeing an out of network provider would mean paying cash for visits and most patients simply will not pay the standard $80 charge for an office visit. The result is that strong relationships are increasingly rare.
These economic realities mean that January becomes a month of good-byes for doctors. Just this week I received two emails from families asking if there was any way I they could stay in my practice. One family has been with me for 17 years. I delivered their children and have been their doctor through depressions, anxieties and the loss of a parent. As much as they want to stay in my practice, the insurance won't pay, so they are moving on.
I wonder how long it will take for the new doctor to develop the closeness that will allow for effective care for emotional and family issues. Given the current environment such closeness may never develop, for within a few years the family may be forced to change again.
There is another problem facing patients and doctors as well. Insurers are cutting what they pay (up to 50% on some ObamaCare plans). In order to stay doctors are cramming more visits into their schedule, racing through the office day with nary a moment for conversation. I wonder how many diagnoses will be missed and how much poor communication will occur as the pursuit of cheap care results not only in new physicians but in shorter office visits as well. It is hard to get to know someone in 7-10 minutes!
For me personally, there is sadness. It is hard to say good-bye to people you have taken care of for years. I could contract with these lower paying plans in order to keep patients, but if I am forced to rush people in and out in order to pay the bills relationships will all of my patients will suffer. As I will not compromise the quality of care I provide and have already cut expenses as much as I can, I have no choice. I cannot contract with plans that do not pay a reasonable rate. So I watch patients leave. How tragic.
Healthcare reform has brought many changes. I do not think that the end of caring physician-patient relationships was supposed to be one of them.
- Bart