The Death of Primary Care

Question: Would Hello Health encourage more doctors to go into primary care?

Jay Parkinson: I think a system like Hello Health could definitely encourage more people to go into primary care, absolutely.  However, for the past at least 10 years, about 5 percent of the doctors have been going into primary care.  Most high performing healthcare systems in the world have about 75 percent primary care doctors and 25 percent specialists.  In America, we're about exactly opposite.  We have 75 percent specialists.  And we're about two generations behind the curve on this one.  So, once Boomers retire or die, primary care is sort of dead with them, which is unfortunate because that's what sort of controls your experience and your health.  That's the person you should be able to depend on.  But right now, specialists are making double, triple, quadruple, as much as primary care doctors, and seeing half as many patients.  So, what's the incentive for doctors to go into primary care?  There's not much.  A system like Hello Health that encourages and pays primary care doctors for communication and pays them more on par with specialists would absolutely work. 

But there are other issues where the medical institutions devalue the art and talent of primary care in exchange for the big bag neurosurgeon and the respect they get. 

Question: What would be the implications of the death of primary care in the U.S.?

Jay Parkinson: I don't know, that's going to be really interesting.  I mean, that's the kind of stuff I'm sort of thinking about right now.  What I think is most interesting about the death of primary care and the rise of the Internet as well, when you think about it, the Internet connecting me with information and connecting me with patients is actually doing something really interesting to the practice of medicine.  You spend about one hour a year with doctors, and about 8,765 without doctors.  So, what does that mean to your life?  Well, doctors aren't the cure all for your health, I mean, you are.  Right.  So, I mean, you’re sort of like the CEO of your body and your doctor is a sort of consultant that you call on every once in a while, right? 

So, that basically means there are a ton of tools that are just now springing up that connect us with good information, that relevant to you as well as connect us with other patients that are having similar problems as you.  So, I hope that the Internet can prevent office visits, especially primary care visits.  And help people take care of themselves better. 

There's tools now, you can connect with doctors via video chat.  I think those tools have serious issues though because nobody really uses video chat with strangers.  And who are the doctors who are on video chat?  Why aren't they seeing patients in their office?  You know?  But I think that there are opportunities to build systems like this. 

The issue is, how do you, when people need a prescription maybe, for say, antibiotics, that can't really be done over the Internet with today's sort of laws and regulations.

Recorded on March 9, 2010

The tools and information on the Internet may be able to help prevent office visits, especially primary care visits.

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