Continuing my discussion of the findings in our recently published study on the ways family physicians deliver better care at a lower cost than a multi-ologist model, today I will talk about how family physicians deliver care at lower cost facilities. I think I’ll make this post on the cost-effectiveness of family physicians the last one of the series.
This source of efficiency has a little to do with the judgment family physicians exercise compared to ER docs and many urgent care doctors. It also is very practical: clinic fees are lower than currently-allowed ER or urgent care fees.
I think most lay people don’t realize this, but there are very few emergencies in emergency rooms. By emergency, I mean new symptoms or injuries that have a reasonable risk of causing loss of life or limb if not addressed within a few hours. The truth is that the majority of ER visits could have been managed in a well supported family medicine center.
And by well supported, I mean ambulatory facilities that can perform basic lab work, basic x-rays, give IV treatments, cast and splint injuries and fractures, etc. The problem is that family physicians have no incentives to provide these services. ERs and urgent cares are allowed to charge extra to all patients because of these services, but family physicians are not.
This issue is not just a U.S. problem. Debates are ongoing around the world about the limited amount of time family physicians provide out-of-hours coverage. Recent commentary in England shows that after-hours call center nurses tell many patients to just go to the ER with all but the most mild symptoms, which has backed up the ERs there and significantly increased ER volumes.
The value family physicians bring to all encounters in all facilities is judgment. The kind of judgment I’ve talked about in many of the previous posts. Until payers are willing to appreciate this talent and value it appropriately, patients with urgent and non-urgent needs outside of the M-F 9-5 window will continue to receive overly-priced spotty care that costs everyone too much.
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