Nowadays, it’s clear that physician burnout is real. We know the statistics.
The American Medical Association reports that physician burnout – defined as a long-term stress reaction involving emotional exhaustion, lack of empathy toward patients, and a feeling of lower personal achievement – nearly doubled from 2020 to 2021.
Becker also reports that the primary care specialties – internal medicine, pediatrics, and family medicine – are among the top 5 most burned-out specialties.
Well, ten years ago, that was me.
I have been practicing medicine since 1998. I came to the United States from Kenya in 1993 and did my residency at Cook County from 1995 to 1998. After that, I moved to the Tampa area and began practicing as an attending in a fee-for-service environment.
It was tough. I saw as many patients as possible – often 25 to 30 patients daily. Back then, the primary physician also went to the hospital to see patients, and we were often on-call after hours.
As time went on, it really started taking a toll.
We expanded the clinic, and there came a time when the volume was overwhelming. You start deciding, what’s the real value of my life anyway? Especially when you’re missing family time and everything. I knew I wouldn’t last long like this.
Then our practice started to work with Humana, and they offered us a switch from fee-for-service to a partial Medicare risk contract, which is part of a value-based care continuum. We accepted. Through that experience, we began to understand the true meaning of value-based care and quality over quantity.
What’s the risk? And what is value-based care?
A Medicare risk contract is an agreement where practices accept a fixed dollar reimbursement per Medicare enrollee for delivery of a full range of prepaid health services.
Value-based programs reward healthcare providers with incentive payments for the quality of care they give to people with Medicare, according to the Centers for Medicare & Medicaid Services.
To put it short: in our practices, we receive a fixed dollar amount, and we are rewarded for the patient’s outcomes. This new practice model allows us to see fewer patients and spend more time with them.
How things have changed
When we switched financing models, everyone asked, “Why are you doing this? What’s the reward?”
The patient’s reward is being able to reduce their medication use and feeling more satisfied with their care. What’s my reward? For one, when you reduce costs, the savings can go back to the physicians and the staff.
Secondly, the way I saw it was if I was seeing 30 patients per day and making one amount of money, and now, I’m seeing 15 per day and making the same or more, then why struggle? Why would I not take care of this senior population?
That was one of the biggest drivers to convince other physicians to try it out. They realized it’s about quality, which is how most of us wanted to practice when we entered medical school. The typical annual visit is booked for 40 to 45 minutes.
And that trust patients once had for their physicians? Value-based care gave me that back. It allows me to spend more time with the patients and often get to know their families as well. Also, since we own so many pieces of their healthcare journey, we can build patient trust during longer visits and through frequent touchpoints between the patients and the staff.
Offering a one-stop shop
There are lots of barriers for seniors looking to get good care. A lot of them don’t want to go – or can’t get – to 10 different places to see their doctors or get tests done. If they can get care in one place, then it’s easier. That’s another bonus of the value-based care model.
Many value-based practices offer ancillary services in-house to control costs. The benefit is that the patient only has to come to that one place – for visits, lab work, X-rays, fitness activities, and EKGs.
There’s also value in the patient having a relationship with you and your entire staff and not having to wonder who will see them today and how that person might treat them. They can just pick up the phone and know who to expect on the other line.
It comes back to physician wellness
The only way I can provide good care is for me to be healthy. I can advise my patients, but how effective am I if I don’t take care of myself and get burned out? Plus, I likely wouldn’t be practicing medicine for long.
I am so grateful for this type of practice model. It gave me longevity I would not have had in the old model.
I currently split my time between clinical hours and the administrative work overseeing our 27 clinics throughout Florida as a chief medical officer. I take pride in explaining value-based care to newer physicians coming out of residency and how it can give them career fulfillment too.
I love coming to work. I enjoy the relationships I have the time to develop with patients and their families. And I feel confident that we are providing good care. To think, I almost stopped practicing ten years ago. So glad I didn’t. This model made all the difference.
Chandravadan Patel is an internal medicine physician.