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Where Have All the Family Practice Doctors Gone? First Aid for Primary Care

By Alan W. Dappen, MD; Steve Simmons, MD; Valerie Tinley, FNP of Doctokr Family Medicine

We are a family doctor, an internist and a family nurse practitioner working on the front line of the American health care system. We share a moral and ethical duty to protect the health of our patients along with all our colleagues who labor daily doing the same.We as Americans are proud of what has long been considered a first-rate health care system. Sadly, this system is broken despite our best efforts. Americans spend much more per capita for care as any other country. The World Health Organization has graded our care as 37th “best” in the world. Even worse, American citizens were the least satisfied with their medical care compared to the next five leading socialized industrialized countries, including England, Germany, Canada, Australia and New Zealand. There are many things wrong. Let’s examine a few:

Primary care medicine in America is gasping for its last breath. Internists, family doctors, pediatricians (whom health experts consider essential to a robust and cost-effective delivery system) are leaving primary care in droves. The number of newly trained generalist doctors has plummeted so fast that extinction of the generalist doctor has been forecasted within 20 years by both the American Academy of Family Practice and the American College of Physicians.

Patients are angry and exasperated with long delays, poor service and confusing and redundant paperwork. To date 17% of us are uninsured and this number will quickly grow in a deepening recession.

Employers face a huge cost burden as health insurance prices go through the roof. CEOs consistently say the runaway costs in health care benefits (which double in price every seven to ten years) threaten the viability of their companies. Since 2000, the number of small businesses offering health insurance has dropped 8%.

Health insurance companies are making so much money that several states have motioned legislation compelling insurance companies to disclose the percentage of premiums spent on actual medical care. Not surprisingly, their lobbyists are resisting. It is not uncommon for insurance companies to keep 30-40% of every dollar for “administration” and profits. Many of these companies are on record reaffirming their commitment to shareholders and short-term profits.

Doctokr (“doc-talker”) Family Medicine is a medical practice that was created to respond to the conflicts and problems listed above. We have worked to resuscitate the soul of the Marcus Welby-style patient-focused physician while adding technology to deliver fast, responsive and informed care. All fees are transparent and time-based and are the responsibility of our patients to pay. All parties that interfere with the doctor patient relationship or increase our costs have been removed from the equation. The practice delivers “concierge level” services: 24/7 access, connectivity to the doctor no matter where our patients are located, same day office visits for those that need to be seen, even house calls for those unable to get to our office. By removing the hurdles and restoring transparency and trust, 75% of our clients get their entire primary care needs met for $300.00 a year.

This post is written by three medical professionals who stopped waiting for someone else to find a solution and are actively changing primary care in ways that dramatically improve quality, convenience and access, while drastically reducing costs. The US deserves excellent health care and it must be done right. To understand why we would bother to “walk the walk,” we ask your indulgence and participation while we “talk the talk.” We hope this format will educate and inform you in ways that move you to participate in your care. Health care is about you, just as much as it about us, because we are all patients. We all have a stake in shaping the inevitable need for reform.

The next upcoming topics:

  1. Where did the Marcus Welby, MD-style of primary care go and how can we get it back?
  2. How have you as a patient lost control of your body and health?
  3. Turning the primary care model upside down: What does primary care need to do to reinvent itself so that it serves its patients without other conflicting interests?
  4. Begin the exploration of the unexamined assumptions of health care….

Until next week, we remain yours in primary care.

– Alan, Steve, and Valerie


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6 Responses to “Where Have All the Family Practice Doctors Gone? First Aid for Primary Care”

  1. Katie Brewer says:

    I truly see this as an area of commonality with nurses and doctors – nurses have been moaning of the shortage of qualified nurses to deliver bedside for what, 10 years? Now we see this looming shortage of primary care doctors. I would love to see these two groups unite to solve our problems together – many of the causal issues are similar – your recent podcast with the three nurse bloggers points that out!

  2. #1 DInosaur says:

    Gee, that’s exactly how I run my solo family practice. Unfortunately I still feel too responsible to those of my patients who can’t afford my services without their insurance, so I’m still doing the HMO/referral/insurance nonsense. Concierge care at insurance payment levels; it sucks. I’ll work up my nerve to dump it all and go cash only in another year or two.

  3. Emily Downward says:

    Sounds like an interesting service. Wish they were in my area!

  4. Peter Dunn says:

    If there’s no development with health care, even policyholders of health insurance plans don’t get the assurance that they are gonna be treated in the best ways.

  5. Barbara K. says:

    Many mental health providers have gone to that model. One consequence is that their practice becomes inaccessible to the folks at lower income levels, even with a sliding fee scale. How does the practice you describe deal with this issue — especially for those whose care needs exceed $300

  6. Responding to Comment #1
    Like we mentioned in our comment below to Barbara K, over half of our patients do not have insurance or have high-deductible insurance, so we understand your struggle. If you do make the leap, we’d be interested in to hear reports of how it is going!

    Response to Comment #5
    Funding and finding high quality primary care for the poor was and will always remain a problem. Solutions will continue to require subsidies either via non-profits or the federal or state government.

    A theme that will keep appearing through our weekly content will be “no money no mission,” and trying to get people to understand, no matter where you stand on the political spectrum of health care that health care is not free. The primary mission of our practice at this time is to demonstrate a day to day solution focusing on responsive, high quality care that significantly reduces barriers to reaching a medical expert, gets people the care they need, when they need it and significantly reduces the system cost of care.

    The innovations we practice can easily by adopted by health centers throughout the country already but then you need to decide; “Do I want to spend $1 million to subsidize those who can’t afford care or adopt a new paradigm like doctokr which reports better care, happier patients, happier doctors and delivers the same, in fact better care for $500,000.00.” Almost 50% of our patients have no insurance or high deductible insurance. Without any other subsidy, we too are doing what we can. Our ideas, we think, are part of the solution for the poor but we emphasize the word “part.”

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