Why not give patients something they love?

I’m sick of the patient experience. As a practicing physician, and as a consumer of health services, it’s demoralizing for me.

I recently read a study that said one of the reasons for physician burnout is the inability to get things done for patients in the system. It’s commonly held that doctors don’t want to treat Medicaid patients because they don’t get paid. But we do get paid, albeit not as much. The reason physicians are reluctant to take care of Medicaid patients is because it’s so difficult to get them what they need due to limitations of the system. While magnified in the Medicaid population, this same frustration exists with every health consumer. An inefficient system creates a bad user experience.

As an emergency physician, I see everybody, and it frustrates me to watch people struggling to navigate the system. In 2017, almost everyone has coverage. Privately and publicly insured Americans are healthcare’s paying customers all of whom are being made to wait, upwards of three weeks on average, just to see their primary care provider.

Here is a paraphrase of the last ten conversations I’ve had with health systems that are actively exploring a virtual care strategy:

Me: How do you make your money?
Health System: Diagnostics, specialty visits, and procedures performed under our roof.
Me: How do you acquire customers?
Health System: Well, they go see their primary care doctor and are referred in.
Me: But you’ve told me there is a 3-week bottleneck before people can get in to see their doctor. Why are your customers waiting?

The way to remove this bottleneck is to increase the surface area of the system.

Hospitals are spending millions on marketing to recruit patients. But they aren’t doing anything meaningful to retain patients as members once they’ve made their choice. My proposition is to deploy a tool that widens the front door and that delights the consumer. What do people want? They want to talk to a doctor. Why not give customers direct access to a doctor? Make it a doctor inside the system who’s only going to refer and order in your system, using your resources (the ones you told me you make your money from)? Let the diagnostics occur ahead of the scheduled visit to the doctor, and when appropriate, refer directly to the specialist.

Why not just give patients something they love? Health systems seem to want to put a nurse out front, or a medical assistant, or a questionnaire, or a phone tree, or a chatbot these days—what’s the matter with just giving the patient a physician? Too expensive, you say? By positioning an expert out front, you increase the surface area for contact between the community and your services. By giving members direct access to a doctor who can exercise clinical judgment and advance the customer’s course of care you not only make access to care more efficient, you delight the patient by streamlining their experience. What happens when systems don’t do this? The patient is seen by someone else.

Health systems think it’s cost prohibitive to make a team of their own doctors available, that you could never get doctors texting instantly with patients. Here’s the trick—pay them. Still not believing? We just proved that the physician can provide twice the value of the nurse advice line at half the cost in our deployment within the largest integrated delivery network in the nation.

I love having big conversations and doing great things to improve health care at CirrusMD, but then I go back to my emergency room where I find patients at their peak frustration with the system; upset to be there, but without anywhere else to go.

I’m sick of it.

We can do better.