More And More Work For The PCP

We always hear about how little time the average primary care physician (PCP) spends with a patient although some research shows it’s actually going up. At the same time, there is a debate about whether healthcare reform will push us into a massive physician shortage which seems to exist in some areas already. I keep hearing about more and more things that the PCP should be doing during this encounter.

• They should be counseling on medication adherence.
• They should be addressing gaps-in-care.
• They should be handling prior authorizations real-time using a computer system.
• They should provide the patient with Ix (information therapy) steering them to apps and articles for them to understand their treatment.
• They should be coordinating with the patient’s care manager.
• They should be screening everyone for obesity.
• They should be screening everyone for alcohol abuse.

It was the last two that were recent recommendations for the US Preventative Services Task Force that prompted me to comment here. I’ve heard everything from about 8 minutes to 15 minutes per patient encounter and complaints about the amount of time spent on documentation and administration continuing to go up. So, how does a physician add in all these different tasks into this already short time window when patient already leave confused and not remembering most of what the physician told them.

Of course, concierge medicine and other physician practices are trying to change this in certain pockets. And, ideally Accountable Care Organizations (ACOs) or Patient Centered Medical Homes (PCMHs) where the focus is less on volume and more on outcomes have a chance to change this.

I guess the question in my mind is whether the physician is this gatekeeper or whether chronically ill patients need a care manager / patient navigator to help them understand their benefits, take advantage of the resources available to them, leverage their care team, and understand their disease and clinical options.