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Doctor-patient relationships evolving with technology

The nation’s major drugstore chains and other stores are opening more in-store clinics in response to the Affordable Care Act.
The nation’s major drugstore chains and other stores are opening more in-store clinics in response to the Affordable Care Act. Associated Press file

There has always been a certain aura around the provision of medical care. While a doctor offers services in exchange for payment, the doctor-patient relationship goes deeper than a simple transaction. Physicians take on responsibility for people when they are sick and vulnerable.

For this reason, health care historically avoided the commoditization that characterizes other industries. The Wal-Marts of the world crowded out local mom-and-pop shops in retail. Fast-food giants revolutionized the way we eat. The same can be said for media, manufacturing and even farming. The rationale is that consolidation leads to economies of scale that decrease costs and standardize quality for the consumer.

Yet medicine was different. As the business of health care grew more complex in the mid- to late 20th century, doctors fought to maintain their independence as solo practitioners. The focus remained on customized care.

That’s now changing. Physicians have moved from a private practice model to one in which they are employed. An Accenture report found that the number of independent physicians dropped from 57 percent in 2000 to 39 percent in 2012. Meanwhile, physician recruiting data from Merritt Hawkins shows that the number of physician searches by hospitals grew by almost 500 percent between 2004 and 2013. Hospitals themselves are consolidating into large health systems that serve millions instead of just one community.

There are several reasons for these changes. For instance, the administrative burdens of maintaining a practice have increased exponentially over time. Health systems can improve efficiency by coordinating back-office services like billing, thus letting caregivers focus on patients.

The pros and cons of health care consolidation remain hotly contested. On one hand, it may fulfill its promise of lower costs, and standardized metrics can improve quality. On the other hand, targeting medicine to population parameters may lead to cookie-cutter medicine that loses sight of what’s best for individual patients.

Regardless, discussions around the causes and consequences of consolidation often miss an important point. The commoditization of health care is not a debate; it’s an inevitability. Patients have embraced a new mentality in interacting with health care providers that emphasizes “on-demand” care.

A recent survey by The Advisory Board Company found that patients prioritize convenience when accessing primary care, placing it above provider continuity and credentials. New delivery models give patients that convenience. Telemedicine is one of the most popular approaches, whereby providers offer remote care using email, videoconferencing and other technologies. Another is retail health clinics, walk-in clinics in retail outlets. They are typically staffed by nurse practitioners or physician assistants, and can treat patients for minor complaints.

Large health systems like Kaiser Permanente and Sutter Health have the size and technological capacity to implement these models in a way that individual physicians cannot. What’s more, they have the ability to maintain continuity of care with integrated electronic health records.

These trends will only intensify. In the next 20 to 30 years, I expect primary care as we know it to disappear. Patients will no longer schedule a doctor’s appointment when they have a medical complaint. Instead, they will be screened and often treated away from the office setting.

To use a retail analogy, getting a physical will be as easy as walking in to Wal-Mart. An Amazon equivalent will let patients address many conditions online. Complicated cases will be referred to specialists. PCPs employed by health systems will take on a new role as health care managers who oversee these services, coordinate preventive efforts and focus their clinical time on patients with complex chronic conditions.

The rise of health systems has changed the nature of medical practice. Providers and patients will always have a unique relationship, but that relationship is evolving. This is an opportunity to create a system that better meets patients’ needs.

Akhilesh Pathipati is a Stanford medical student and Harvard graduate who has worked on health initiatives in Massachusetts and California. He is a Sacramento native.

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