Why is my primary care doctor leaving?

Primary Care Doctor

Is your primary care doctor leaving? “Doctor, you’re not going to leave in a year, are you?” Over the last 15 years of practicing as a primary care physician, I’ve been asked this question many times. It’s among the first questions I am asked by new patients after their doctor retires early, changes jobs, or enters a different style of practice. On their very first visit with me, they want to make sure that I’m not going anywhere.

Career Choice

For generations, primary care physicians have chosen this career because they want to help people and make a difference in their lives. This was my dream as well. Unfortunately, with the changes in medicine over the last several years, fulfilling this dream has become harder and harder. According to a 2015 Medscape Physician Lifestyle Report, the number of Internal Medicine and Family Physicians reporting burnout increased from 43% in 2013 to 50% in 2015. What has caused this jump? The biggest causes are the stress of seeing more and more patients and the fear that the quality of the care doctors provide is in jeopardy.

Changes in Health Care

Changes in Health Care

The practice of medicine has changed drastically since I finished my primary care residency 15 years ago. During my first several years of practice, I was able to spend the vast majority of my time with my patients. That’s changed. Now almost half of the work doctors do is on the computer, with no patients in sight. The problem is that there is no time allotted for this work. This work is squeezed in between the 15 or 20-minute time slots of a full patient schedule. It fills up the doctor’s lunchtime and spills into evening time at home. If it takes 5-10 minutes to do refills, answer patient messages, and fill out insurance forms between each visit, how much time does that leave for each patient who has an appointment? Unfortunately, it’s not much.

What’s Driving the Change?

How did we get here? Let me share three main reasons behind this change. The first issue is technology. We can now manage many issues and illnesses with online communication. Messaging between the doctor and patient has doubled in the last three years. This is a hard trend to resist. Imagine if a patient with whom you have a long relationship writes to you and asks you to write a prescription for a medication for travel. Would you tell them that they have to make an appointment with their primary care doctor so that you can write that prescription? Many times, providing the care online is the best and most efficient option. The second major factor is related to the rising cost of medical care. Many patients have insurance plans with high deductibles. This discourages office visit and encourages more online communications. Medical costs have also put pressure on reimbursements and have made it so that primary care physicians feels that they have to keep their schedules full in order to maintain their income. Costs have also led to an increase in insurance paperwork. Many insurance companies require physicians to write a letter to authorize even common medications or procedures. Lastly, more is involved with a regular office visit today than ever before. There are more illnesses and conditions that have treatments and more recommended preventative care. We now have more treatments, many new medications, and expanded guidelines for testing and treatment. If a primary care physician were to follow all of the recommended guidelines for just preventative care to an average patient, it would take over seven hours per workday. That would leave no time to see any patients who had illnesses or any other non-preventative concerns. The trend of primary care physicians leaving the field could not come at a worse time. With the baby boomer generation aging, it is expected that we’ll be short 45,000-60,000 primary care physicians by 2020.

Peninsula Doctor: The Difference

Let’s return to my patients’ question of “Doctor, you’re not going to tell me that you’re leaving in a year, are you?” My answer has always been “No.” I always expected to be here for the long haul, but I’ve chosen to leave the large group practice to start my own small practice. This is because I no longer see the large practice as a sustainable model for providing the best care. I want to be able to answer all of my patients’ online messages, return their calls promptly, and be the most up to date on all of their conditions. I want to be able to call the specialists that are consulting on my patients and discuss what else we could try, or what next steps we could take to improve their care. If my patient is in the hospital, I want to be able to go to the hospital, read the chart, talk to the patient and the other physicians involved, and explain to my patient anything they may not fully understand. I want to be the primary care physician that I was inspired by my father to become. I want to know my patients intimately and provide the best possible care. For all of the above reasons and my inability to change anything at my current practice, I am opening my new medical practice, Peninsula Doctor, where I will be able to provide the care that I dreamed of providing when I first went into medicine. Peninsula Doctor is a Concierge Medical practice that limits the total number of patients to 200. There is an annual membership fee that insurance doesn’t pay to allow for this reduction in volume. The private concierge practice has a lot to offer patients. Patients will have a doctor that is available when needed and cares for them at all times. Their doctor will have the time to do more preventative care and treatment planning, as well as more time to do the research and communication that is necessary to provide the best care. In the event of something unexpected, patients can always count on their doctor being there, whether it’s over the phone, in the hospital, at a nursing home, or in the patient’s home. This is what I had hoped medicine would be when I first started this journey almost 20 years ago. At my new Peninsula Doctor clinic, I will focus on what my mission as a doctor has always been: providing people the highest quality of health care.

Dr. Ian Kroes: from 'family' to 'family doctor'


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