Primary Care Doctors Can Thrive in America and at Kaiser Permanente

Doctors should not have to wait until retirement before remembering our calling – why we do what we do.

It’s about putting others first. Helping others in their time of need, worry, and illness. Often this meant sacrifice and putting others ahead of ourselves and our families. Nothing could be more noble than serving others.

Yet in today’s environment, it can be very hard to remember this. As people live longer through medical advancements, providing care is increasingly and more complicated. Patients who would have died decades ago now survive and encounter other chronic illnesses and those set of complications.  We face new initiatives like “best practices” and ideal workflows via Lean projects (Toyota Production Model) to make care more affordable by removing unnecessary costs and delays. We struggle with electronic medical records which show promise of having every piece of information available for patient care but still aren’t yet displayed in a way we need to not review every piece of information available. Expansion of health insurance via the Affordable Care Act (ACA) otherwise known as “Obamacare” added millions of Americans to the health care system. Unfortunately, there was no comparable increase in doctors to handle these new patients. To top it all off as health care becomes increasingly unaffordable and insurers are competing harder for patients, doctor compensation is under intense scrutiny even as many of us are still paying off student loans.  These challenges were highlighted in the Forbes blog post “Tell People What It Is Really Like to be a Doctor”.

Why would anyone ever want to do primary care?

It’s hard to remember why we do what we do.

Caring for others can be what you imagined it to be when you first went to medical school. It can be good for doctors and patients if the health care system is streamlined like the one I worked at for the past 15 years.

Patients say things like this.

 

Since wrapping up my clinical practice, I’ve been inundated with similar and heartfelt patient emails and letters.

A Patient Centered Medical Home Thrives in a Village

Primary care succeeds by providing care in a patient centered medical home. It thrives when it is supported by a strong village. Medical care is increasingly a team oriented endeavor. Although most of the time patients only need to see me, it is my team and my 8000 colleagues of various specialties and their support staff who makes me look good as together provide great patient care. When lab results are released online for patients to view within hours of the blood draw, when xray results are completed by the time patients return from radiology, when patients need to see a specialist they can see one the same day, speak to one real time, or book online themselves when convenient for them, patients feel cared for. They get the care they need quickly and easily. They spend less time worrying and waiting and more time getting better.

We joined Kaiser Permanente because we have a streamlined system that makes caring for patients easier. We joined colleagues determined to make that streamlined system even better.

As a consequence, the thank yous from patients belong to my colleagues who make me look even better.

Patients know it is the village or integrated care and the complete team that makes their care exceptional.

Physician leaders must lead change and must always focus on the patient

A few years into my career and with support of my colleagues, I became a physician leader. The challenges for a physician leader is far different than that of a practicing clinician, yet the focus is still the same. All of the issues of making care more affordable, providing even more streamlined care and better care for increasingly complex patients, and all of the other challenges facing doctors nationally face us as well. But as a physician leader, we also need to support our doctors and staff to ensure they still get to do what they aspired to do: taking care of patients. Though there is no health care system that is perfect, based on patients’ testimonies, I believe we have largely succeeded and will continue to do so.

Though I believe that Kaiser Permanente is the answer for many doctors and patients how care can and should be delivered, it is not the only way and it isn’t for every doctor and patient. Our country it too vast and too varied to only have one way of doing things.  It is up to the public to decide what how they want their care delivered. In a competitive market, there continues to be more innovations particularly in the primary care. Startups like Turntable Health and Iora Health are re-imaging and betting on this.

Yet, patients at Kaiser Permanente are very satisfied with the care they receive. The quality of care is among the best in the nation. This has been confirmed by many organizations including JD Power and Consumer Reports. The doctors I work with are proud about the care we provide and how hard we work to make the care and service even better. Inside a well organized and integrated system, primary care doctors, specialty doctors, and patients can focus on preventing, healing, curing, and treating illness and building long term relationships.

Making long term meaningful relationships is why I went into primary care

Our colleagues inside an integrated health care system work tirelessly to make sure that happens with every doctor and patient encounter. It’s hard work.

Yet, having long term meaningful relationships with patients is one of the most gratifying parts of being a doctor.

This is why we went into medicine.

The best decision I ever made

So as I take a hiatus from clinical medicine, I know that doctors who desire wish to practice in a supportive environment, who wish to work with liked minded mission-driven colleagues who want to make a difference, who value making a connection with patients, and who want to remind themselves why they went into medicine in the first place, consider joining. It was one of the best decisions I have ever made.