American Academy of Family Physicians (AAFP) board member Dr. Leonard Reeves published a very compelling column on December 4 (2017) making the case that there is a difference between healthcare and sick care. His post advocated for a national primary care benefit for all, regardless of employment or insurance, as a way to promote better health rather than simply responding when people are sick. The article is good reading for any doctor, but particularly those involved in family medicine.
This article will focus on the idea of healthcare versus sick care rather than addressing Reeves’ desire for universal primary care benefit. That universal benefit aside, embracing the principle of healthcare versus sick care can change the way doctors practice family medicine. The principle is a profound one equally valuable to locum tenens doctors, private practice owners, and employed physicians.
The Fundamental Principle
Reeves’ fundamental principle rests on understanding what we are talking about when we refer to healthcare in the U.S. More often than not, the reference has nothing to do with good health at all. Healthcare discussions mainly center around caring for those who are sick and/or providing the insurance benefits to pay for that care.
In essence, Reeves maintains that we are actually talking about sick care when we engage in healthcare discussions. He makes a very valid point. America’s family medicine practices are awash with patients in need of care because they are sick. How rare it is for a patient to visit the doctor when there is absolutely nothing wrong, solely for the purposes of receiving preventative care. And even when such patients do show up, doctors do not have sufficient time to spend with them.
What we really have in this country is a sick care system, according to Reeves. As he sees it, a true healthcare system would focus as much on keeping people healthy as it does restoring them to health in times of illness. It would place a heavy emphasis on methods of intervention that equip patients to eat right, exercise regularly, and otherwise proactively care for themselves.
The current circumstances under which doctors work is described by Reeves in his column as ‘piecework’. Just as a factory worker might get paid based on the number of pieces he produces every day the average family medicine doctor gets paid based on the number of patients he or she sees in the office. We have a system based on volume rather than quality.
Elements of the Affordable Care Act were put in place to change this model. That change is happening, albeit a lot slower than many of us would like. But even as we transition from the old fee-for-service model to outcome based medicine, doctors still don’t have enough time in the day to see all their patients. They give so much time to the sick that they don’t have time for the well.
Where to Go from Here
Though Reeves offered a universal primary care benefit as one solution to the current problem, such a benefit would probably not address the underlying reality of not enough doctors to see all the patients who need care. So, where do we go from here?
For the time being, family medicine practitioners just have to make do with the resources they have. Hopefully the transition to outcome based medicine will pick up speed in the coming months and, as a result, bring a quick end to the piecework mentality. In the meantime, we somehow have to find a way to recruit more young people into the medical profession – particularly family medicine.