Dr. John Dunn: An emergency care perspective on primary care and what needs to change

This commentary is from John Dunn, MD, Jeffersonville resident and physician at UVM Urgent Care Center. He practiced in Vermont for about 30 years.

Dr. Fay Homan wrote an excellent commentary that appeared here Dec. 1 about the need for more primary care here in Vermont.

At UVM Urgent Care Center, I see people every day who use our facilities because they don’t have a primary care provider or their provider can’t see them for weeks. We often provide patients with a list of primary care practices that would accept new patients, but many will try every name on the list without success.

After 20 years of practicing emergency medicine, I decided to try my hand at primary care, to try to “keep my patients out of the emergency room”. I worked with a small family medicine group and then ran my own practice for several years. I was seeing about 12 patients a day, to allow time for phone calls and paperwork, arguments with insurance companies, etc. I made house calls, was on call for my patients 24/7, and performed all office procedures such as sutures, joint injections, EKGs, etc. that Dr. Homan mentioned.

The problem? After three years of practice, my gross salary was $60,000 per year without benefits. Subtract taxes, retirement, and health insurance, and you can imagine what’s left. As I approached my 60s I needed to do something else so I closed my doors and joined UVM Urgent Care which has been great for me and an important safety net for a lot of people who don’t. do not have access to easily accessible health care.

Granted, I could have increased my daily solo patient count to 20 or more, or moved to a concierge model, charging patients an annual fee, but I didn’t think that was right for me.

Dr. Homan is right: we need more primary care. Honestly though, many have said this for decades, and not much has changed for the better.

Most primary care providers work long hours and spend an inordinate amount of time filling out forms and applying or fighting with insurance companies, for less pay than most of their colleagues.

To “bring more emphasis on preventative care and chronic disease management,” according to the head of the Green Mountain Care Board, we need to pay primary care providers better and reduce their administrative burden. More time with patients and less on computers.

If I can “Buy now with one click”, why can’t I complete a note about my patient, click “Done”, have the visit code, billing and any other data needed go directly to the insurance company and see the payment At the end of the day?

Making such changes means a major overhaul of our systems. Higher payments for primary care should come from somewhere, and who will give up a piece of the pie? Insurance, pharmaceutical and device manufacturing executives, hospital administrators, higher paid providers and others? Our patients are paying far too much like this.

Unless we as a society are prepared to force change on all “actors” and redirect resources, primary care will become a thing of the past.