Connected Concierge

What is it to practice medicine today? What is it going to be in 10 or 20 years? Would you tell your kids to go to medical school?

I’ve heard these questions a lot, not directed at me, but at practicing docs, my wife included. I remember talking to docs when I was in medical school, both academic physicians and community docs, and hearing over and over how the glory days of medicine were over. I get asked by a doc, on almost a weekly basis about career options outside of clinical medicine. I also get asked if I regret going to medical school. For the record, I don’t. I wouldn’t change anything, other than to maybe have some of my debt forgiven.

Then I came across this article by a gastroenterologist. The author brilliantly lays out the nightmarish process required to become a physician today, including issues related to time commitments, career alternatives, reimbursement, and debt. For those who are unfamiliar, it’s worth reading to see the black box from the inside. For those physicians or those close to physicians, it’s worth reading to give voice to your own process and to read something that makes you nod just about every paragraph. It also may come off as whiny and might even piss off a few lawyers, so heads up.

Older docs may be wondering why the younger ones are whining so much. Work hours rules continue to evolve and reduce the maximum hours residents are allowed to spend at the hospital. Overall work hours have helped but I still know fellows who bust 80 hours almost every week (amongst other blatant violations) and other residents that are not-so-subtly told to make sure they report hours within the work hours limits to avoid getting programs in trouble.

That’s crap, and people I know at those programs know it, but rocking the boat is not considered worth it. And that’s also not universal. I have several resident friends that are strongly encouraged to be honest about work hours because the programs truly want to stay in compliance. These topics tend to dominate our social outings.

Readers may be wondering where the I’m going with all this and if it has anything to do with connected health, startups, or patient engagement. That KevinMD post above got me thinking. It’s written as an attempt to give docs a voice. Why do docs need a voice? As my father-in-law loves to tell me (he manages specialty and concierge practices), "doctors have given away the farm." I think it’s been a while since they even managed the farm, let alone owned it.

Clinical medicine has grown in complexity from a scientific (biopharma, genetics, our understanding of physiology and pathology) and evidence-based perspective. So have the other aspects of practice, such as practice management (billing and coding), documenting (EMRs), malpractice (legal), marketing (consumerization), and probably a bunch of others I don’t even think about. This is forcing lots of docs to become employed.

The word on the street in med school and training is solo and largely independent practice are dead or dying. Being employed makes sense. It allows docs to focus on seeing patients without worrying about lots of the other stuff, or at least spending less time thinking about it. I’ve also been thinking about this a lot lately as my wife is going through the job search process and interviewing.

The downside of more employed physicians is that medical doctors are becoming trade workers, and my cynical perspective tells me they are being employed solely so that somebody else can resell their license. It goes beyond reselling and starts to become dictating how docs even use their licenses or are paid for their licenses.

Then I remembered this article from a couple months back. It was based on a survey that found that 10 percent of docs would change to concierge practices, or direct primary care, in the next 1-3 years. I’ve always loved the concept of concierge medicine, at least I’ve loved the concept if it was affordable to more people. Direct primary care, the cheaper West Coast version of concierge that has One Medical Group as its cheerleader, involves docs directly contracting with patients to offer most primary care services. Patients get same-day appointments and docs typically spend more time with patients. Lots of the middlemen, the people who take a piece of the transaction, are cut out. It’s pretty cool stuff if you can find a practice like it.

Ten percent of doctors is a solid number. It’s not anywhere close to a majority, but concierge never will be the majority. Most importantly for this post is that’s 10 percent of doctors who could,  in the next three years, benefit from technologies that connect patients to practices, provide access to records, provide medical education, and extend the convenience that concierge practices offer to members. For developers, this should be a huge target to solve distribution problems.

While 10 percent is great, some of what holds doctors back is the large commitment when you convert a practice to concierge (is anybody doing partial concierge today?) Maybe technology can help bump up that 10 percent, making it easier for providers to move to a more direct-to-patient model powered by connected health technologies. Sherpaa Health is doing this for employers without sophisticated technology, providing employees with direct access to specialist physicians 24/7 via telephone.

It’s exciting to see technology as enabling more direct connectivity between provider and patient. It enables providers to practice their trade directly with patients, instead of through lot and lots of layers. It opens doors to transparency and more direct accountability. It also has the potential of significantly lowering costs.

Concierge has a clear incentive to make the connection between provider and patient, but maybe the lessons learned can be leveraged beyond concierge. Even if not, healthcare is huge, there will never be a one-size-fits-all solution, and  any double-digit percentage is significant. Let’s keep watching concierge and start building or adapting technologies to it.

Travis Good is an MD/MBA involved with health IT startups. More about me.

  • Most of us want to feel independent and be able to manage patients in a way that we know is best for the individual without someone looking over our shoulder every step of the way.

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