For those of us old enough to remember, Marcus Welby, M.D. was the consummate family doctor. He knew the whole family, was the first line of defense, and provided consistent and competent care across the continuum of healthcare needs. For those of you who are scratching your head, Marcus Welby, M.D. was a TV show that aired in the late 60s and 70s.
Today, in contrast to Dr. Welby, there are few family doctors providing this type of service. The relationship has become a transaction, often not even with the doctor but with the nurse practitioner or physician’s assistant. And, the visit is as much an exercise in documentation on the electronic medical record as one-on-one bonding between the doctor and patient.
What is the consequence of our current system?
Specialists get put in the Primary Care Provider (PCP) role. When a problem occurs in a joint, patients go straight to an orthopedic surgeon. A stomach ache? Time for a gastroenterologist. A blemish on the skin? A visit to the dermatologist is in order. But research has shown that for common problems, going to a specialist leads to additional tests and procedures and the majority of the time makes no difference on the quality of care.
The cost of care goes up. One study found that going to a specialist for a complaint of stomach or chest discomfort cost $120 for a family doctor and $450 for a specialist — again, with no difference in the outcome. In the world of high deductible health plans, this is a big difference to the average family!
But specialty care is only a part of the cost problem. The U.S. healthcare system is paid to do more tests and procedures, not to help people live healthier lives. We have a marketplace where a patient can buy services, not a system where a person is guided through the appropriate continuum of care (disease specific battle plan). Within a few days, the doctor, hospital, or imaging center receives their payment — whether it contributed to the health of the patient or not. There’s very little accountability, often resulting in questionable outcomes. I’m sure if Dr. Welby was asked, he would say, “It just goes to show that more care is not better care, better care is better care!”
Continuity of care is reduced when we remove primary care from the equation. In addition to fragmented care by multiple specialists, it’s estimated that more than 10 percent of all medical tests have already been performed by another provider. But, with no one directing care, this information slips through the cracks and results in millions of dollars of unneeded tests performed each year — increasing the cost, or worse, resulting in extra radiation from x-rays (that, it’s estimated, may be responsible for 5-10 percent of cancer cases in the U.S.).
So what is to be done? How can we bring Dr. Welby back? What can the modern-day Dr. Welby do?
In Canada, they’ve done just this. They have “dual purpose” primary care. They position primary care to be the first line of defense and to be the advocate of the patient as they navigate the healthcare system — providing continuity of care. The result? Their healthcare system is half the cost of the U.S.’s, people live longer, and the likelihood of a patient being harmed in the Canadian system is significantly lower than that of the U.S. In future blogs, we’ll explore how this works and what we can do for corporations to repeat this success at a self-insured client level. Be on the lookout!
