Top-Down Demands on Primary Care Creating Medical Populism in Response to Burnout, AJMC® Commentary Says
(CRANBURY, N.J. – December 6, 2018) –
In a thought-provoking commentary in the current issue of The American Journal of Managed Care®
), a family physician draws parallels between populist movements in society and physician burnout in primary care and warns that the failure of healthcare leaders to recognize the systematic issues facing the profession portends a worsening shortage of primary care doctors.
James O. Breen, MD, a board-certified family medicine practitioner with Lee Physician Group in Fort Myers, Florida, writes frankly about the anger felt by physicians as they grapple with an ever-increasing set of regulatory burdens, obsession with quality metrics, and struggles with reimbursement imposed from the top of the medical elite—governmental payers, agencies, state medical boards, legislators, and medical associations.
Comparing the frustration felt by doctors with that of people who feel that they are not being heard by their government, Breen notes that populist movements, whether they are disparaged or commended, are based on sharp distinctions between “everyday people” and “elites.”
“The perception of corruption, opacity, and technocratic complexity leads adherents to challenge a rigged system tilted in favor of those who make the rules at the expense of everyone else. This alienation thus undermines the legitimacy of established institutions of governance and order,” he writes in the commentary, “Primary Care Burnout and Populist Discontent
One signal of this discontent, Breen says, is growing interest in an alternative payment model called direct primary care (DPC), in which providers forgo insurance arrangements in favor of monthly payments from patients, with whom they can then spend more time. (DPC is different from concierge practices, which may still bill insurance companies in addition to collecting fees from patients for an enhanced level of service.)
By rebuffing all payers, DPC physicians also remove themselves from some administrative burdens, Breen notes.
Failure of healthcare leaders to do more than tweak work environments with stress-relief initiatives or similar marginal efforts to tackle burnout will only fuel the growing discontent among primary care doctors, who may in turn remove themselves from the established medical system by continuing to set up DPC arrangements, create alternatives, or seek early retirement, Breen warns.
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