For nearly a century, people have assumed that primary care doctors were the gatekeepers to health care. As waits to see PCPs ballooned from getting a house call that day to 40-something day waits, PCPs have rightly lost their status. Because we’re an enterprising nation, urgent care centers, retail clinics, ZocDoc, and telehealth arose to fill the demand for accessible care. But all of them sacrificed continuity and relationships for immediacy. And our culture increasingly expects immediacy due to expectations created by other industries (uber). I think you can have both — immediacy and continuity — but only if you reimagine primary care as a service, not a PCP.
All of these new services are terrible entry points into healthcare.
Urgent care centers are typically independent entities loosely tethered to the local hospital networks. Retail clinics are literally Walgreens and CVS. ZocDoc connects you with PCPs (most likely new and less experienced PCPs) who need to pay ZocDoc to fill their practice. And telehealth is a bank of random doctors (again, a PCP with free time…Really? Who the hell are these people and why?) somewhere in your state who can talk with you for 10 minutes and once they realize they can’t diagnose and treat you (they can only diagnose ~30 stupid simple issues), you’re on your own again looking for another local entry point into healthcare.
As a consumer, you either have an untrusted, untethered entry point, or you have a trusted relationship.
As relationships have fallen by the wayside, consumers are on their own. Local hospital systems view primary care as the loss leader that’s incentivized to refer to higher revenue-generating specialist services. Primary care departments then get the shaft as hospitals don’t have the vision to reimagine primary care as a series of services that intelligently route people to exactly who and what they need. They’re still doubling down on the old-fashioned, increasingly inaccessible PCP.
Consumers literally have two choices
- Wait weeks to spend money just to be told by a PCP that they probably need someone/something else
- Go to an urgent care, retail clinic, or telehealth
Reimagining primary care is the secret to intelligent healthcare usage and, when consumers feel like they have services that actually serve their needs, they’ll be lifelong customers. But primary care won’t look like today’s primary care. It’ll be a whole new concept. It won’t feature the PCP as the central figure. It’ll be an immediately accessible online service that either treats online or routes intelligently.