Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How the surplus of patients will impact primary care

Dike Drummond, MD
Policy
October 2, 2012
Share
Tweet
Share

I believe the projected shortage of physicians caused by  the Affordable Care Act will drive primary care into two opposite tracks. Each is a distinct and logical response to the patient overload and each points out gaping holes in our medical education that must be addressed.

The Association of American Medical Colleges  estimates that there will be a shortage of 63,000 doctors by 2015 and 130,600 by 2025 in the wake of the SCOTUS decision to let the Affordable Care Act stand. This tidal wave of newly insured patients has to be served somehow and medical schools and residency programs cannot supply anywhere near these numbers of new physicians in this short of a time frame.

How will healthcare markets respond – especially with regards to primary care?

I see two likely options.

1. Volume driven: Doctor as apex of a care pyramid. In the more traditional practice structure, the physician will be come the leader of a care team supervising a number of physician extenders who provide the majority of the hands on care. The skill and experience of the physician will be saved for the more complicated and severe cases seen that day. The majority of the doctor’s activity will be devoted to leading and coordinating the care provided by the pyramid of NPs and PAs who are their direct reports.

The challenge to this model is the complete absence of functional leadership skills training in most medical school and residency programs. 30 to 50% of these physicians’ time will likely be spend in leadership and management activities for which they are not prepared on graduation.

2. Service driven: Concierge/direct care model. As the typical patient begins to notice they are only seen by a physician on rare occasion, a certain percentage will become willing to pay for that privilege. I suspect this will quickly grow to a tidal wave of new demand for concierge medical services, where you pay a reasonable monthly fee to guarantee you are always seen by your doctor.

The surplus of patients means a shortage of doctors.  As the shortage worsens,  I believe a larger and larger segment of our population will become willing to pay to continue to see their doctor as they do today.

The huge popularity of this service will have another important driving force – the office duties of the physician are exactly the opposite of those in example #1 above. Here the physician is often seeing less than 15 patients a day, providing direct patient care and continuing to have meaningful personal relationships with their patients.

The challenge to this model is the absence of business training, specifically marketing training, in most medical education programs. The concierge model is inherently entrepreneurial and will always involve a fairly sophisticated marketing program to be successful.  This is not an insurmountable obstacle and I have yet to meet a newly board certified MD who understands the essentials of marketing.

So if you have 10 years or more of practice ahead of you, I suggest you look at these models and get ready to be met by a fork in the road. Will you choose to lead a team or build your cash/concierge practice? If you are leaning in one direction, I suggest you get started building your missing skill set — be that leadership or marketing. The wave of newly insured patients is coming.

Dike Drummond is a Mayo-trained family practice physician, burnout survivor, executive coach, consultant, and founder of TheHappyMD.com. He teaches simple methods to help individual physicians and organizations recognize and prevent physician burnout. These tools were discovered and tested through Dr. Drummond’s 3,000+ hours of physician coaching experience. Since 2010, he has also delivered physician wellness training to over 40,000 doctors on behalf of 175 corporate and association clients on four continents. His current work is focused on the 7 Habits of Physician Wellbeing. Dr. Drummond has also trained 250 Physician Wellness Champions, and his Quadruple Aim Blueprint Corporate Physician Wellness Strategy is designed to launch all five components in a single onsite day. He can also be reached on Facebook, X @dikedrummond, and on his podcast, Physicians on Purpose.

Prev

Spinning medicine into soundbites hides the facts

October 2, 2012 Kevin 1
…
Next

How well does your doctor play with others?

October 3, 2012 Kevin 1
…

Tagged as: Patients, Primary Care, Public Health & Policy

Post navigation

< Previous Post
Spinning medicine into soundbites hides the facts
Next Post >
How well does your doctor play with others?

ADVERTISEMENT

More by Dike Drummond, MD

  • Stop physician burnout: the hidden danger of AI note-writing software

    Dike Drummond, MD
  • Why resilience training alone won’t fix physician burnout

    Dike Drummond, MD
  • Ensure your physicians always have crisis support: 5-step awareness program

    Dike Drummond, MD

Related Posts

  • Primary care colonialism: the impact of profit-driven health care on communities

    Michael Fine, MD
  • The solution to a crumbling primary care foundation is direct primary care

    Sara Pastoor, MD
  • Direct primary care: Great for some doctors, but challenging for patients

    Ken Terry
  • Primary care faces a very difficult winter

    Ken Terry
  • Primary care today: There are several concerning trends

    Sue S. Bornstein, MD
  • Primary Care First: CMS develops a value-based primary care program for independent practices

    Robert Colton, MD

More in Policy

  • Online eye exams spark legal battle over health care access

    Joshua Windham, JD and Daryl James
  • The One Big Beautiful Bill and the fragile heart of rural health care

    Holland Haynie, MD
  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • The hidden health risks in the One Big Beautiful Bill Act

    Trevor Lyford, MPH
  • The CDC’s restructuring: Where is the voice of health care in the room?

    Tarek Khrisat, MD
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why the heart of medicine is more than science

      Ryan Nadelson, MD | Physician
    • How Ukrainian doctors kept diabetes care alive during the war

      Dr. Daryna Bahriy | Physician
    • Why Grok 4 could be the next leap for HIPAA-compliant clinical AI

      Harvey Castro, MD, MBA | Tech
    • How women physicians can go from burnout to thriving

      Diane W. Shannon, MD, MPH | Physician
    • What a childhood stroke taught me about the future of neurosurgery and the promise of vagus nerve stimulation

      William J. Bannon IV | Conditions
    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 9 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why the heart of medicine is more than science

      Ryan Nadelson, MD | Physician
    • How Ukrainian doctors kept diabetes care alive during the war

      Dr. Daryna Bahriy | Physician
    • Why Grok 4 could be the next leap for HIPAA-compliant clinical AI

      Harvey Castro, MD, MBA | Tech
    • How women physicians can go from burnout to thriving

      Diane W. Shannon, MD, MPH | Physician
    • What a childhood stroke taught me about the future of neurosurgery and the promise of vagus nerve stimulation

      William J. Bannon IV | Conditions
    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How the surplus of patients will impact primary care
9 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...