I want to share this good news, but at the same time, I am a bit afraid to let the word get out. Our rural health clinic in Brewster has found a way to keep family medicine alive.

My generation of doctors has experienced incredible changes. The internet revolution is one of them. When I went to medical school in 1995, the internet was slow and clunky and limited in its practicality. We studied at libraries with shelves of books and periodicals all around us. Nowadays, I have reference websites on my phone and laptop for diagnostic protocols, the latest treatment guidelines, and medication dosages. This same revolution that gives me real-time evidence-based practices also brought along the electronic medical record, which has been both a blessing and a curse. I am of the class of doctors who initially learned how to handwrite office and hospital notes. I recall some of my internal medicine notes being several pages long. It seems old-fashioned now, but that wasn’t that long ago.

In that same time period, the American primary care system in our country also changed radically. One of these changes has been the transition away from physician-owned clinics. This trend started in the late 1990s and has continued to grow. A recent study found that as of January 2021, 69 percent of U.S. physicians were working for entities not controlled by physicians, with 49.3 percent of those owners being hospitals or health care systems and 20 percent being either private equity or publicly traded insurance companies. This change in practice ownership continues to grow due to financial, administrative, and other regulatory changes that are not going away. One of the most palpable differences that affects primary care the most is management by nonclinical administration.

When I came to North Central Washington in 2002, I bought into a physician-owned practice. We had an office manager, but the decisions were made by the physician owners. The people seeing the patients decided how best to run the practice. We decided the days we worked, how many patient slots we had each day, and how much vacation time we would take in a year. I was the first partner to take maternity leave, and we worked through that together. At the time, taking eight weeks off seemed a bit revolutionary.

Due to the ownership model now being nonclinical, the model of how practices are managed has almost totally been replaced by administrators who are making the decisions and then telling the physicians how they need to structure their days. This has been problematic in many systems, and some say it was a major player in higher rates of clinician burnout that we were seeing even before the COVID-19 pandemic. Already, there was a sense of physicians and advanced practitioners being pushed harder with more administrative demands, as well as being asked to see more patients each day in shorter time slots. Along with these changes, there is also a loss of agency when clinicians are not involved in the decision-making. Even when working conditions are nearly the same, being an employed physician can lead to more dissatisfaction. One 2022 study found that “physician-owned practices are more likely to be satisfied with the EHR” and “to have positive perceptions of time spent on documentation.” We can learn something from this.

Of course, the pandemic added an accelerant to this already burning bush of increasing physician pressures and burnout. This led to the “great resignation,” where many physicians and advanced practitioners left medicine at a younger age than they had planned. In family medicine alone, 117,000 physicians left practice in 2021. Since then, many thousands more have left practice along with nurses and other health care workers. This has led to significant staffing shortages in both clinics and hospital settings. One national study showed only one out of five primary care clinics were fully staffed, and that 40 percent of primary care clinics had to take on new patients because other practices had closed. Unfortunately, this trend looks like it is going to continue. Based on 2021 Association of American Medical Colleges data, only 33 percent of physicians in practice in our country are in primary care (family medicine, internal medicine, and pediatrics). Even when you add in nurse practitioners and physician assistants, it is still not enough to provide primary care to our country.

The response to all of this has led many organizations to push their physicians and staff to see more and more patients. This is not only to keep afloat financially but also to accommodate patient demand. I know many practices that are only allowed to have 15 to 20-minute appointments no matter what is going on with the patient. The physicians and advanced practitioners at these clinics feel strapped for time and are concerned they are not able to listen well and provide optimal care. This same model does not feel good to patients as they get rushed through their visits and often cannot see the physician or clinician with whom they have the strongest connection.

Here’s the good news. I know we can’t go back to the handwritten note with five lines written in cursive diagnosing acute otitis media, but family medicine doesn’t have to die. I know this because where I work, we practice in a way that feels good to this family doctor who trained over 20 years ago. We found a way to balance these competing forces and create a sort of harmony. We put our commitment to our community first. This includes our staff community and our patient community. We created a standard that says we create a supportive environment for our staff and patients. We listen to each other and try to figure out how to make things work so we provide the optimal patient experience plus the optimal staff experience. We believe that a happy and healthy medical team provides the best medical care.

We believe that providing optimal care may take more time. This means that I still have 40-minute appointments to meet new patients. I just saw a new 67-year-old patient who had not seen a doctor in close to 10 years. He brought me three Honeycrisp apples from his orchard. It was the first time a new patient brought me a gift, and I was so pleased that I had the time to listen to him and provide full-scope family medicine. As I go through my day seeing patients, I am listening to their stories. As physician author Abraham Verghese said, “When I see a patient, I take a history, and what is a history but a story?” Being heard is what people want, and that requires keen listening and a collaborative approach to address the issues that are ailing them. What allows us to do this? I asked our CEO this question, and here is his reply: “I know that for a member of our team to bring their best every day, we must have a positive, enriching culture. What that really means is that we have to embrace being balanced in all we do. Yes, the financial pressures are always there, along with the need for improved quality and meeting the demands of regulation. But we can never afford to lose sight of the fact that we are human beings taking care of other human beings, and for that to go well, we must always attend to maintaining our humanity first, and all the rest is secondary to that.”

It is possible to have a primary care clinic that has clear commitments and then lives up to them. If we can do it, then I would assert the same can exist nationwide. As a recent Kaiser Health News article points out, having a relationship with a “doctor who knows your health history and has the time to figure out whether the pain in your shoulder is from your basketball game, an aneurysm, or a clogged artery in your heart” is what we need and what we can create. We need to prioritize primary care in our country before it is too late to salvage. The life expectancy in the U.S. is declining while we have a higher number of specialists per capita in the world and spend more on health care than any other high-income country. Being a primary care doctor is not a sexy profession that plays well in medical dramas. But I have had countless patients tell me I saved their life. I have had countless patients tell me their story and say it is the first time they have shared it with anyone. I want to continue to practice medicine in a way where I am healthy and well in order to keep my patients healthy and well. So, just look to rural Washington to know that when there is the will, a way can be found.

Amy Ellingson is a family physician.