Why Primary Care Has A Bright Future


I have made a new friend. His name is Dave Chase and he is the CEO of Avado.com.   I have been reading his stuff at KevinMD and we have now been emailing each other back and forth as I try to pick his brain.    Here is one of the editorials he wrote for KevinMD that he allowed me to publish here.  I think you will like it.

At a time when half of primary care doctors say they’d leave medicine if they had an alternative and the NY Times reports on a family physician who can’t give away his practice this hardly seems like the obvious time to claim that primary care is positioned for a renaissance. However, if there’s one thing savvy investors have demonstrated, when everyone says to invest in something that is usually the time to get out. Conversely, when the conventional wisdom is to avoid something, that’s often the time savvy investors jump in.

For my money, if I could invest in family medicine residency programs right now, I would. As the national conference for family medicine residents and medical students takes place this week, they should feel emboldened that they have made the right decision. Hats off to them for following their passion and bucking conventional wisdom when people told them to avoid family medicine.


The following reasons are why I believe primary care is due for a renaissance:

  1. Some of the most successful entrepreneurs and venture capitalists of the last 20 years are investing in primary care based practices. Benchmark Capital is one of the most well regarded venture capitalists with investments in organizations such as eBay and Twitter. They have been a major backer of One Medical Group which has had great success with their primary care model. The founders of Amazon, Dell and Expedia have backed Qliance, one of the pioneers of the direct primary care model. These investors know about disrupting the status quo. Whereas traditional practices have been slow to adopt technology, these organizations are using technology as a point of differentiation.
  2. The rise of onsite clinics that have primary care as their foundation continues to create more demand for primary care doctors. Dissatisfaction by purchasers of healthcare will continue to expand the onsite clinic trend.
  3. Retainer-based direct primary care is exploding around the country providing an alternative for primary care physicians to the insurance bureaucracy laden model most practice in. Earlier Brian Forrest’s Direct Pay Health was profiled on KevinMD. Separately, I called Samir Qamar’s MedLion the most important organization in Silicon Valley no one had heard about. They’ve proven a model that is affordable and effective while providing primary care physicians with a much improved professional experience.
  4. Simple laws of supply and demand. There’s already a shortage of primary care. Look to Massachusetts to see the further demands expanding coverage has put on primary care.  While one can argue the merits of that health reform, it’s indisputable that it has created more demands on primary care. Analysts believe a core reason CIGNA and Humana have bought onsite clinic businesses is to ensure they have a supply of primary care physicians as demand increases for primary care.
  5. In the so-called “Pharma 3.0″ trend, pharmaceutical companies are repositioning themselves as “health outcomes” companies. Major players I’ve spoken with are putting primary care as central focus areas which is a shift from where many of them have focused. In one case, they are already delivering primary care themselves.
  6. As the Chief Technology Officer of the U.S. outlined in this video on market opportunities in healthcare innovation, the reimbursement model is radically shifting. With Patient Centered Medical Home (PCMH) pilots consistently showing positive return on investment, the PCMH pilots coming out of the federal reform set up a major shift in reimbursement as outlined in the video segment. If they show, as they have virtually everywhere else, that there’s a positive ROI, Medicare reimbursement can shift without any congressional action. With Medicare reimbursement driving overall reimbursement, the impact of that would be massive.
  7. Studies such as IBM’s global study on the $2B they spend annually on healthcare have produced a consistent conclusion. That is, the formula is quite simple. The countries with the highest proportion of primary care have the healthiest populations and spend lower per capita on healthcare. Every government and business is budget constrained and these findings will be hard to ignore.

The knee-jerk reaction to the predicted renaissance of primary care is to believe it will come at the expense of specialists. As I commented in an earlier piece on Direct Primary Care, that potential zero-sum-game is the elephant in the room, but the biggest fat in the system is burdening day-to-day healthcare with insurance bureaucracy. Physicians would be well advised to address that rather than fight amongst themselves in my opinion.

No renaissance comes without some bumps in the road, but I’d argue that the next twenty years of primary care will be far better than the last twenty.

Dave Chase is CEO of Avado.com, a Patient Relationship Management software company, previously founded Microsoft’s Health business and was a consultant with Accenture’s Healthcare Practice.  He can be found on Twitter @chasedave.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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5 Responses

  1. David Lubin, MD says:

    As a Primary Care doc, just nearing Medicare age but not sure about retirement age, I can tell you that docs in my age group will leave PC for the most part as long as insurance companies continue to challenge how we practice medicine, insisting on prior authorizations for medications that patients have been receiving for 6 years, listing 15 reasons why I want an MRI after careful evaluation of a patient based on my 35 years in practice. And then with the “advancement” of EHR, turning us all into transcriptionists as we listen to our patients, typing at the keyboard, making corrections, never looking them in the eyes nor really seeming to pay attention to what they’re REALLY telling us, we will lose them, as well as decreasing actual income in favor or pleasing the insurance companies and government so that they can track everything that we do, or don’t do.

  2. Andy says:

    Very interesting take on the situation, especially re the rise of different types of primary care practice models. As a current medical student at a U.S. medical school, I know that very few of my classmates are considering going into primary care because of all the negative anecdotes we hear about financial and bureaucratic pressures. I hope some of these new models will take off and provide FPs with answers to these challenges in a way that allows them to provide affordable care for everyone.

  3. Pat Conrad says:

    Salient and thoughtful post, Doug. There may be many good points herein, barring undue pressures from regulatory overhead and malpractice threats. In terms of economics, there is much here to consider; the discipline may rebound as a good way to pay the bills, but I don’t as yet see anything that will make the primary care job enjoyable again.

  4. Theodore Bacharach says:

    Primary care has a future, unfortunately it favors the people who will be able to hire physicians. Whether the primary care doctors get any benefit from this is questionable.

  5. Griff says:

    As a semi-primary care (psychiatrist), I have to say this looks dead on. We are already seeing a shift in insurance companies view of our “worth” to them and they’re interested in increasing services rendered at our level to see a decrease in medical costs overall.

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