Why (non-DPC) Doctor’s Visits Feel Rushed

Why Doctor's Visits Feel Rushed

If you’ve ever felt that your visit to the primary care doctor was rushed, you're not alone. Many patients are frustrated by medical appointments' increasingly brief and impersonal nature. Let's delve into the reasons behind this and what it means for patient care, acknowledging the shared frustration.

Mal-aligned Incentives

In recent years, the healthcare landscape has shifted significantly. Large corporate entities, aka healthcare systems, have bought out many independent practices. These healthcare systems emphasize profitability and efficiency more than patient-centered care. The predominant reimbursement model in the US Healthcare system is “Fee-For-Service”(FFS). This model incentivizes volume (seeing more patients) over the quality of care.  In this model, insurances reimburse for direct care or patient visits. Some systems will counteract this by tacking on additional metrics to incentivize providers to improve “quality of care” (i.e., financially rewarding those who achieve a specific target percentage of patients above predefined metrics annually). The metrics vary yearly, but commonly measured things include the percentages of patients with controlled diabetes, controlled blood pressure, or the percentage of your panel up to date on colon cancer screening.  You may think this sounds good until you consider that a doctor with a panel size of 3000 patients (or more) likely has much less influence on those numbers than expected.  Quality metrics, short patient visits, and large panel sizes are a recipe for failure.  Improving outcomes requires time and trust. 

There is a push to re-align incentives with patient outcomes more comprehensively; however, this, too, has its limitations.    “Value-based care” (VBC) is a newer payment model that incentivizes providers to focus on quality outcomes rather than the quantity of services rendered. In VBC, the emphasis is on the overall health of the patient, rather than the number of visits or procedures. The potential benefits of VBC include improved patient outcomes, reduced healthcare costs, and a shift towards a more patient-centered approach. “The Centers for Medicare and Medicaid Services (CMS) has set a goal to have 100% of all Medicare beneficiaries tied to quality or value by 2030. Yet 40% of Medicare payments are still tied to Fee-for-Service as of 2020.” (Ahmed) Implementing VBC requires significant upfront financial and technology investments. Though it does stand to lower overall healthcare costs, it partially does so by limiting patient choice. Kaiser Permanente is an example of a healthcare system that has implemented VBC.

The Impact on Patients

Most of my patients come from FFS-based systems, so they are accustomed to 15-minute face-to-face visits (regardless of the patient issue) and long appointment wait times.  When I left my healthcare system, I had a panel of 3000 plus patients and a 3-6 mo appointment wait time.  Most appointments are “limited to “ your top 2-3 concerns; otherwise, schedule another appointment. Don’t think about bringing up new or chronic issues during your annual physical either; you get slapped with another co-pay for that visit (which is not always the doctor’s doing). This rushed atmosphere can lead to mistrust, overlooked symptoms, and a feeling of being unheard. It certainly does not leave room for lifestyle counseling and education.

The Impact on Doctors

Systematic time constraints place significant pressure on doctors. Because schedules are booked so far in advance, there are few slots for acute or simple patient visits.  Thus, most doctor schedules are packed with chronic conditions, complex medical cases, or comprehensive physicals. These tight schedules leave little time during the “work day” for paperwork, patient correspondence, and administrative tasks. The result? Work spills over into the evenings and weekends, and despite sacrificing sleep and time with your family, the work never ends.  Doctors in these environments must adapt to becoming cogs in the wheel or face moral injury. 

Lack of Continuity and Personal Connection

Another significant downside of the corporate medicine model is the lack of continuity in care. Patients are effectively not assigned to doctors; they are assigned to an office with a team of doctors and providers. There is certainly room for teams in medicine, however, not at the expense of the doctor-patient relationship. Fragmented care, sparse visits with your doctor, and time constraints lead to a lack of personal connection, making patients feel like just another number. Doctors feel the pain of this, too.  

A Way Forward

Direct primary care and other forms of independent practices are unlikely to meet the primary care needs of the whole population. However, I hope that by pushing the envelope and setting a new standard for primary care—quality over quantity, longer appointment times, and prioritization of the doctor-patient relationships—healthcare systems will have no choice but to change their practices. Maybe, just maybe, more students will choose primary care. 

Finding Purpose: A Key to Health and Well-Being

In the hustle and bustle of daily life, it’s easy to overlook one of the most vital elements of a fulfilling existence: having a sense of purpose. Research shows that a clear sense of purpose can lead to numerous health benefits, including lower stress levels, better sleep, and increased longevity. But what exactly is “PURPOSE,” and how can you find yours?

Understanding Purpose

Purpose is the feeling that your life has meaning and direction. It gets you out of bed in the morning and drives you to pursue your goals. Whether living out your faith, raising a family, excelling in your career, or volunteering for a cause you’re passionate about, purpose gives your life a sense of direction and motivation. Regardless of your purpose, I firmly believe your purpose should involve an act of service to others. 

Health Benefits of Having a Purpose

1. Reduced Stress: Knowing your purpose and worth can help you navigate life’s challenges more resiliently.

2. Improved Mental Health: A strong sense of purpose is linked to lower rates of depression and anxiety.

3. Physical Health: Purposeful individuals enjoy better overall health and are likelier to engage in healthy behaviors.

Finding Your Purpose

1. Self-Reflection: Take time to think about what matters most to you. What are your passions, values, and strengths? Reflect on activities that make you feel energized and fulfilled. Are you currently giving your time and energy to things that you value? Are you presently engaging in activities that leverage your areas of strength?

2. Set Goals: Establish short-term and long-term goals aligning with your strengths, interests, and values. Having clear objectives can provide a roadmap to finding and living your purpose.

3. Explore and Experiment: Don’t be afraid to try new things. Engage in different activities, volunteer, or take up hobbies that interest you. These experiences can help you discover what truly resonates with you. Also, don’t be afraid to let go of things that don’t align with your strengths and values. 

4. Seek Connections: Build relationships with others who share your interests and values. Community and support networks can provide inspiration and motivation on your journey.

5. Reflect and Adjust: Discovering your purpose is often an iterative process. Periodically reassess your goals and activities to align with your evolving strengths, interests, and values.

Remember, your purpose doesn’t have to be grand or life-changing. Even small, everyday actions that align with your values and passions can contribute to a meaningful life. Start your journey to finding purpose today, and enjoy the myriad health benefits that come with it. 

At Seeds of Health, discussions about purpose are as common as blood pressure checks. We know how much this matters to your health and well-being because it matters to us, too.