When Doctors Dump Insurance for Subscription Model, Who Benefits?
Are Millennials Ready to Ditch their Regular Doctor?
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","credit":"Monkey Business Images/iStock","description":null,"imgSizes":{"thumbnail":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-400x267.jpg","width":400,"height":267,"mimeType":"image/jpeg"},"medium":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-800x533.jpg","width":800,"height":533,"mimeType":"image/jpeg"},"large":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-1180x786.jpg","width":1180,"height":786,"mimeType":"image/jpeg"},"fd-lrg":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-1920x1280.jpg","width":1920,"height":1280,"mimeType":"image/jpeg"},"fd-med":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-1180x786.jpg","width":1180,"height":786,"mimeType":"image/jpeg"},"fd-sm":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-960x640.jpg","width":960,"height":640,"mimeType":"image/jpeg"},"post-thumbnail":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-672x372.jpg","width":672,"height":372,"mimeType":"image/jpeg"},"twentyfourteen-full-width":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-1038x576.jpg","width":1038,"height":576,"mimeType":"image/jpeg"},"guest-author-32":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-32x32.jpg","width":32,"height":32,"mimeType":"image/jpeg"},"guest-author-64":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-64x64.jpg","width":64,"height":64,"mimeType":"image/jpeg"},"guest-author-96":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-96x96.jpg","width":96,"height":96,"mimeType":"image/jpeg"},"guest-author-128":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-128x128.jpg","width":128,"height":128,"mimeType":"image/jpeg"},"detail":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care-75x75.jpg","width":75,"height":75,"mimeType":"image/jpeg"},"kqedFullSize":{"file":"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Millenials-and-health-care.jpg","width":2716,"height":1810}},"fetchFailed":false,"isLoading":false}},"audioPlayerReducer":{"postId":"stream_live"},"authorsReducer":{"byline_futureofyou_219067":{"type":"authors","id":"byline_futureofyou_219067","meta":{"override":true},"slug":"byline_futureofyou_219067","name":"David Gorn","isLoading":false},"cfarr":{"type":"authors","id":"3252","meta":{"index":"authors_1591205172","id":"3252","found":true},"name":"Christina Farr","firstName":"Christina","lastName":"Farr","slug":"cfarr","email":"cfarr@kqed.org","display_author_email":false,"staff_mastheads":[],"title":null,"bio":"Christina Farr (\u003ca href=\"https://twitter.com/chrissyfarr\">@chrissyfarr\u003c/a>) is the former editor and host of Future of You. She was previously with Reuters, covering digital health and Apple and before that, she reported for Venture Beat. Christina was born and raised in London and has graduate degrees from University of London and the Stanford School of Journalism. Farr’s work has appeared in a variety of publications, including the New York Times, the Daily Telegraph, the Bay Citizen and SFGate.com. She has appeared as a featured expert on NBC, ABC and Reuters TV, among others, and frequently speaks at health and technology conferences. 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You can tell a knitter lives there: baskets of wool and hanks of yarn adorn the room, and in the corner sits a wooden spinning wheel.\u003c/p>\n\u003caside class=\"pullquote alignright\">A new model gains in popularity: no insurance but unlimited doctor visits are provided for a monthly fee.\u003c/aside>\n\u003cp>But arthritis has put an end to that hobby. And for a while, Caponio, 69, wasn't even getting out.\u003c/p>\n\u003cp>\"I kind of stopped going downtown,\" she says, in her Midland, Texas twang, a holdover from childhood. \"Omigod those stairs.\"\u003c/p>\n\u003cp>She's talking about a steep, 17-step staircase leading to her front door. Three hip replacements left negotiating them a dangerous proposition.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"I tend to fall. And I fell on those damned stairs once.\"\u003c/p>\n\u003cp>And that's where Lorraine Page enters the picture.\u003c/p>\n\u003cp>Besides the house calls, Page provides a little more than Caponio might expect from a primary care doc available through Medicare. Page, for instance, has aided her patient with a number of safety issues, including helping her find someone to rig up a chairlift on those stairs. Now, she can sit on a seat at the top and glide to the bottom.\u003c/p>\n\u003cp>\"It opens up a whole new world for me,\" Caponio says.\u003c/p>\n\u003cp>\u003cstrong>A Different Model\u003c/strong>\u003c/p>\n\u003cp>A whole new world is what Dr. Page herself has been experiencing, ever since she left the traditional clinic setting to try something different. She does have a small office, but prefers to visit most of her patients in their homes.\u003c/p>\n\u003caside class=\"pullquote alignright\">When they learn they can get off the production line, 'Doctors will be in mass exodus.'\u003ccite>Dr. Pamela Wible\u003c/cite>\u003c/aside>\n\u003cp>She's one of a growing number of doctors who have cut loose from what she calls the \"assembly-line, volume approach\" that most of her colleagues have experienced. These breakaway docs are now using a health care delivery model called direct primary care. Page has cut back on the number of patients she sees, and spends more time with the ones she does. She doesn't take insurance and deals mostly in cash. Page charges each time she sees a patient, but most direct primary care doctors bill a monthly fee for unlimited visits.\u003c/p>\n\u003cp>In her previous practice, Page says, the pressure to see more patients in less time wore her down, as did the need for an army of support staff to process the copious paperwork required by insurance companies.\u003c/p>\n\u003cp>\"At our office, we had six full-time doctors. And we had seven full-time insurance people. So [that's] more than one full-time person trying to get reimbursement for patients I was seeing.\"\u003c/p>\n\u003cp>The benefits of leaving that bureaucratic load behind includes more time with patients but shorter days as her total load has been reduced. And she's doing the kind of family-care medicine for which she was trained.\u003c/p>\n\u003cp>\"And I enjoy it a lot more,\" Page says. \"Let's not minimize that.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"vPRJXQNXVX11c9sC2BeSG7GGPJpZybhw\"]\u003c/p>\n\u003cp>\u003cstrong>What Doctors Want\u003c/strong>\u003c/p>\n\u003cp>A 2012 \u003ca href=\"http://www.medscape.com/features/slideshow/compensation/2012/public\" target=\"_blank\">Medscape study\u003c/a> found that 46 percent of primary care physicians showed such dissatisfaction with their careers, they wouldn't pursue medicine if they could choose again. Another\u003ca href=\"http://www.physiciansfoundation.org/healthcare-research/a-survey-of-americas-physicians-practice-patterns-and-perspectives\" target=\"_blank\"> study\u003c/a>, from the Physicians Foundation, found 60 percent of primary care doctors would not recommend a career in medicine. Just six percent described the morale of their colleagues as positive.\u003c/p>\n\u003cp>Overall, says Wanda Filer, president of the American Academy of Family Physicians, primary care doctors feel overworked and ineffective. \"Most patients are just rushed out the door,\" she says. \"That's not what doctors want to do. This new model of care gets the physician and the patient out of that hamster-wheel model.\"\u003c/p>\n\u003cp>Filer says about three percent of the organization's 69,000 primary care doctors have made the move to direct primary care in the past couple of years, and that number is increasing rapidly as other physicians see it succeed.\u003c/p>\n\u003cp>In fact, Filer says, her organization has taken the unusual step of convening informational seminars for the large number of family doctors who have expressed interest in getting off the grid and starting a kinder, gentler practice.\u003c/p>\n\u003cp>\u003cb>Cash and Care\u003c/b>\u003c/p>\n\u003cfigure id=\"attachment_220077\" class=\"wp-caption alignright\" style=\"max-width: 357px\">\u003cimg class=\"wp-image-220077\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/emiliescott1-885x1180.jpg\" alt=\"Dr. Emilie Scott of Irvine, Calif.\" width=\"357\" height=\"476\">\u003cfigcaption class=\"wp-caption-text\">Dr. Emilie Scott of Irvine, Calif., says the direct primary care model has put 'the heart back in medicine' for her. (David Gorn/KQED) \u003ccite>(David Gorn/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>While direct primary care has some similarities to \u003ca href=\"http://www.healthline.com/health-news/the-future-of-healthcare-could-be-in-concierge-medicine-063015\" target=\"_blank\">concierge medicine\u003c/a>, it differs in that direct primary care rejects insurance. And, because concierge medicine sprang from wealthy patients’ desire for greater access to their doctors, patients can \u003ca href=\"http://www.wsj.com/articles/SB10001424052702303471004579165470633112630\" target=\"_blank\">pay up to thousands of dollars a month\u003c/a> for same-day appointments, round-the-clock phone access, house calls and other services.\u003c/p>\n\u003cp>In contrast, direct primary care doctors charge a relatively small monthly fee. While that can be an extra cost for those who also need insurance to cover more serious medical problems, many patients have high-deductible plans, making the monthly expense of direct primary care a good deal, especially for those who go to the doctor a lot.\u003c/p>\n\u003cp>For doctors, the main idea behind direct primary care is to simplify -- scale down, deal mostly in cash and focus on taking better care of fewer patients. This includes a good deal of listening and analysis of how a patient's current environment or life situation may be affecting their health.\u003c/p>\n\u003cp>This type of service \u003ca href=\"http://www.kevinmd.com/blog/2011/07/direct-primary-care-reduces-primary-care-costs.html\" target=\"_blank\">took off as a movement\u003c/a> in 2011, and the model was first evaluated in a 2013 \u003ca href=\"http://www.chcf.org/publications/2013/04/retainer-direct-primary-care\" target=\"_blank\">study\u003c/a> by the California Health Care Foundation. It's gaining significant traction, says Laurence Baker, the chair of Stanford University's Department of Health Research and Policy.\u003c/p>\n\u003cp>\"Absolutely it's a growing segment of primary care,\" he says. \"The model we have is challenged in a lot of ways, the longer a patient waits to see a doctor, the shorter time spent with the doctor. So we have to think about what else we can do to change that.\u003c/p>\n\u003cp>\"I would be surprised if it took over the world,\" Baker added, \"But I certainly wouldn't be surprised if it grew substantially more in the next few years.\"\u003c/p>\n\u003cp>\u003cstrong>'Doctors Will Be in Mass Exodus'\u003c/strong>\u003c/p>\n\u003cp>The reason doctors need to see so many patients in rapid succession is because of huge overhead, says Pamela Wible, a physician in Eugene, Ore., who helps doctors set up their ideal practice using the direct primary care model. In fact, she says, most doctors see just a small fraction of gross earnings.\u003c/p>\n\u003cp>But the kind of streamlined operation found in direct primary care allows doctors to keep a greater share of the money coming in, she says, even if they make less overall than in a traditional practice.\u003c/p>\n\u003cp>\"My expenses are so low, they're now about 10 percent of my practice,\" Wible says. \"And it used to be 74 percent.\"\u003c/p>\n\u003cp>Wible says the direct primary care model has at its heart the relationship between doctor and patient. She says doctors \"will be in mass exodus\" once they learn they can run their practice differently and \"get off the production line.\"\u003c/p>\n\u003cp>Dr. Emilie Scott did just that, in March. She had worked in an academic medical setting for many years, then in a large group practice for another five before venturing out on her own.\u003c/p>\n\u003cp>There are no waiting room magazines in her tiny Irvine medical office, because there is no waiting room. And that's because there is no waiting.\u003c/p>\n\u003cp>She charges her patients $59 per month. Just five months in, she says, her practice is already breaking even.\u003c/p>\n\u003cp>\"For me, it puts the heart back in medicine,\" Scott says, grinning. In the past, \"I had to see patients in a rapid style, trying to get patients out the door. It wears on you.\"\u003c/p>\n\u003cp>She understands the fear some doctors have of taking the leap, in part because of the massive debt they've incurred from medical school. But, she says, \"The point here isn't to become a millionaire. You make a good living, and you can practice in line with your values.\"\u003c/p>\n\u003cp>Scott said some of her patients are surprised at how little her service costs.\u003c/p>\n\u003cp>\"I had one woman who said she couldn't afford it but said she'd listen, and then I explained it, and she was like, 'Are we on Candid Camera or something? What's the catch?'\"\u003c/p>\n\u003cp>\u003cstrong>Shrinking the Physician Pool?\u003c/strong>\u003c/p>\n\u003cp>Janet Coffman, a health policy professor at the University of California, San Francisco, says she doesn't expect direct primary care to explode on the medical scene. Rather, she believes it will make slow and steady inroads. She doesn't think insurance companies will fight the model, even though it cuts them out of the medical care delivery system.\u003c/p>\n\u003cp>But one major effect direct primary care could have, she said, is to further shrink the already inadequate pool of primary care physicians.\u003c/p>\n\u003cp>\"If I were an insurance company, I think I'd be more concerned about recruiting and keeping PCPs because of this,\" Coffman says.\u003c/p>\n\u003cp>Betsy Imholz, director of special projects for Consumers Union, agrees that could be a concern if direct primary care catches on.\u003c/p>\n\u003cp>“Primary care is one of the least lucrative areas for doctors to go into,” Imholz says, “and therefore sometimes difficult for insurers to get sufficient numbers of.”\u003c/p>\n\u003cp>Imholz sees some other potential problems with the model. While she understands why both doctors and patients are attracted to direct primary care — “the old \u003ca href=\"https://www.youtube.com/watch?v=Y10VEkyKd3w\" target=\"_blank\">Marcus Welby\u003c/a> model,” as she puts it — she thinks it’s a move in the opposite direction of the current push for an integrated health care system. Ideally, doctors would have access to patients’ electronic health records, and \u003ca href=\"http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf409988\" target=\"_blank\">all-payer claims databases\u003c/a>, at least \u003ca href=\"http://www.commondreams.org/newswire/2016/08/03/all-six-states-keep-consumers-dark-cost-medical-procedures\" target=\"_blank\">theoretically\u003c/a>, would allow purchasers of insurance to compare costs.\u003c/p>\n\u003cp>“It goes against this coordinated care model that the Affordable Care Act and the U.S. is coming to,” she says, “having things not fragmented but coordinated [in a way that] enables us to check, make quality assessments.”\u003c/p>\n\u003cp>Imholz is also concerned this type of practice could attract healthier people, who might see direct primary care as a substitute for insurance rather than an extra. And that could deprive the ACA \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2016/03/30/theyre-sicker-plus-aca-enrollees-cost-more-in-care-major-insurer-finds/\" target=\"_blank\">risk pool \u003c/a>of the very type of patients \u003ca href=\"http://www.newsweek.com/obamacare-premiums-rise-10-percent-2017-490268\" target=\"_blank\">needed to keep cost increases manageable\u003c/a>.\u003c/p>\n\u003cp>Consumers in California, Imholz said, should also keep in mind a little-known benefit of the plans offered on the state’s health care exchange, Covered California: those plans are required to offer three visits outside of the deductible, costing only a co-pay.\u003c/p>\n\u003cp>Ultimately, she says, if patients do want to go the route of direct primary care, they should create their own \u003ca href=\"https://www.healthit.gov/providers-professionals/faqs/what-personal-health-record\" target=\"_blank\">personal health record\u003c/a> for each visit, in case at some point they need to visit a specialist for a serious health problem.\u003c/p>\n\u003cp>As to whether direct primary care will positively impact patients' health, Laurence Baker says it's not clear whether or not the longer office and home visits end up providing better care.\u003c/p>\n\u003cp>\"I'm not sure we know if this makes you healthier at the end of the day,\" Baker says. \"It will make you happier, definitely, but the jury is still out about whether it improves outcomes.\"\u003c/p>\n\u003cp>\u003cstrong>'It's Lovely'\u003c/strong>\u003c/p>\n\u003cp>Back in Half Moon Bay, physician Lorraine Page says she doesn't need data. She tries to find the words for the improvement she has seen in her life and the lives of her patients.\u003c/p>\n\u003cp>\"It's … lovely,\" she says with a laugh. \"It's just lovely. The patients do better, I get to see the whole person, the whole family. It's true family practice. And it's very straightforward. I see the person, I get paid. It's simple.\"\u003c/p>\n\u003cp>This type of practice, she says, is what many young doctors-to-be have in mind when they first think about entering medicine.\u003c/p>\n\u003cp>It's an odd twist that Page's current work is considered the cutting- edge of primary care medicine, when it so closely resembles a kind of 1950s Norman Rockwell painting of what a general practitioner is.\u003c/p>\n\u003cp>Most doctors don't even think about what they want anymore, Page says. They get caught up in the system and don't realize there's another choice.\u003c/p>\n\u003cp>But leaving was surprisingly easy.\u003c/p>\n\u003cp>\"Look, your skills are in your mind,\" Page says. \"You can do that anywhere.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Jon Brooks contributed to this report.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Many primary care physicians have had enough of the traditional health care system, so they've broken away to create their own practices, where they don't take insurance and charge a monthly fee. ","status":"publish","parent":0,"modified":1473625581,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":65,"wordCount":2202},"headData":{"title":"When Doctors Dump Insurance for Subscription Model, Who Benefits? | KQED","description":"Many primary care physicians have had enough of the traditional health care system, so they've broken away to create their own practices, where they don't take insurance and charge a monthly fee. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"When Doctors Dump Insurance for Subscription Model, Who Benefits?","datePublished":"2016-09-11T18:00:21.000Z","dateModified":"2016-09-11T20:26:21.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"219067 http://ww2.kqed.org/futureofyou/?p=219067","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/09/11/dropout-docs-primary-care-physicians-exit-the-system-to-go-it-alone/","disqusTitle":"When Doctors Dump Insurance for Subscription Model, Who Benefits?","source":"Future of You","audioUrl":"http://www.kqed.org/.stream/anon/radio/science/2016/09/WEBDocsOffGrid160912.mp3","nprByline":"David Gorn","path":"/futureofyou/219067/dropout-docs-primary-care-physicians-exit-the-system-to-go-it-alone","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Lorraine Page, believe it or not, makes house calls.\u003c/p>\n\u003cp>One place she visits is the home of Ann Caponio, a one-bedroom apartment in Half Moon Bay, California. You can tell a knitter lives there: baskets of wool and hanks of yarn adorn the room, and in the corner sits a wooden spinning wheel.\u003c/p>\n\u003caside class=\"pullquote alignright\">A new model gains in popularity: no insurance but unlimited doctor visits are provided for a monthly fee.\u003c/aside>\n\u003cp>But arthritis has put an end to that hobby. And for a while, Caponio, 69, wasn't even getting out.\u003c/p>\n\u003cp>\"I kind of stopped going downtown,\" she says, in her Midland, Texas twang, a holdover from childhood. \"Omigod those stairs.\"\u003c/p>\n\u003cp>She's talking about a steep, 17-step staircase leading to her front door. Three hip replacements left negotiating them a dangerous proposition.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I tend to fall. And I fell on those damned stairs once.\"\u003c/p>\n\u003cp>And that's where Lorraine Page enters the picture.\u003c/p>\n\u003cp>Besides the house calls, Page provides a little more than Caponio might expect from a primary care doc available through Medicare. Page, for instance, has aided her patient with a number of safety issues, including helping her find someone to rig up a chairlift on those stairs. Now, she can sit on a seat at the top and glide to the bottom.\u003c/p>\n\u003cp>\"It opens up a whole new world for me,\" Caponio says.\u003c/p>\n\u003cp>\u003cstrong>A Different Model\u003c/strong>\u003c/p>\n\u003cp>A whole new world is what Dr. Page herself has been experiencing, ever since she left the traditional clinic setting to try something different. She does have a small office, but prefers to visit most of her patients in their homes.\u003c/p>\n\u003caside class=\"pullquote alignright\">When they learn they can get off the production line, 'Doctors will be in mass exodus.'\u003ccite>Dr. Pamela Wible\u003c/cite>\u003c/aside>\n\u003cp>She's one of a growing number of doctors who have cut loose from what she calls the \"assembly-line, volume approach\" that most of her colleagues have experienced. These breakaway docs are now using a health care delivery model called direct primary care. Page has cut back on the number of patients she sees, and spends more time with the ones she does. She doesn't take insurance and deals mostly in cash. Page charges each time she sees a patient, but most direct primary care doctors bill a monthly fee for unlimited visits.\u003c/p>\n\u003cp>In her previous practice, Page says, the pressure to see more patients in less time wore her down, as did the need for an army of support staff to process the copious paperwork required by insurance companies.\u003c/p>\n\u003cp>\"At our office, we had six full-time doctors. And we had seven full-time insurance people. So [that's] more than one full-time person trying to get reimbursement for patients I was seeing.\"\u003c/p>\n\u003cp>The benefits of leaving that bureaucratic load behind includes more time with patients but shorter days as her total load has been reduced. And she's doing the kind of family-care medicine for which she was trained.\u003c/p>\n\u003cp>\"And I enjoy it a lot more,\" Page says. \"Let's not minimize that.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What Doctors Want\u003c/strong>\u003c/p>\n\u003cp>A 2012 \u003ca href=\"http://www.medscape.com/features/slideshow/compensation/2012/public\" target=\"_blank\">Medscape study\u003c/a> found that 46 percent of primary care physicians showed such dissatisfaction with their careers, they wouldn't pursue medicine if they could choose again. Another\u003ca href=\"http://www.physiciansfoundation.org/healthcare-research/a-survey-of-americas-physicians-practice-patterns-and-perspectives\" target=\"_blank\"> study\u003c/a>, from the Physicians Foundation, found 60 percent of primary care doctors would not recommend a career in medicine. Just six percent described the morale of their colleagues as positive.\u003c/p>\n\u003cp>Overall, says Wanda Filer, president of the American Academy of Family Physicians, primary care doctors feel overworked and ineffective. \"Most patients are just rushed out the door,\" she says. \"That's not what doctors want to do. This new model of care gets the physician and the patient out of that hamster-wheel model.\"\u003c/p>\n\u003cp>Filer says about three percent of the organization's 69,000 primary care doctors have made the move to direct primary care in the past couple of years, and that number is increasing rapidly as other physicians see it succeed.\u003c/p>\n\u003cp>In fact, Filer says, her organization has taken the unusual step of convening informational seminars for the large number of family doctors who have expressed interest in getting off the grid and starting a kinder, gentler practice.\u003c/p>\n\u003cp>\u003cb>Cash and Care\u003c/b>\u003c/p>\n\u003cfigure id=\"attachment_220077\" class=\"wp-caption alignright\" style=\"max-width: 357px\">\u003cimg class=\"wp-image-220077\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/emiliescott1-885x1180.jpg\" alt=\"Dr. Emilie Scott of Irvine, Calif.\" width=\"357\" height=\"476\">\u003cfigcaption class=\"wp-caption-text\">Dr. Emilie Scott of Irvine, Calif., says the direct primary care model has put 'the heart back in medicine' for her. (David Gorn/KQED) \u003ccite>(David Gorn/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>While direct primary care has some similarities to \u003ca href=\"http://www.healthline.com/health-news/the-future-of-healthcare-could-be-in-concierge-medicine-063015\" target=\"_blank\">concierge medicine\u003c/a>, it differs in that direct primary care rejects insurance. And, because concierge medicine sprang from wealthy patients’ desire for greater access to their doctors, patients can \u003ca href=\"http://www.wsj.com/articles/SB10001424052702303471004579165470633112630\" target=\"_blank\">pay up to thousands of dollars a month\u003c/a> for same-day appointments, round-the-clock phone access, house calls and other services.\u003c/p>\n\u003cp>In contrast, direct primary care doctors charge a relatively small monthly fee. While that can be an extra cost for those who also need insurance to cover more serious medical problems, many patients have high-deductible plans, making the monthly expense of direct primary care a good deal, especially for those who go to the doctor a lot.\u003c/p>\n\u003cp>For doctors, the main idea behind direct primary care is to simplify -- scale down, deal mostly in cash and focus on taking better care of fewer patients. This includes a good deal of listening and analysis of how a patient's current environment or life situation may be affecting their health.\u003c/p>\n\u003cp>This type of service \u003ca href=\"http://www.kevinmd.com/blog/2011/07/direct-primary-care-reduces-primary-care-costs.html\" target=\"_blank\">took off as a movement\u003c/a> in 2011, and the model was first evaluated in a 2013 \u003ca href=\"http://www.chcf.org/publications/2013/04/retainer-direct-primary-care\" target=\"_blank\">study\u003c/a> by the California Health Care Foundation. It's gaining significant traction, says Laurence Baker, the chair of Stanford University's Department of Health Research and Policy.\u003c/p>\n\u003cp>\"Absolutely it's a growing segment of primary care,\" he says. \"The model we have is challenged in a lot of ways, the longer a patient waits to see a doctor, the shorter time spent with the doctor. So we have to think about what else we can do to change that.\u003c/p>\n\u003cp>\"I would be surprised if it took over the world,\" Baker added, \"But I certainly wouldn't be surprised if it grew substantially more in the next few years.\"\u003c/p>\n\u003cp>\u003cstrong>'Doctors Will Be in Mass Exodus'\u003c/strong>\u003c/p>\n\u003cp>The reason doctors need to see so many patients in rapid succession is because of huge overhead, says Pamela Wible, a physician in Eugene, Ore., who helps doctors set up their ideal practice using the direct primary care model. In fact, she says, most doctors see just a small fraction of gross earnings.\u003c/p>\n\u003cp>But the kind of streamlined operation found in direct primary care allows doctors to keep a greater share of the money coming in, she says, even if they make less overall than in a traditional practice.\u003c/p>\n\u003cp>\"My expenses are so low, they're now about 10 percent of my practice,\" Wible says. \"And it used to be 74 percent.\"\u003c/p>\n\u003cp>Wible says the direct primary care model has at its heart the relationship between doctor and patient. She says doctors \"will be in mass exodus\" once they learn they can run their practice differently and \"get off the production line.\"\u003c/p>\n\u003cp>Dr. Emilie Scott did just that, in March. She had worked in an academic medical setting for many years, then in a large group practice for another five before venturing out on her own.\u003c/p>\n\u003cp>There are no waiting room magazines in her tiny Irvine medical office, because there is no waiting room. And that's because there is no waiting.\u003c/p>\n\u003cp>She charges her patients $59 per month. Just five months in, she says, her practice is already breaking even.\u003c/p>\n\u003cp>\"For me, it puts the heart back in medicine,\" Scott says, grinning. In the past, \"I had to see patients in a rapid style, trying to get patients out the door. It wears on you.\"\u003c/p>\n\u003cp>She understands the fear some doctors have of taking the leap, in part because of the massive debt they've incurred from medical school. But, she says, \"The point here isn't to become a millionaire. You make a good living, and you can practice in line with your values.\"\u003c/p>\n\u003cp>Scott said some of her patients are surprised at how little her service costs.\u003c/p>\n\u003cp>\"I had one woman who said she couldn't afford it but said she'd listen, and then I explained it, and she was like, 'Are we on Candid Camera or something? What's the catch?'\"\u003c/p>\n\u003cp>\u003cstrong>Shrinking the Physician Pool?\u003c/strong>\u003c/p>\n\u003cp>Janet Coffman, a health policy professor at the University of California, San Francisco, says she doesn't expect direct primary care to explode on the medical scene. Rather, she believes it will make slow and steady inroads. She doesn't think insurance companies will fight the model, even though it cuts them out of the medical care delivery system.\u003c/p>\n\u003cp>But one major effect direct primary care could have, she said, is to further shrink the already inadequate pool of primary care physicians.\u003c/p>\n\u003cp>\"If I were an insurance company, I think I'd be more concerned about recruiting and keeping PCPs because of this,\" Coffman says.\u003c/p>\n\u003cp>Betsy Imholz, director of special projects for Consumers Union, agrees that could be a concern if direct primary care catches on.\u003c/p>\n\u003cp>“Primary care is one of the least lucrative areas for doctors to go into,” Imholz says, “and therefore sometimes difficult for insurers to get sufficient numbers of.”\u003c/p>\n\u003cp>Imholz sees some other potential problems with the model. While she understands why both doctors and patients are attracted to direct primary care — “the old \u003ca href=\"https://www.youtube.com/watch?v=Y10VEkyKd3w\" target=\"_blank\">Marcus Welby\u003c/a> model,” as she puts it — she thinks it’s a move in the opposite direction of the current push for an integrated health care system. Ideally, doctors would have access to patients’ electronic health records, and \u003ca href=\"http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf409988\" target=\"_blank\">all-payer claims databases\u003c/a>, at least \u003ca href=\"http://www.commondreams.org/newswire/2016/08/03/all-six-states-keep-consumers-dark-cost-medical-procedures\" target=\"_blank\">theoretically\u003c/a>, would allow purchasers of insurance to compare costs.\u003c/p>\n\u003cp>“It goes against this coordinated care model that the Affordable Care Act and the U.S. is coming to,” she says, “having things not fragmented but coordinated [in a way that] enables us to check, make quality assessments.”\u003c/p>\n\u003cp>Imholz is also concerned this type of practice could attract healthier people, who might see direct primary care as a substitute for insurance rather than an extra. And that could deprive the ACA \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2016/03/30/theyre-sicker-plus-aca-enrollees-cost-more-in-care-major-insurer-finds/\" target=\"_blank\">risk pool \u003c/a>of the very type of patients \u003ca href=\"http://www.newsweek.com/obamacare-premiums-rise-10-percent-2017-490268\" target=\"_blank\">needed to keep cost increases manageable\u003c/a>.\u003c/p>\n\u003cp>Consumers in California, Imholz said, should also keep in mind a little-known benefit of the plans offered on the state’s health care exchange, Covered California: those plans are required to offer three visits outside of the deductible, costing only a co-pay.\u003c/p>\n\u003cp>Ultimately, she says, if patients do want to go the route of direct primary care, they should create their own \u003ca href=\"https://www.healthit.gov/providers-professionals/faqs/what-personal-health-record\" target=\"_blank\">personal health record\u003c/a> for each visit, in case at some point they need to visit a specialist for a serious health problem.\u003c/p>\n\u003cp>As to whether direct primary care will positively impact patients' health, Laurence Baker says it's not clear whether or not the longer office and home visits end up providing better care.\u003c/p>\n\u003cp>\"I'm not sure we know if this makes you healthier at the end of the day,\" Baker says. \"It will make you happier, definitely, but the jury is still out about whether it improves outcomes.\"\u003c/p>\n\u003cp>\u003cstrong>'It's Lovely'\u003c/strong>\u003c/p>\n\u003cp>Back in Half Moon Bay, physician Lorraine Page says she doesn't need data. She tries to find the words for the improvement she has seen in her life and the lives of her patients.\u003c/p>\n\u003cp>\"It's … lovely,\" she says with a laugh. \"It's just lovely. The patients do better, I get to see the whole person, the whole family. It's true family practice. And it's very straightforward. I see the person, I get paid. It's simple.\"\u003c/p>\n\u003cp>This type of practice, she says, is what many young doctors-to-be have in mind when they first think about entering medicine.\u003c/p>\n\u003cp>It's an odd twist that Page's current work is considered the cutting- edge of primary care medicine, when it so closely resembles a kind of 1950s Norman Rockwell painting of what a general practitioner is.\u003c/p>\n\u003cp>Most doctors don't even think about what they want anymore, Page says. They get caught up in the system and don't realize there's another choice.\u003c/p>\n\u003cp>But leaving was surprisingly easy.\u003c/p>\n\u003cp>\"Look, your skills are in your mind,\" Page says. \"You can do that anywhere.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Jon Brooks contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/219067/dropout-docs-primary-care-physicians-exit-the-system-to-go-it-alone","authors":["byline_futureofyou_219067"],"categories":["futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1011","futureofyou_190","futureofyou_559"],"featImg":"futureofyou_220075","label":"source_futureofyou_219067"},"futureofyou_21578":{"type":"posts","id":"futureofyou_21578","meta":{"index":"posts_1591205157","site":"futureofyou","id":"21578","score":null,"sort":[1439394766000]},"guestAuthors":[],"slug":"convenience-or-loyalty-what-do-millennials-value-more-when-it-comes-to-their-health","title":"Are Millennials Ready to Ditch their Regular Doctor?","publishDate":1439394766,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>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.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>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 \u003ca href=\"http://www.onemedical.com/\">One Medical\u003c/a>, a new brand of concierge care that prides itself on its online offerings.\u003c/p>\n\u003cp>\"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.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>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 \u003ca href=\"http://www.doctorondemand.com/\">Doctor On Demand\u003c/a>, a San Francisco company that offers video visits with doctors for $40 per session.\u003c/p>\n\u003cp>\u003cstrong>Is the Lack of Loyalty a Bad Thing? \u003c/strong>\u003c/p>\n\u003cp>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.\u003c/p>\n\u003caside class=\"pullquote alignright\">“The notion of having a single doctor that is theirs is a foreign concept\"\u003cbr>\n\u003ccite>Dr. Pat Basu, chief medical officer at Doctor On Demand\u003c/cite>\u003c/aside>\n\u003cp>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.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>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, \u003ca href=\"http://content.healthaffairs.org/content/34/7/1113.abstract\">recently-published research\u003c/a> 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.\u003c/p>\n\u003cp>\"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 \u003ca href=\"https://www.pcpcc.org/\">Patient Centered Primary Care Collaborative\u003c/a>, a coalition of health care providers, patient advocates and employers based in Washington DC that advocates for higher quality care at a lower cost.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>\"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 \u003ca href=\"http://www.venrock.com/\">Venrock\u003c/a> and a former specialist assistant to President Obama who helped write the Affordable Care Act.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>\"There's certainly a lot lost when the next doctor tries to figure out what to do with you,\" he said.\u003c/p>\n\u003cp>\u003cstrong>Wanting it All\u003c/strong>\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>\"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.”\u003c/p>\n\u003cp>During a recent trip to the East Coast, I paid a visit to Manhattan-based \u003ca href=\"https://www.zocdoc.com/\">ZocDoc\u003c/a>, 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.\u003c/p>\n\u003caside class=\"pullquote alignright\">“Even in this digital age, someway, somehow there needs to be a connection [between doctor and patient]\"\u003cbr>\n\u003ccite>Paul Grundy, IBM's director of healthcare transformation \u003c/cite>\u003c/aside>\n\u003cp>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.\u003c/p>\n\u003cp>\"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.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>\"F\u003cspan class=\"s1\">or small stuff, do I have loyalty? No,\" he said. \u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">\"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.\"\u003c/span>\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>Dr. Robert Wergin of the \u003ca href=\"http://www.aafp.org/about.html\">American Academy of Family Physicians\u003c/a> 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.\u003c/p>\n\u003cp>\"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.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>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 cfarr@kqed.org \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Unlike previous generations, young people today have countless options when it comes to their medical care.","status":"publish","parent":0,"modified":1439423778,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":31,"wordCount":1523},"headData":{"title":"Are Millennials Ready to Ditch their Regular Doctor? | KQED","description":"Unlike previous generations, young people today have countless options when it comes to their medical care.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Are Millennials Ready to Ditch their Regular Doctor?","datePublished":"2015-08-12T15:52:46.000Z","dateModified":"2015-08-12T23:56:18.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"21578 http://ww2.kqed.org/futureofyou/?p=21578","disqusUrl":"https://ww2.kqed.org/futureofyou/2015/08/12/convenience-or-loyalty-what-do-millennials-value-more-when-it-comes-to-their-health/","disqusTitle":"Are Millennials Ready to Ditch their Regular Doctor?","path":"/futureofyou/21578/convenience-or-loyalty-what-do-millennials-value-more-when-it-comes-to-their-health","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>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.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>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 \u003ca href=\"http://www.onemedical.com/\">One Medical\u003c/a>, a new brand of concierge care that prides itself on its online offerings.\u003c/p>\n\u003cp>\"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.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>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 \u003ca href=\"http://www.doctorondemand.com/\">Doctor On Demand\u003c/a>, a San Francisco company that offers video visits with doctors for $40 per session.\u003c/p>\n\u003cp>\u003cstrong>Is the Lack of Loyalty a Bad Thing? \u003c/strong>\u003c/p>\n\u003cp>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.\u003c/p>\n\u003caside class=\"pullquote alignright\">“The notion of having a single doctor that is theirs is a foreign concept\"\u003cbr>\n\u003ccite>Dr. Pat Basu, chief medical officer at Doctor On Demand\u003c/cite>\u003c/aside>\n\u003cp>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.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>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, \u003ca href=\"http://content.healthaffairs.org/content/34/7/1113.abstract\">recently-published research\u003c/a> 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.\u003c/p>\n\u003cp>\"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 \u003ca href=\"https://www.pcpcc.org/\">Patient Centered Primary Care Collaborative\u003c/a>, a coalition of health care providers, patient advocates and employers based in Washington DC that advocates for higher quality care at a lower cost.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>\"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 \u003ca href=\"http://www.venrock.com/\">Venrock\u003c/a> and a former specialist assistant to President Obama who helped write the Affordable Care Act.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>\"There's certainly a lot lost when the next doctor tries to figure out what to do with you,\" he said.\u003c/p>\n\u003cp>\u003cstrong>Wanting it All\u003c/strong>\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>\"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.”\u003c/p>\n\u003cp>During a recent trip to the East Coast, I paid a visit to Manhattan-based \u003ca href=\"https://www.zocdoc.com/\">ZocDoc\u003c/a>, 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.\u003c/p>\n\u003caside class=\"pullquote alignright\">“Even in this digital age, someway, somehow there needs to be a connection [between doctor and patient]\"\u003cbr>\n\u003ccite>Paul Grundy, IBM's director of healthcare transformation \u003c/cite>\u003c/aside>\n\u003cp>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.\u003c/p>\n\u003cp>\"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.\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>\"F\u003cspan class=\"s1\">or small stuff, do I have loyalty? No,\" he said. \u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">\"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.\"\u003c/span>\u003c/p>\n\u003cp>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.\u003c/p>\n\u003cp>Dr. Robert Wergin of the \u003ca href=\"http://www.aafp.org/about.html\">American Academy of Family Physicians\u003c/a> 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.\u003c/p>\n\u003cp>\"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.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>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 cfarr@kqed.org \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/21578/convenience-or-loyalty-what-do-millennials-value-more-when-it-comes-to-their-health","authors":["3252"],"categories":["futureofyou_452","futureofyou_1"],"tags":["futureofyou_453","futureofyou_80","futureofyou_558","futureofyou_559"],"featImg":"futureofyou_24778","label":"futureofyou"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. 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