50 years ago it was commonplace to have a primary care physician. Today, it is far less common. Do we still need PCPs, or are we just as well off going to the nearest “doc in the box” to get our care? It can be more convenient to go to one of these same day clinics. It is also simple to google medical information, such that many patients already have an idea of what they need when the come in the door. I would argue that a relationship with a PCP is still extraordinarily valuable (and yes, I am biased, I am a family doc after all!). Here is an example to illustrate my point:
Today I was talking with a family member who does not currently have a primary care doctor. She is 41 years old. She is done having babies. She does not really have any active medical problems (or so she initially claimed), so when the structure of her doctor’s office changed (and inadvertently booted her out of the system), she simply never re-established. She now needs a Tuberculosis test placed for employment purposes, so guess what her plan is? She is going to walk into an urgent care. She has pretty good health insurance, and a good job, so the $50 co-pay is not really a big deal to her. What she may not be considering however is all of the other associated costs: She is going to take an afternoon off of work, probably spend 2 hours in a waiting room as she is DEFINITELY the lowest acuity on the triage list, and she is going to pay $50 for a nurse to pop some tetanus toxoid into her skin, then she will go back three days later and repeat the process to get the thing read. She will have her little slip of paper stating she is not a tuberculosis carrier, but she will also have cost herself time and money, and she will have cost her insurer another $250 as the average UC visit is about $300. AND if she is unlucky, the insurance company decides it was not a worthy visit she will pay that all out of pocket. All simply because a big system sucked up all her medical data and spit her out without a doc to care for her.
Let us imagine instead that this soul had a PCP on her side. If she or her family were a part of my practice I could have placed the $2 test myself. There would have been no wait, no fuss and no extra charge to her. She would then return three days later to have the test read. In all likelihood, we would get to chatting. I would notice the small precancerous lesion on her cheek, and say, “hey, can I freeze that off for you today?”. She would say, “Yes! You just saved me another $200 at the dermatologist!” Maybe we would even get to chatting about her chronic sinus issues for which she currently calls a teledoc 3x/year when it flares up. Instead of him giving her an unnecessary antibiotic, I could educate her about chronic sinusitis and how to treat flares without antibiotics. And maybe, just maybe, she would say, “hey, you know I have this shoulder thing that has been bothering me for YEARS, but not enough to go to a doctor about” And at that point, I would probably say, “Let’s have you come back next week for another appointment, there is no additional charge, and in the meantime, try these exercises!”
Yes, a primary care doc that cares, and knows what they are doing, can save the system, and by extension patients, a lot of money. Even if you are young, healthy, and with “no medical problems.”