Unlike previous generations, young people today have countless options when it comes to their medical care. Millennials can video chat with a doctor practicing anywhere in the country, or sign up with a concierge medical group and schedule an appointment with the next-available provider online.
A millennial myself, I haven’t had a steady primary care doctor since I moved to the U.S. four years ago. I prize convenience over anything else, even if it means having to repeat basic information like my allergies and family history. Over the past few months, I’ve interviewed more than a dozen millennials and a range of health experts to find out whether I’m the exception or the norm, and whether doctor-patient loyalty is truly a thing of the past.
My friend Olivia June Poole couldn’t tell me the name of her primary care doctor. When she’s feeling unwell, she makes an appointment online through San Francisco-based One Medical, a new brand of concierge care that prides itself on its online offerings.
“I personally don’t care what doctor I see as long as they’re competent, they have access to my medical records, and I can see them as soon as I need to,” said Poole, a technology entrepreneur in her late twenties.
Almost all of the millennials I spoke with said they had high expectations for their primary care and were willing to “doctor shop” until they felt satisfied. Most saw value in same-day appointments, online scheduling and access to their medical record, as well as the option to text or email the doctor between visits.
These days, “the notion of having a single doctor that is theirs is a foreign concept” to millennials, said Dr. Pat Basu, the chief medical officer at Doctor On Demand, a San Francisco company that offers video visits with doctors for $40 per session.
Is the Lack of Loyalty a Bad Thing?
Unfortunately, I did not find a large-scale dataset to prove that millennials are less loyal to their doctor than previous generations — one may not exist yet. But bits and pieces of research paint a picture of a millennial-set that is increasingly demanding of their primary care doctors.
A 2012 survey from Harris Poll, a market research firm, found a disparity between the desire for online health services and the availability of those services. Among those surveyed, 52 percent of baby boomers said they were “very satisfied” with their health care experience, compared to 48 percent of Gen Xers and just 35 percent of millennials.
Services like Doctor On Demand do offer people the option to see the same doctor again. But according to Basu, 30 to 40 percent of patients do not typically maintain a relationship with one doctor, as it means longer wait times. That number jumps to more than 50 percent for patients in their twenties.
But copious data does exist to show that there’s still a great deal of value in a doctor-patient relationship, particularly for those with chronic or complex medical conditions. For instance, recently-published research in the journal Health Affairs found that in California, continuity with a regular source of primary care leads to fewer hospitalizations and emergency room visits.
“Even in this digital age, someway, somehow there needs to be a connection [between doctor and patient],” said Paul Grundy, IBM’s director of healthcare transformation and the founding president of the Patient Centered Primary Care Collaborative, a coalition of health care providers, patient advocates and employers based in Washington DC that advocates for higher quality care at a lower cost.
Grundy’s research from 2008 found that those who have a regular relationship with a primary care doctor, or “healer” as he calls them, cost the health system one-third less and experience a 19 percent lower mortality rate over a 15-year window than those who can’t name their primary care doctor.
“If you have a medical condition like cancer or HIV, then you should value the relationship,” added Bob Kocher, an investor at health care-focused investment firm Venrock and a former specialist assistant to President Obama who helped write the Affordable Care Act.
According to Kocher, there isn’t an easy way for one doctor to share instructions or learnings for the next doctor. Information can get lost in the shuffle. Patients may undergo repeat tests, and will very likely need to spend time filling out a family history.
“There’s certainly a lot lost when the next doctor tries to figure out what to do with you,” he said.
Wanting it All
What surprised me in my research is that while millennials do shop around for primary care, similar to how they compare auto insurance or airline flights, many said they were willing to commit once they’ve found a doctor who fits the bill. Others told me that they would prioritize seeing their regular doctor and would only consider seeing a new doctor via Doctor On Demand or One Medical if the wait time for a visit surpassed a couple days.
Ali Boldish, 28, of Medford, Ore., still values loyalty above all else. She said she has taken the time to choose a doctor who will spend time really listening to her, rather than staring at a screen or hastening her out the door after a few minutes.
“I trust they [my doctor] will be open and honest with me and that they trust me to hear not only my worries but my thoughts as well and take those into account,” she said. “I expect not to be rushed.”
During a recent trip to the East Coast, I paid a visit to Manhattan-based ZocDoc, a website that helps millions of patients each month across the U.S. schedule doctor’s visits. The vast majority of people who use ZocDoc are under the age of 40.
Many patients who use ZocDoc hold a similar view as Ali Boldish. Three out of four returning patients will choose the same doctor, company spokeswoman Amy Juaristi said, adding that many of the doctors who have signed up to ZocDoc offer texts and email communication as well as weekend and evening appointments to appeal to busy young professionals.
“Twenty-somethings are extremely loyal to their primary doctor if it means they don’t have to give up on convenience. We try to foster that,” said Oliver Kharraz, the company’s president and founder. In order words, millennials are willing to wait a bit to see their regular doctor, but not a few weeks or months.
Nikolaos Bonatsos, a 31-year-old venture capitalist based in Palo Alto, has been seeing the same doctor for four years. Recently, he said he felt a bout of fatigue and tried to schedule a time to talk about his symptoms. Only when he didn’t hear back for two days, did he opt to schedule an online visit via One Medical with a doctor who happened to be available.
“For small stuff, do I have loyalty? No,” he said.
“In the era of text messaging and instant gratification, speed matters a lot. Traditional health providers don’t do well,” he added. “So if you are a techie or a hypochondriac you start looking around for other alternatives.”
For their part, primary care groups say they’re doing their best to improve the experience for young people, so they don’t flock to a virtual alternative.
Dr. Robert Wergin of the American Academy of Family Physicians said the organization conducts surveys of its members every year, which show a steady increase in doctors modernizing their practices by offering email communication and online access to billing and/or medical records since 2008. The American Academy of Family Physicians represents over 120,000 U.S. doctors.
“Our approach is to encourage doctors to think about what a millennial would want and adapt,” Wergin said. “We still think patients benefit from having a consistent physician, or at least gravitating to one when they can.”
Do you value your relationship with your primary care doctor? Have you ever consulted with your doctor via video chat? Share your story with me at firstname.lastname@example.org