This commentary is by John Dunn, M.D., a resident of Jeffersonville and a doctor at the UVM Urgent Care Center. He has practiced in Vermont for about 30 years.
Dr. Fay Homan wrote a great commentary that appeared here on Dec. 1 about the need for more primary care here in Vermont.
At the UVM Urgent Care Center, I see people every day who use our facility because they either don’t have a primary care provider or their provider can’t see them for weeks. We often provide patients with a list of the primary care practices that are reportedly taking new patients, but many will try all of the names on the list without any success.
After 20 years of practicing emergency medicine, I decided to try my hand at primary care, to try to “keep my patients out of the emergency room.” I worked with a small family practice group and then ran my own practice for several years. I saw about 12 patients per day, to allow time for phone calls and paperwork, fighting with insurance companies, and so on. I made house calls, was on call for my patients 24/7 and did all of the office procedures such as suturing, joint injections, EKGs, etc. that Dr. Homan mentioned.
The problem? After three years of practice, my gross salary was $60,000 per year with no benefits. Subtract taxes, retirement and health insurance, and you can imagine what’s left. Heading into my 60s, I needed to do something else, so I shuttered my doors and joined UVM Urgent Care, which has been great to me, and is an important safety net for many who lack readily available health care.
Granted, I could have upped my solo practice daily patient tally to 20 or more, or switched to a concierge model, charging patients an annual membership fee, but I didn’t feel these were right for me.
Dr. Homan is right: We need more primary care. Honestly, though, many have said that for decades, and little has changed for the better.
Most primary care providers work long hours, and spend an inordinate amount of time filling out forms, and reporting to or fighting with insurance companies, for lower pay than most of their colleagues.
To “provide a shift to more of a focus on preventative care, management of chronic diseases,” as per the head of the Green Mountain Care Board, we need to pay primary care providers better and reduce their administrative burden. More time with patients and less on computers.
If I can “Buy now with one click,” why can’t I finish a note on my patient, click “Done,” have the visit code, billing and any other needed data go directly to the insurance company, and see the payment by the end of the day?
To make such changes means major overhaul of our systems. Higher payments for primary care would need to come from somewhere, and who will give up a piece of the pie? Insurance, pharmaceutical and device manufacturing executives, hospital administrators, more highly paid providers and others? Our patients pay way too much as it is.
Unless we as a society are willing to force change on all of the “players” and redirect resources, then primary care will become a thing of the past.