Concierge Medicine and Access

May 8, 2020
3 min read

Updated: Feb 23

Definition

Access to healthcare means timely visits and seamless communications with me, my team, and the network of specialists I've built over the last 25 years. Improved access leads to early intervention, fewer errors, and better outcomes.

The Modern Crisis of Access

Patients find it harder than ever to secure appointments, receive call-backs, or obtain specialist referrals. Several systemic factors contribute to this breakdown:

Primary Care Shortage: Over the decades primary care has become a less popular career choice for medical students. Many residency spots in primary care are left unfilled. This may be due to pay disparities between primary care and the specialties. It has been estimated, by the year 2032, there will be a shortage of between 21,000 and 55,000 primary care doctors in the US.
Popularity of Concierge Medicine: To add to the primary care shortage, in big cities, many doctors are choosing the concierge medicine model leaving the remaining primary-care doctors to pick up the slack.
Regional infrastructural mismatch: With its influx of people into the state, Florida has the highest shortage of physicians. And compared with 'medical meccas' like New York State and Massachusetts, we have far less NIH funding and medical schools per capita. This is why we rank 39th out of 52 in overall state healthcare performance.
Increasing Complexity: Our current increase in lifespan carries with it an increase in chronic disease. We have more technology than ever before to diagnose and treat these diseases, but it takes an army of professionals to organize and implements all the testing and treatments. A doctor may see the same number of patients as before, but each patient requires much more time and more care.
Administrative Burden: Doctors are overwhelmed with demands from insurance companies, electronic health record documentation, and complex billing. Research suggests that for every one hour spent in direct patient care generates two hours of chart work, including spending an additional 2-3 hours working at home after a 12-14 hour day.
Minimal Office Staff: With decreasing reimbursement doctors run their offices with minimal staff. Their staff become easily overwhelmed, leaving little time for what's really important: coordination of patient care. This includes helping you with appointments, ordering test, and retrieving records to be stored in your chart.
Fragmented Health Systems: Different specialists and testing facilities use different electronic health records and don't communicate with one another. Due to HIPAA privacy laws, we are not only forced to get consent, but rely on 1980's fax machines to gather information.

In short, patients face reduced access to healthcare as fewer doctors are expected to handle a larger number of patients and deal with more complex problems with fewer resources. They are under pressure from all sides.