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The Challenges of Consumerism for Primary Care Physicians

Timothy Hoff, PhD
Implementation of retail health consumer tactics in primary care poses challenges for primary care doctors that must be recognized and addressed.
Primary care physicians may also perceive the tactic of greater transparency, achieved through an abundance of standardized metrics, as being out of alignment with the attributes they believe matter most in providing their patients with good care. For example, retail health consumer transparency prefers efficiency-focused measures of aspects like wait times and how long a service takes from start to finish. Conversely, primary care physicians prioritize elements of their work with patients that often are less “efficient” or take more time, including establishing interpersonal trust; extended listening; mutual respect, emotional support, and friendship; and gaining insights into the social and behavioral contexts of patients’ lives.22-24 The performance measurements used in retail healthcare, which involve simplified process measures and outcomes that may have less clinical significance for doctors, often undervalue these harder-to-measure, complex aspects of relational excellence and the intangibles of a strong doctor-patient relationship.

Greater performance measurement of the kind delivered by retail health thinking also depends on the EHR and information technology inserted in heavy doses into everyday clinical practice. For many doctors, using the EHR remains an unattractive part of their workday, creating dissatisfaction.21 They believe that the EHR often interferes in their relationships with patients, takes away from more important activities in their workday, increases workloads unnecessarily, and undermines their well-being.25,26 Many primary care doctors have experienced the heavy documentation burden that the EHR thrusts upon them.27 At this point in time, relying on the EHR or its equivalent as the centerpiece of promoting price and quality transparency, or on other technology like electronic patient portals or care delivery apps as tools making care more convenient or accessible for patients, remains a risky proposition for primary care doctors, especially if they do not see appropriate reimbursement for using such technology.

The Transactional Focus in Retail Tactics

Another retail health consumer tactic is that of “volume selling,” which means getting patients to purchase or access lower-cost, often more trivial health services on a frequent basis. Mass production of these types of services, using technology and highly standardized workflows, facilitates this type of selling. In this way, a retail-oriented healthcare system focuses on excelling transactionally.17 This tactic presents a challenge generally for the field of primary care. This is because in a highly transactional care delivery system, there is less emphasis on building relational excellence of a human-to-human nature, which is critical for effective primary care medicine in the eyes of primary care doctors.

What this means is simple: When the focus is on perfecting a system of volume selling rooted in “lowest-cost” production flows—such as those seen in various wellness services like fitness monitoring or low-level primary care visits to walk-in clinics—investing in strongly relational and time-lasting doctor-patient relationships is less emphasized. In such a system, relational dynamics like building trust, engaging mutual respect, and possessing deeper knowledge of patients’ social and emotional circumstances may at times “slow down” what is meant to be quick and convenient care delivery, but to physicians, these are crucial aspects of practice that define strong doctor-patient relationships.

Using patient data on a “big” scale to create homogenous groupings of like patients possessing similar needs, wants, and preferences is another retail health tactic that presents challenges to primary care physicians. This is called market segmentation, and its main purpose is to target appropriate services to the right patients (ie, patients whose unique features suggest that they may be targeted to purchase and use those services).28 This retail tactic presents at least 2 challenges to primary care physicians. The first is that market segmentation may be used by sellers of healthcare services to bypass the doctor and go directly to the patient to convince them to buy particular items, some of which, like wearables, then place greater demand on the physician for their expertise—expertise that may or may not be reimbursed appropriately.

A second challenge is that the profession of family medicine still rests on the bedrock of individualized care and understanding the patient’s unique social, behavioral, and emotional contexts that drive their health status.29,30 A self-perceived “competent” family doctor might say that beyond the most basic acute care and chronic disease management delivery, segmenting groups of patients, and making them less different from one another in the process, undermines what good primary care is all about, which in turn also lessens some of the joy of practice for these professionals.

Reconciling retail health consumer tactics with what primary care physicians see as relevant for good patient care and their own well-being is not insurmountable. Yet, it suggests a protracted period of time during which primary care physicians’ specific version of good care is integrated appropriately with the retail health consumer version. Primary care physicians need more of a voice in defining what a consumerist approach to primary care delivery means and where its limits lie. Otherwise, there is potential for these physicians to be less motivated to partake in much of what the retail health consumer perspective seeks, which will bring only more confusion to a primary care system currently suffering an identity crisis in American healthcare.

Author Affiliations: D’Amore-McKim School of Business, School of Public Policy and Urban Affairs, Northeastern University, Boston, MA; Saïd Business School and Green Templeton College, Oxford University, Oxford, UK.

Source of Funding: None.

Author Disclosures: The author reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; provision of patients or study materials; and administrative, technical, or logistic support.

Address Correspondence to: Timothy Hoff, PhD, D’Amore-McKim School of Business, Northeastern University, 360 Huntington Ave, Boston, MA 02115. Email:

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