Is the role of the traditional primary care physician becoming obsolete?

Bambi Francisco Roizen · May 10, 2019 · Short URL:

Future of Clinics Week1 - who is the 21st Century doctor? Startups reinventing clinics

Archana and I are hosting our next salon at the end of June. As we did last year, we're dedicating one salon to the future of clinics, whether it's at a traditional brick-and-mortar location or at home. It's basically the care provided when a patient meets the doctor or caregiver or some health service. 

In the old days, the doctor came to see us. The doctor knew all our medical history. In the late 20th century, we would visit them at their clinic, or at the hospital. Today, where we see the doctor is changing. Their role is changing as well. 

So what does that future look like? We'll discuss at our Future of Clinics event, hosted by HP and Vator. Join us on June 26 at HP headquarters for an intimate, round-table discussion where we engage our audience. Use "Vatorweekly" as a discount code.

Between now and then, check in with my weekly roundup for some relevant news on this topic.

Startups at the front lines of shaping our clinics

My colleague Steve Loeb did a nice job curating a bunch of the new players in the field of clinics. He gives a brief description on their offering, whether they have a physical location and how much they cost. What you'll find is that many of these new brick-and-mortar clinics are membership-based, such as Forward, One Medical, and Parsley Health. Many are focused on a more holistic approach, such as Crossover Health, which makes available a nutritionist, mental health therapist and physical therapist in the same room. Some are far more extreme in their intent to redesign traditional medical healing. This new clinic, I will call it clinic because it does provide healing, is The Well in Manhattan, which (from the photos) looks like you've entered a swanky spa and gym, with guided service to your guru of choice. The Well has "practitioners" that cover alternative medicines from "functional medicine" to "Chinese medicine" to food as medicine. As someone who believes medications are being prescribed like candy, I love this place as it emphasizes that our minds and bodies can heal themselves. 

The other trend is at-home care. Upstarts like Heal are now making house calls more commonplace. Heal is covered by these insurers: Medicare, Aetna, Cigna, Anthem and UnitedHealth. If you're not covered by those insurers, or you don't have any insurance, you can pay $99 a visit.  

Read more.

Why so many primary care doctors are closing their doors


I'm sure many people were thinking this, but it was Vinod Khosla who managed to say it loud enough. Back in 2012, he said that 80 percent of doctors would be replaced. What he meant was that some of their jobs would be replaced by robots and machines. Indeed, in this do-it-yourself-information-accessible world, it's obvious people are relying less on advice from their doctors and more on self-diagnosis. And that information they're requesting is also providing input into some data-gathering software (Google, Alexa, future robot nurse) that's knowing a ton about people's medical history. 

The author points out that office visits to PCPs declined 18 percent over a four-year-period for adults under 65. But office visits to practitioners and assistants more than doubled, according to Health Care Cost Institute.  

He gives these economic reasons:

More employer-sponsored health plans enabling people to go directly to specialists. Fewer family doctors as more medical students select other higher-paying jobs that yield salaries that are 50 percent higher to 3X. Many doctors transitioning to work for more concierge services. 

Read more at MarketWatch  

Dr. Carroll on Walgreen's Healthcare Neighborhood strategy


The MarketWatch article also pointed to Walgreens announcement last month that it will start running primary-care physician services inside some of their retail stores. Walgreens is partnering with Village Medical to open up facilities that are 2500 square ft. They will be next to Walgreens and called: Village Medical at Walgreens.

Dr. Patrick Carroll, Walgreen's Chief Medical Officer, spoke at our last Future of Clinics in 2018 and shared why Walgreens is expanding its scope of care as part of its "Healthcare Neighborhood" strategy. Within this strategy, Walgreens has opened up "about 15 urgent cares around the country because we see urgent care as a lot of value in terms of an access point. They literally can take care of 95 percent of the conditions that come through their door. Great access points, particularly the three that we set up in rural and semi-rural communities. It is a fundamental access point to care in that community. We’ve also set up lab services in our stores, hearing, vision services, a really robust virtual health offering, including a partnership with New York Presbyterian where in out Duane Reed stores there are tele-health kiosks that connect to an EU group run by New York Presbyterian physicians. So we really look at creating a healthcare neighborhood that allows an access point to care and really trying to push that retail health model in collaboration with our partnerships to go beyond those 30 diagnoses, because we have to get into chronic disease management in the retail health space to really make an impact.”

It's time to fire your doctor

I have a presentation I give at the Money Show titled: Innovations driving healthy returns. If you're at the Las Vegas Money Show, come say hi! One point I've made in the last couple years (the presentation evolves but that point remains the same) is that data is the new doctor. In my slides, I used to have Skynet, the fictional AI, neural-network system. Now I just use one big database image (see above), which essentially illustrates the move toward AI doing a ton of the screening and diagnostic work and assistants, lab techs, nurses, etc. executing on care.  

Andy Kessler writes something similar in the WSJ Op-Ed pages. Andy outright asks when do we fire our doctors - a great, catchy headline. It's a good read, and definitely underscores the point that today's doctors are being marginalized. 

Read more on WSJ.   

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Bambi Francisco Roizen

Founder and CEO of Vator, a media and research firm for entrepreneurs and investors; Managing Director of Vator Health Fund; Co-Founder of Invent Health; Author and award-winning journalist.

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