I am delighted to bring you this new (old) model of primary care, and greatly appreciate the opportunity to explain how it all evolved for me. Let me start by simply listing my 4 main incentives:
- To be able to spend the proper doses of time, energy, skill, and resources necessary to deliver high quality, primary medical care . . . primary medical care that effectively and efficiently promotes and optimizes health, and aggressively manages illness, injury, disease, suffering, and dying;
- To be able to creatively and strategically broaden the basic services typically available from an office-based practice, filling care voids -- such as transitional care and navigational care -- that when filled, exponentially help patients succeed in attaining better health;
- To allow the above to occur without restrictions imposed by insurance plans, government programs, corporations, hospital administrators, and other various third parties who unfortunately often place their own interests and priorities over those of patients; and,
- To make the above available in a portable way to those who NEED it (due to immobility), as well as those who PREFER it (for the quality, privacy, and convenience it offers).
Let me expound by contending that our nation's very skilled and capable health care providers are being operationally squelched to the point where they have become so ineffective and inefficient that we now have a major (and growing) crisis on our hands -- both for providers and for patients (not to mention our ever-growing national debt, with over 20% of our GNP now allocated for healthcare expenditures, much of which are highly unnecessary and wasteful).
Physician burn-out is rampant and getting worse. Doctors are changing careers or retiring at record levels. They are telling their children (and anyone else who will listen) to pursue any career other than medicine. Applications to medical schools accordingly continue to plummet. Critical shortages of doctors now exist in many areas, and the problem is worsening. Many patients have trouble accessing a provider. Typically, once they do, the care they receive is abrupt, brief, rushed, and incomplete. Issues go unaddressed. Services are omitted. Mistakes are more likely. Care is compromised. Prevention is down-played. Ultimately, each patient cared for under this system ends up being less healthy than they could be, or should be.
Reasons are many, but the main one is lack of time. Providers simply cannot dedicate adequate time to their patients under the current system. Insurance payments encourage short, abbreviated visits. Insurance obstacles (like pre-approvals, pre-authorizations, denials, appeals, formularies, etc.) waste huge chunks of physician and staff time daily, forcing providers to rush through their visits to stay on time. Computerized documentation required by the government -- not for improved care, but rather for data gathering and reporting -- further slow providers and rob them of precious time with each patient. (Indeed, in 2019, providers were found to have spent 30-50% of each patient encounter on the computer . . . ridiculous!) And practice administrators (now mostly employed by large health care systems) are 'encouraging' physicians and staff to see as many patients as possible each day to maximize profits.
All of this 'high-volume rushing' and 'hassle-juggling' and 'plate-spinning' and 'corner cutting' (call it what you like) is wasting huge amounts of our nation's exquisite medical talent and training, as it slowly and unfortunately burns them out one by one. But more disheartening, it is depriving patients of precious care. Again, it is my contention that no one served under this current system is as healthy as they could or should be, if given the proper dedication of time, energy, skill, and resources. It may be a shock for many to hear that physicians nationwide are routinely failing to adequately address basic patient needs, like obesity, diabetes, cholesterol, exercise, asthma, tobacco abuse, skin assessments, cardiac risk assessments, vascular risk assessments, cancer screenings, vaccination status, and so much more every day - all due to LACK OF TIME!
I have watched and waited for years, hoping for positive change, only to see conditions continue to worsen. In 2018, I made the difficult decision to change course . . . to leave my office-based practice of 25 years and embark on a new model of medical practice that allows adequate time with each patient. I initially thought of calling it "It's About Time Primary Care" - meaning not only that we've all waited long enough for primary medical care that makes so much more sense, but also that patients are allocated the TIME they actually need to optimize their health.
Meanwhile, keenly aware of the growing number in our community who are confined to their homes by disability and frailty, it occurred to me that I could make this model portable and take it on the road. This would make it available to so many more, while at the same time minimize my overhead costs (no office or staff or billing) in order to make up for a smaller volume of patients I could see in a day.
I receive tremendously favorable feedback almost daily about this model of primary care -- definitely a win-win situation for patient and physican alike. Thank you for your interest and support! And I very much welcome your comments and feedback, both positive and negative, so feel free to contact me as you wish about Doc At Your Door.
William L. Simpson, MD
Doc At Your Door, PLC
