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Can the Internet save primary care?

I’ve been thinking a lot lately about the plight of family physicians – reimbursal for their services continues to decline, overhead steadily increases, and pressure to see a minimum of 30 patients a day can drive them to near despair. Family physicians want to provide quality care for their patients, but are exhausted by volume demands and paperwork.

If you missed this article about the primary care crisis in America in the New England Journal of Medicine, it’s an excellent read. Here are some excerpts:

Excessive demands contribute to long waiting times and inadequate quality of care for patients. A growing proportion of patients report that they cannot schedule timely appointments with their physician. Emergency departments are overflowing with patients who do not have access to primary care. The majority of patients with diabetes, hypertension, and other chronic conditions do not receive adequate clinical care, partly because half of all patients leave their office visits without having understood what the physician said.

These problems are exacerbated by the system of physician payment. Thirty minutes spent performing a diagnostic, surgical, or imaging procedure often pays three times as much as a 30-minute visit with a patient with diabetes, heart failure, headache, and depression…

These factors add up to an unsurprising result: fewer U.S. medical students are choosing careers in primary care. Between 1997 and 2005, the number of U.S. graduates entering family practice residencies dropped by 50 percent…

Who might support a national policy to rescue primary care? Employers and insurers, public and private, may reap a return on investment by fostering a more effective primary care sector that will reduce health care costs… Whoever takes up the cause of primary care, one thing is clear: action is needed to calm the brewing storm before the levees break.

A recent article in the Wall Street Journal sent ripples through the blogosphere. It was about how a few family physicians found a way to drastically reduce overhead – by being a solo practitioner and using technology to replace office staff and automate billing as much as possible.

Drs. Charlie Smith and Joe Scherger are family physicians here at Revolution Health who are leading the charge towards high tech solutions for family physicians. Charlie explains his philosophy in his recent blog post:

Having practiced primary care for over 30 years, I’m convinced the model of receiving in office care for every problem is not working well. I really like the ideas espoused by Don Berwick in changing the model of care in the doctor’s office to that of seeing patients in groups, treating them by phone or by e mail, rather than in the office. Using phone calls or e mails to sort through the patient issues, the doctor can decide to see the ones who really need to come into the office and the others can be taken care of without an office visit. This is a MUCH more efficient method, allows you to take care of many more people that need care, and gets people the care when they need it, rather than forcing them to wait until they can fit into a slot in your office.

The ideal way to partner with your doctor to use the health care system in the most effective way possible is to call or e mail him whenever possible, use the internet to research all of your health conditions, and only go into the office when you require in office care, such as exams, procedures, lab tests or x rays. Become an e patient!

I personally believe that Revolution Health can substantially improve the life of family physicians through innovative technologies designed to automate their practices as much as possible (thus reducing overhead and time spent on paperwork), as well as educating patients about the management of their diseases and conditions, (thus improving outcomes and increasing pay for performance bonuses), and triaging low acuity issues through online physician emailing services and retail clinics (thus helping patients receive the care they need without excessive use of office time).

Who will take up the cause of primary care (asks the NEJM)? Revolution Health will. Let’s work together to improve the quality of life for physicians and patients alike.

This post originally appeared on Dr. Val’s blog at

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2 Responses to “Can the Internet save primary care?”

  1. CharlieSmithMD says:

    Kudos for a nicely written piece. Predictions of upcoming overall physician shortage is likely to worsen this situation subtantially over the next decade! The AMA Council of Graduate Medical Education has recommended that Medical Schools train 3,000 more medical students nationwide per year to try to fill anticipated shortages. Predictions in the next decade are for a need for 200,000 physicians more than we currently have practicing in the US ( If we don’t embrace technology effectively, the crisis will extend beyond primary care. Revolution is well positioned to participate in the solution by providing great consumer tools, lowering the barrier for access to health care, and encouraging and supporting patients in their quest to take control of their own health care.

  2. Dr. Scherger says:

    Family Medicine and primary care will not be “saved” by sticking to the now old and tired model of a busy office schedule. The work of comprehensive primary care has become too complex to be done in brief visits. A new care model must develop, and Revolution Health can help with this. I have been giving my email to my patients for 10 years, and do most of my communication and care of patients through online communication. Of course, I continue to see my patients, but the visits are unhurried, on time with all the time necessary for healing. The ideal micro practices (IMP) all do good old fashioned relationship centered care using new methods of communication (see Family Medicine will floursish again when if reinvents itself for the 21st century. The finances will follow this innovation, and patients may pay directly out of their new insurance deductables for 24/7/365 access to their personal family physicians. $30 a month “access fee” for 1000 patients gives the family physician $360,000 a year to mold a low overhead practice.

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