Jacqueline DiChiara has a great piece this week about the impact of physician shortages on the future of medicine. Hit the link for the full article, but I want to highlight one section that addresses the growth of direct primary care (DPC) and the interest that doctors—especially younger ones—have in the model.
You can find the Physician Foundation's study here. I have talked extensively about why DPC innovations are important not only for patients, but for doctors as well. Patients can generally expect to see cost and access improvements when they join a DPC program; meanwhile, doctors can generally expect to see lower costs and greater control over their practices. Indeed, for many doctors, moving to a DPC model offers them a way to remain in the field of primary care rather than be pushed out of it.
Expanding insurance—as Obamacare has attempted to do—fundamentally doesn't accommodate these cost, access, and professional control priorities. Instead, the Affordable Care Act doubles down on a broken status quo that ignores the system's effect on a host of important policy considerations, including the prices for care paid by patients and the supply of doctors serving the system. Gayle Brekke, a health insurance actuary writing for the Benjamin Rush Institute, captures the quandary well:
In the health care system, when a 3rd party (insurance company, government) is paying the bill from the first dollar of coverage, patients (consumers) do not have an incentive to shop for value. They are not spending their own money at the point of service. In fact, patients often feel like they pay high insurance premiums so they want to consume more health care in order to feel like they are getting value from their insurance coverage.
Until the health care industry grapples with its longstanding cost and, relatedly, access problems, patients will continue to be let down by the system and primary care doctors will continue to get squeezed by it.