Redefining the physician -patient relationship needs to become our priority. Direct specialty care is a revived concept. The goal is to regain the patient’s trust in the medical system. Reuniting physicians and patients and eliminating all “middlemen” will restore the faith in medical system. Often, I find patients confused about who is responsible for their increased medical costs and lack of access. They think an insurance policy will cover them for medical services. However, patients are surprised to find that is not the case. Quite often, we hear that our medical system is broken.
Why are physicians blamed for this?
Physicians are blamed for the lack of patient access, increased costs, copayments, and surprise bills. However, as a physician previously employed in the traditional system, I can testify that there is minimal control of our schedule. Physicians, have no involvement in any of the costs related to the care we provide (consultations, copayments, laboratory, imaging, or medication).
National healthcare spending hit a total of $3.8 trillion in the year before COVID-19 hit.
Do you know that physician salaries represent just 8.6% of the annual costs of the US healthcare system?
Why do patients have difficulties finding a specialist?
Patients do not have quick access to a subspecialist unless they are admitted to the hospital for a medical emergency. The waiting time is from 3 to 6 months depending on the area where the patient is located. Access to specialists can be somewhat more accessible if you are lucky to be in a metropolitan area, especially on the west or east coast. However, if you are located in a rural area, don’t be surprised that you are not having a specialist like me for hundreds of miles radius. Don’t be surprise that you need to travel for 2 hours to a close metropolitan area to have access to a specialist. That means many months worrying about your diagnosis, and many months of pain. Read this true story of a patient in a great metropolitan area without having access to a specialist for months despite carrying insurance. Why is this happening?
Why aren’t physicians allowed to practice in multiple US states?
Why are physicians trained in the US not allowed to practice in all states? After all, we are trained on the curriculum approved by the US academic-centered. We are board-certified in our specialties by a national exam coordinated by ABIM. We are asked to license, certify and maintain certification at different levels from medical state boards to ABIM boards. again and again. We have to provide to each medical board in each US state the same documentation.
Are there enough specialists in the US?
The answer is NO. I recently commented about these issues in my latest article on KevinMD.com. The truth is there are not enough specialists. Moreover, there are not enough fellowship spots available to close the gap. Additionally, insurance companies limit the number of specialists in their preferred provider panels. And, if that wasn’t enough – because of the pressures on everyone’s schedules, subspecialists receive unnecessary consultations that might be better if they are sorted out at the primary care level. Therefore, primary care physicians are also short on time and not appropriately compensated for their work. That also creates a bottleneck in the program.
What can be done to redefine the relationship with patients?
First, remove licensing and accreditations barriers for physicians practicing in good faith in one US state. Due to possible liability issues, physicians are afraid to use telemedicine to provide their consultations. Telemedicine is here to broaden access and will remain here as a viable and convenient option for patients.
Rheumatologist OnCall was created to broaden the access to patients in multiple US states. Currently, I am licensed in 6 US states, but there are so many patients across the lines of these states that are reaching out to my company for help.
Second, specialists should be allowed and their time compensated adequately for providing peer-to-peer consultations with primary care physicians. In this way, that will cut down the care costs for patients that might or might not require a consultation.
Third, remove the middlemen from the interactions with patients. A physician is competent enough to provide medical care and advise the patient what workup and treatment are needed. A physician should be aware of consultations, laboratory services, imaging services, and treatment prices. Direct care specialty reunite the patient and the physician.
Restore the relationship with patients via direct specialty care
Like me, many specialists took the Hippocratic Oath with the most incredible pride as, after many years of sacrifice, we finally can practice medicine. As we got into medicine, to help and we promised not to harm, not even financially. Reestablishing the relationship with patients we are becoming accessible, accountable and together with patients we decide what is in their best interest. The patients should be aware of healthcare costs before receiving these services unless they are dealing with an emergency and are not involved in the decision. In this way, the patients do not end up in a financial crisis.