The NEW Marcus Welbys


Maybe the battle is already lost. Over the last thirty years a head-in-the-sand mentality has sucked in and buried an entire profession.

And now here I am, challenging the only thing many older doctors have left: their pride.

But I have to call it as I see it. And what I see every day is more evidence of the further struggles for Primary Care Practitioners (PCPs).

Here are the two latest examples:

The first is a firestorm I naively created on LinkedIn. You may have missed it but last week was Nurse Practitioner Week and I noticed a post with their slogan: “Brains of a doctor: heart of a nurse.” I interpreted this as a knock on the humanity of doctors. I commented simply, “A backhanded slap at physicians.”

(Don’t get me wrong: empathy was never a top priority in my training. In fact it was looked down upon. Empathy, like having a “good bedside manner,” was viewed as the last refuge of a physician who didn’t know his stuff. Still I resented the implication I lacked “heart.” I’m a nice guy…and haven’t doctors been beaten up enough lately?)

I was blindsided, though, when my single sentence pushed a button for dozens of angry NPs. But the point is why it pushed a button:

They angrily misinterpreted my comment as an attack on their brains. I’d been defensive about a doctor’s humanity: but they responded by being even more defensive about a perceived slight to their intelligence. I was barraged with NP stories about their abilities. And how they were tired of condescending doctors like me. While I acknowledged NPs could perform 80% of what doctors did, they insisted they could it all. (To which I replied, “Pride is a good thing…up to a point.”)

So what’s the point for Primary Care docs? Namely that NPs just can’t wait to largely take your place. They smell blood and they are all too ready to push you further into a corner. Many, to my surprise, view it as payback for past abuses. (Yet more karmic retribution for a history of condescending behavior.)

All of which brings me to my second ominous sign: this week Walgreens opened its first pilot optical boutique in a Chicago store. You’ve probably seen similar specialty areas in Costco, Wal-Mart, and other box stores. But here’s the difference: I see Walgreens every two blocks! And their game plan is clear: to become the initial access point for vast amounts of primary care.

Consulting group Accenture predicts the number of retail clinics in the U.S. will double to 2,815 from 2014 levels by 2017. Also that one in three consumers will have visited one. All those clinics, of course, all be staffed by independent NPs (perhaps backed up by a telehealth line to a PCP’s office.).

Those clinics will thrive, driven by convenience, higher insurance deductibles, increasing co-payments, and large numbers of young people who’ve rejected insurance entirely. (Some advice: buy stock in Walgreens.)

More important is some bottom line advice for Primary Care Practitioners. You’re about to become even more expendable…and that means even more abused.

But there’s also good news. The problem for PCP’s isn’t your inherent value: it’s your role. Your unique skills and seven years of knowledge equity give you value: but your current day-to-day role does not.

Giving yourself value means changing that role to focus on what makes you unique. It means embracing a new mindset and a new set of responsibilities. In responding to my LinkedIn comment a Physician Assistant (similar but not identical to an NP) named Ann Marie Strong described that new role better than I could. She wrote in her clinic she handles most patients but:

“Our MDs see patients we refer to them (complex patients typically) and they see fewer patients in a day allowing them to be available for questions from us as well as helping the RNs who work on the phones. Our RNs have robust standing orders and can treat simple problems on their own when they fall within protocol. Everyone works at the top of their license.”

This is the future for PCPs. I’d bet the mortgage on it. And is it that bad to see fewer patients, leverage your skills as a team leader, and finally function at “the top of your license?”

Change means learning new skills, raising your EQ, and perhaps even accepting financial risk for your patients’ outcomes. Scary. But better to embrace these changes now….than to be dragged yet again into the future.


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