A combination of reimbursement challenges and medical education gaps have affected the physician and patient relationship, Brett Shore, MD, said.
Dr. Shore, of Newport Beach, Calif.-based DISC Sports and Spine, joined "Becker's Spine and Orthopedic Podcast" to discuss these factors and how he is thinking about the larger healthcare landscape.
Note: This is an edited excerpt. Listen to the full conversation here.
Question: Based on your experience, how has the patient provider dynamic changed over time?
Dr. Brett Shore: Due to decreased reimbursements and increased healthcare costs, one of the things we've seen is the overall amount of time that the patients have with providers has gone down, and as a result, the use of physician extenders has increased. Now in some ways, this is not necessarily a bad thing, but it does decrease the amount of trust and relationship that has developed between patients and physicians. Unfortunately, as reimbursements continue to go down and the volume of patients required to maintain a thriving and efficient practice increases, this will only continue to become a problem.
Q: In recent years, people have become more interested in improving their overall health. But it seems like with social media and the likes, people are feeling more comfortable taking matters into their own hands rather than seeking out professional opinions. Why do you think that is?
BS: One of the things that I recall as a medical student … is that areas of wellness, specifically, exercise, diet and sleep, were not really taught or emphasized in medical school. Additionally, the development of our modern field of medicine is really a disease-based model, and reimbursement and patient care is really structured based on the illness and injury model. We have ICD codes for illness and injury. We have CPT codes for treatments and procedures. But there really isn't a straightforward way to bill or to maintain a thriving practice by focusing on maintaining the patient's health and wellness. I think patients realize this, and they realize that physicians both don't necessarily have the training or time and also the structure of medicine is really not set up in such a way that we're always the best people to focus on health and wellness. There's an increase in the amount of literature that has been published in the last 15 to 20 years on the importance of sleep, diet and exercise in a patient's health and longevity. Patients are aware of this and are not getting this information from their physicians. So as a result, I think they're understandably seeking it out on their own.
Q: Looking ahead, if the macroeconomic challenges of healthcare do not change, how do you anticipate that industry will evolve? Do you think it'll turn more into a consumer based service rather than a personal one?
BS: This is one of the big questions that I think everyone's trying to sort out in the healthcare space. I think there will probably be a trend towards larger organizations, which we've already seen. Larger organizations have the ability to spread out the costs of bureaucratic maintenance of healthcare practices, and that will likely advantage larger groups over individual practices. But it will open the door potentially for some sorts of hybrid models that allow for some physician autonomy within the group, but they also have some element of back office staff that allows for dealing with the increased amount of paperwork and other things associated with the macroeconomic challenges. Additionally, one of the things that has also been happening already is a greater shift of cost to patients. More and more of the costs are being shifted to out of pocket things and to the consumers themselves, rather than to either the insurance companies or to the other healthcare organizations.