Primary Care Has a Dirty Little Secret

We are like restaurants that charge handsomely for sit down dinners but give away food for free at the takeout window. And we pay our providers only for serving the dining room guests. If traffic gets backed up at the drive-through, we hold our providers responsible, even though we never planned for our ever increasing demand for takeout.

In simpler times, patients went to the doctor when they felt unwell, and doctors didn’t claim responsibility for what patients did on their own time between visits.

Now, doctors are working just as hard taking care of patients in the office, but they are also expected to, on their own time, handle all sorts of ongoing hand-holding between visits. This happens through phone calls, electronic messaging and reading and commenting on endless streams of reports from case managers, specialists, hospitals, emergency rooms, walk-in clinics, pharmacy benefit managers, insurance companies and medical supply companies.

There is talk about how all this extra work will some day generate income streams from cost savings and improved outcomes, but today, the very foundation of how doctors get paid is how many patients they see in the office on a daily basis. Few health care organizations have the cash on hand to schedule provider time for what isn’t going to bring money in during the present budget year.

The dirty little secret we all deal with in primary care is that we make our doctors, PA’s and NP’s see as many patients as they possibly can, with ever increasing demands on the complexity of care they deliver, and on the comprehensiveness of their documentation and quality reporting, and then we quietly assume they will be able to do all this extra, unscheduled and uncompensated work without falling behind, making medical mistakes or simply burning out.

Imagine a CEO who spent all day in meetings and never had any time to himself or herself available to think, plan or write.

Imagine an average office worker, who is said to spend 25% of their time on business related email, suddenly being told that all company emails from now on have to be done outside working hours.

Imagine a judge, presiding over case after case at the bench from 8 am to 5 pm, without any scheduled time to read briefs or write judgements.

Imagine a TV anchor, broadcasting 8 hours a day, never taking any time to study the issues of the day or to speak with colleagues or newsmakers.

Imagine an orchestra, constantly performing, never practicing, never studying the sheet music.

And we are now offering resilience training to our medical providers to help them not burn out…

5 Responses to “Primary Care Has a Dirty Little Secret”


  1. 1 jmccarty3 November 23, 2016 at 2:29 pm

    I have a dirty little secret, too. Specialty care isn’t any different. We are all suffering from the nonsense described in this excellent post.

  2. 2 meyati November 23, 2016 at 3:19 pm

    Admit it, physicians’ pay is tied to doing these things and having stupid life goals-often supervized or it doesn’t count toward the doctor meeting his quota.
    I don’t understand why my physicians care for me-I’m a money losing proposition. I did try to go to cancer support exercise, but the ladies couldn’t understand that head radiation can cause balance and other problems when the head is bent-and they wanted me to do yoga. Then the battle of the bulge. I was told to gain at least 20 lbs to survive cancer treatment, and to keep it on. This interferes with other physicians meeting their quotas in the battle for obesity, diabetes, cholesterol, and CVAs.

    I have a dear PCP and radiology oncologist, and they fight for me to be left alone.

  3. 3 Lenny Husen M.D. November 24, 2016 at 3:09 am

    So well said and sadly, 100% true. I’m the Chair of our Medical Group’s Well-Being Committee. I wish I had the power to change this but I do not. I am a Hospitalist and have it SO good, compared to Primary Docs. If Primary Care Providers aren’t paid for ALL their services and if they don’t have enough time to recharge, Burn Out is inevitable. Thanks for posting this. I just posted it on FB and Twitter.

  4. 4 Jaime November 24, 2016 at 4:31 pm

    Well only take enough patients that you can balance work against down time for R&R in your life. Stop trying to be the big $$$ generator and focus on the number and type of patients you can care for in a quality environment.
    Need for more consumer self help education on maintenance and self care as well as preventive Healthcare 😎😎😎😎 Get rid of Insurance for Profit Healcare providers.😎😎😎😎

  5. 5 Aletha Cress Oglesby, M.D. November 25, 2016 at 3:00 am

    Perfect analogies. And why do we wonder why our health care costs so much with so little benefit to show for it?


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