“The ones you leave behind …”
That phrase often connotes loved ones who have lost a family member, friend or colleague through death.
I have thought of the same phrase often lately in a different context — one of increasing prevalence.
Here, I refer to the patients and colleagues left behind by the loss of a primary physician.
No one would begrudge the retirement of a physician who has served his or her patients over a long career. Your retirement is well-earned, and you deserve to enjoy it to its fullest.
Certainly, there are times when a physician must relocate or, for a multitude of reasons, can no longer continue in a current practice environment.
With some hesitation, I can understand why a primary care physician may decide to limit practice to a narrower scope — to avoid feeling like a jack of all trades and master of none.
The following request is to the physicians who make the choice to enter direct primary care or concierge medicine.
You may have practiced in the Golden Age of physician-led medicine, before you were judged and paid for things out of your control, things that were not necessarily aligned with patient preferences.
Maybe you didn’t — you may have just heard about the opportunity to practice medicine without outside interference.
You may have attended one of the numerous conferences about these models of care and decided it was a good fit for both you and your patients.
You may have finally given up trying to make ends meet while providing increasingly time-consuming services for payment that didn’t allow you to pay back your student loans.
Maybe you watched your colleagues drive a new car and visit fancy places while you drove your 10-year-old model and worried if you could afford to update a 40-year-old bathroom.
Life is much better now in your new world of primary care. You are able to pay your staff more, enjoy longer visits with your patients and spend less time documenting.
Still, there are the ones you leave behind.
There are patients who can’t afford to pay your monthly or annual fee to have access to your services — the ones whose multigenerational families you knew for many years, the patients whom you previously counseled in the darkest points of their lives.
Now, those patients must start over.
These typically will not be the highly motivated, highly engaged patients. They will be the ones who need you the most, or rather, need you to navigate them to community resources.
They will be the ones who took up the most time in your schedule, the ones who made you groan when they told you all the reasons they couldn’t possibly do what you were suggesting they do to self-manage their condition.
It is a relief not to have so many of those patients anymore.
You no longer have to try to convince them that using Xanax three times a day for years probably isn’t good for them, because now that is the role of the new physician.
You no longer have to spend so much time dealing with how to wean them off the Vicodin that you now suspect is not helping their quality of life and may be causing harm. Someone else will face the negative patient review and failed patient satisfaction performance measure after having this tough risk/benefit discussion with the patient.
You may still have patients who call you all the time, send you an abundance of portal messages requesting advice and call you at night for refills, but it is no longer a panel of thousands.
Your former patients miss you. (I know this because they share this with me.) Maybe they too sensed how overwhelming modern primary care medicine had become for you and they wish you well in your new endeavor. They probably aren’t aware of how much you wanted to stop getting Press Ganey survey responses detailing that you spend too much time on a computer in the exam room, or how much time you still spent doing work after hours.
That’s where your old colleagues become the ones left behind.
Their panels grow with your former patients clamoring with little notice to get an appointment to meet the new physician who will refill all those medications.
Their existing patients will become frustrated with no longer being able to get an appointment and they will spend part of each visit complaining about this with their physician who never seems to have time for them anymore. Their front desks and call centers will lose morale dealing with a barrage of calls and complaints about lack of access to primary care, because unfortunately the physicians left behind cannot create an additional day per week to take care of hundreds of new patients.
I suspect you can already acknowledge that there was a ripple effect to your community when you made that difficult choice to say goodbye, and that you simply did what you had to do to remain in the calling you chose. Your mental health or life may have depended on it.
Those of us left behind have made the choice to work within the system and stick with it for the long haul to make it better — to advocate for our patients through our leadership and advocate for ourselves that primary care is valuable.
We’re still here and we miss you.
So with your newfound time and resources, those of us left behind beseech you to use it to help us, too.
Spend some time at your state house talking to your legislators about the value of primary care, the need for electronic records to put the focus back on the patient and the money wasted on enforcing measures of dubious quality.
Get yourself on the Ellen DeGeneres show and dispel the ridiculous medical advice given on the Goop website and The Doctors.
Let’s all keep giving back until the day we retire.
Someday, will I be one of you too?
Sincerely,
The Ones Left Behind
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