The Future of Primary Care Physicians

You are listening to Boomers Today with your host Frank Samson. Well, welcome to Boomers Today. I’m your host, Frank Samson. Of course, each week we’re bringing you very important and useful information on issues facing boomers, their parents and other loved ones.

And as I do on each of our shows, I thank all of you, and I thank all of you because our listeners are growing each and every day, and it’s because of you. You’re sharing our show individual podcasts with family and friends. Many of you listen to the show on Apple Podcasts, Spotify, iHeartRadio, Audible, or just ask Alex and Siri to take you to Boomers Today. Some of you go to our website at Boomers Today Radio dot com as well.

So thank you for all that. But I do know why you’re sharing our information with family and friends and business acquaintances, etc. Because we have wonderful guests and certainly not going to disappoint you today at all we have with us. Doctor Adam Solomon.

Doctor Solomon is a physician leader dedicated to patient first care, quality outcomes, and collaborative healthcare partnerships. He practiced for fourteen years in Salem, Oregon, providing the full spectrum of adult care, inpatient and outpatient as part of a multi specialty medical group. He became managing partner for the group, as well as a board member and eventually president of the Independent Physicians Association. He was also president of the Philanthropic Foundation and a trustee on care Mores, which we’ll learn more about Mutual Employers Welfare trust.

He is now based in Los Angeles and responsible for the quality of patient satisfaction and overall outcome. So, doctor Salavin, thank you so much for joining us on Boomers today. Really appreciate it. Thank you, Thank you so much for having me.

Really appreciate being here. Yeah, no, it’s great. You know, I have a bunch of questions for you, but before we start, maybe you could just kind of give us an overview of care More and what they do. Sure.

Well, on the one hand, you can think of can More pretty much as a medical group. We’ve got offices scattered across southern California. We’re also in Arizona, Nevada, and Tennessee, and for the most part, our providers are primary care. We do have some specialists.

What makes us a little unusual is our collaboration with community based providers in an independent provider association as well, where we provide wrap-around support for the patients that are seeing those independent doctors. Our patients are mainly complex seniors, but we also take them beyond Medicare. We also have Medicaid and patients that are in what are called special needs plans, meaning they have chronic conditions or maybe are eligible for both Medicare and Medicaid. The other thing that makes us unique is the composition of the team.

We really practice team based care. Our focus is on keeping patients healthy and out of the hospital through this high touch, whole person approach. So we have care managers, social workers, pharmacists, community health workers, home visiting nurse practitioners. All of them are part of the team really keeping our patients as healthy as we can get and keeping them out of the hospital.

Yeah great, great, So I’d like to get right into it. I mean, and I think we all see it. I certainly see it that. I sometimes I have my prime Mary care physician, and she’s wonderful, but when I see her, I say, you’re an overload, aren’t you, And she goes, it’s crazy, it’s crazy, and she’ll and quite oftense, she’ll apologize to me that she doesn’t get back to me on something or whatever.

I say, you don’t have to apologize, you know. But. Tell us is this going to get any better? Is it just or is it going to get worse before it gets better? I mean, physicians are on overload today. So what do you expect to happen in the short term, long term, et cetera.

Yeah, unfortunately, I think there are a few things that are coming together. One of them is the know your your audience and more. The boomers are getting older. Within just a few years, I think by twenty thirty, they’ll all be over age sixty five all of this and represent about twenty percent of the population.

So that will be the largest proportion of older adults we’ve had in the United States. And that also impacts the physicians that have been doing primary care. They’re getting older and they’re they’re that workforce is starting to shrink. The other part is the new physicians coming out of training and their selections and they’re they’re generally and this has been going on for many years, not been selecting primary care specialties.

And part of that is the way primary care is reimbursed and generally medicine, so healthcare has been in what’s called a fee for service environment. You do something, you could pay for doing that thing, and you’re not necessarily rewarded if you spend more time to keep a person healthy than if you just spend a really little bit of time to fix a problem and move on. And that’s still the way that’s resurgical specialties. It’s easy for them, they do well.

I shouldn’t say it’s easy for them. They they’re doing something that they get paid to do. And for primary care, the biggest thing you’re giving is your time, your attention, listening and helping people to manage their complex conditions or to prevent them from getting sicker. So your time is limited.

But the way that physicians have tried to address that in the past is shortening the time they’re with patients increasing the volume of throughput, and so that is somewhat of a contributor to the burnout because that time spent with people, getting to know them and feeling like you’re really helping them is a big part of the reward why physicians go into primary care in the first place. And then the other part is this administrative burden that they have. This they have to document all of the things that they’ve they’ve done so they can get paid for the work that they’ve done, they have to submit prior authorism requests and do other things that require more of their time and attention, and it pulls them away from that patient care and limits what they can do. And in many cases you can see physicians nowadays spending more time on the administrative tasks than they are on direct patient care.

Again, that contributes to burnout. So one of the directions we’ve taken, and more and more organizations are taking, is to something called value based care, and the idea is to not focus on doing things. An older physician I used to work with said it was making widgets. We’re not making widgets.

We are providing healthcare. And so if we can keep people healthier, keep them out of the hospital, and not have to direct the money towards that, we can use that money for the supportive team that I mentioned earlier. Having those team members collaborating with the physician expands what the physician can do to keep the population healthier and it supports the patient as well. The other thing that I think is helping or hopefully will help more is AI All of that documentation and charting time is just direct input and a lot of physicians have felt like they’re just transcription is typing in notes.

And with AI now you can have the device listen in on the conversation between the patient and the physician and it will transcribe into the note what occurred so that the physician can check it. I just watched one of these doctor shows last night. Yeah, my wife and I. I won’t mention the show, but they did just that they had to get permission from the patient and then they transcribed, and the doctor was showing the staff here, here’s what happens, and they were looking at it, and then they realized there was a medication that they were going to prescribe.

But it it gave the wraw it. It didn’t transcribe it correctly and actually gave a different medication. So it’s not one hundred percent accurate. Of course, Yeah, you have to check it, but it’s I just watched this last night.

It was just amazing. But are a lot of a lot of physicians using this now or is this all new stuff. Over the last year, just like everyone’s been getting used to chat, GPT and so forth. There have been some companies that have been producing these AI agents that work with the electronic health record, and it’s it is a game changer physicians.

We used we would call the work after work pajamaton. Those physicians would spend the day getting through the patients, taking care of things, answering phone calls, looking at that results, and not being able to do all that charting and so then in the evening they would go home and you know, try to see their family, and then they’d be up late doing all of that charting work. And with the AI assistant, it’s really reduced that down. They’ve saved hours, so it’s been a huge boon to a lot of physicians.

The other thing that the AI can do to help is to sort through records, so because you can imagine people can accumulate quite a big file over time, and there are certain important documents or pieces of information that can be buried deep into the chart and you can spend some time trying to find that last study that showed this, or AI can go through and find it and bring it up pretty quickly. But you’re absolutely right, it’s AI is a supplement, it’s a support and aid. We’re not anywhere near on a point where we can kind of turn things over to AI. You have to be vigilant and check on it just to make sure it hasn’t made any funy.

You mentioned just before about working to keep older adults or healthy and out of the hospital. But how do you do that? I mean, how do the doctors have time to even do that? Or is that something that’s going to be additional services from these physician offices or these groups to really be proactive with patients. I mean, how do you do that? I mean, of course you want to keep them out of the hospital, but how do you educate people? Yeah? I think too. There are just a few factors I think play a huge role in helping to keep people healthy and out of the hospital.

So just the starting point is that longitudinal relationship with a primary care physician. If you have a PCP, you get to know them. They get to know you over time, They get to know your history, they know how well you’re doing, and so they can identify if things aren’t quite on track. They also get to know your health priorities, because sometimes the decisions you make around care might vary from one person to the other base and their values and their priorities and so that next step is making sure that those chronic conditions are managed very well and having that additional team.

So having this team based care will bring additional support, so that extra education, that additional contact. Sometimes capacity to be seen, because if you have just a position in an office and their schedule is full and you need to get seen because you’re not doing well. Sometimes people are told I can’t get you in for several days and you need to go to urgent care or emergency room, and that results in some fragmented care. Medications one of the main stays of keeping people healthy and yet also potentially contributors to causing complications, and so making sure the patient is aware what are the medicines that you’re taking, and you take them on an empty stomach, do you take them in the morning, those kinds of things, so that when you’re seeing a specialist or another provider, they are clear on your medications and can prevent any kind of drug interactions of that kind of stuff.

The other thing I think which is gaining attention and is really important are what we call the social determinants of health. These are things that start to impact like they can impact anybody at any point, but there are certain things that tend to impact seniors a little bit more. Are often at an age where they’re losing caregivers, friends and their support. They can become isolated.

Sometimes getting adequate nutrition or even transportation can all impact healthcare. And so working with a team that can surface some of those issues and work with you to identify ways to address those things, that’s that really helps keep people healthier and out of the hospital. Can we go back to AI for a second, because I fascinating, So tell your thoughts on the positives and negatives of AI and the patient’s hands and the patient’s hands. Uh, And I’m on, Hey, I’m a boomer, I’ve got you know, there used to be a day when you know, get together with friends and you know, you talk about your kids and then you talk about your trails.

Now everybody’s talking about their aches and pains. Yeah, and I know just in you know, I don’t have statistics. Maybe you do, if there are such statistics. If there’s statistics out there, But are people using AI and then avoiding the doctor? And maybe that could be a good thing in some cases, but maybe not such a good thing and others.

So what are your thoughts there? Yeah, i’d sink, well, for years now people have been using Google md right. People go on too, and they put in their symptoms and they try to figure out what’s going on with them. And that was definitely the somewhat of a bane of the physician existence because people come in with these really rare or unusual diagnoses that you know, within just a few seconds you could tell were probably a bit off track. But Google is just connecting you with websites, and now AI is putting things forward that sound plausible.

But even in the literature, it’s interesting. Physicians were using chat, GPT and some of those other AI agents to look up information and would find it would hallucinate up articles. AI will always give you an answer, even if the answer isn’t accurate. Most of the time there’s some really good information there, but it’s not precise.

I think people get swayed a little by some of the reports that those AI programs past the boards or you know, pass the bar exam and all that, But there’s quite a bit of difference between passing the test and really understanding what’s an underlying condition that a person has. So it’s it’s if it helps the dialogue, if it helps bring up a conversation. I think that’s great. My concern is when patients get locked into believing the AI over a clinician that’s had training and years of experience, that’s where the things can get te.

Got it, Got it? So, doctor Salmon, we’re going to take a real quick break. I promise just to recognize our sponsor, and we come back, give you the opportunity to tell you share a little bit more about care more and how people can learn more about the great things you’re doing. And then I do want to talk about after the break, kind of the future of maybe the business models of primary care physicians, what we could expect in the near term and in the long term. Okay, so my question to you is do you know anybody who may be concerned about an older driver? While Senior care authorities Beyond Driving with Dignity program is a facilitated self assessment program for older drivers.

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That’s www. Dot beyond Driving with Dignity dot Com to connect with a senior care authority advisor in your area. We are back with doctor Adam Solomon, who’s a physician leader with care More So Doctor Solomon, you know, tell us more commercial time. Go ahead to brag about your organization and what you’d like to share with our listeners.

Sure, thank you. Care More Health has been around for a few decades now with a special focus on seniors senior care, especially seniors with complex medical conditions. Approach is team based care to keep people healthy and out of the hospital. We are in for states and hopefully eventually an arianare you and you can find us online if you just search for care more.

Health Great great, good good good. So you know, what do you see happening with kind of the business models that may you know for primary care business models for in the near term, next generation of clinicians, let’s talk about that. How do you see things changing there. One of the big changes that has been happening over the last decade or so is this consolidation in healthcare.

It is a challenge to come out of medical school where you don’t get any training in business, to hang up a shingle and have your own independent practice. And that part of that is driven by the things we talked about earlier with the financing to support the practice, because it ends up being unsustainable with the volume you would need to see and what kind of outcomes you would have. So most physicians coming out of practice now are joining groups. That group could be part of a hospital system, it could be part of a large medical group, but sometimes it can still be an organized structure like I mentioned earlier, this independent practice association, where you do have offices that collaborate together with support to manage the overall outcomes of a population of patients.

So recognizing where what type of a situation the practice is in that you’re joining it will affect somewhat the kind of experience that you’re going to have. In general, organizations that are tightly tied to hospitals are going to have a hospital bent to them. They hospitals bring on physicians most of the time with the expectation that those physicians are going to do stuff at the hospital because that’s where the hospitals make their money. Provider groups that are more focused on this holistic care, you’ll be able to find them as you look in and talk to those organizations about what is their approach.

Is it a team based approach, is it a value based care approach? And then you’ll note in your experience of their availability and are there team members that are helping to support your care. Those directions tend to support the physicians and make the lifestyle a little bit more sustainable over time. Got it? You know something that came to mind as you were talking. I’ve seen more and heard more about I guess the term has been used the concierge type of physician.

My understanding, I don’t know a whole lot about it, but that’s what I want to learn from you. Where you have this physician that you’re dealing with but may not be covered by insurance and kind of go to this person who is at your that can call in a sense, can you shed some light on that and what kind of trend you see happening there. Yeah, so that actually is a great point. There’s been growth in this concierge model over the last several years, and in one way, it’s solving two different problems.

Patients have been frustrated by these short visits. They don’t get enough time with their provider. They have questions they want to ask, they want access, and some people are willing to pay a fixed fee in addition to their health insurance to have that access in time. And on the physician side, by getting that additional income for their time, they can reduce the size of their panel and not see as many patients because now they’re generating income just based on this revenue model is subscriptable call a subscription model, So it is for those that can afford the additional costs a nice solution.

The problem is it ends up reducing the number of patients that a physician manages, So that’s kind of contributing to this exacerbation of a shortage in the number of doctors in primary care that are available to see patients. And then of course not everybody can afford it. Health insurance is expensive, and so you’re adding an additional cost on top of that health insurance just to have access to the physician. So that’s why this other concept of value based care where it doesn’t cost the patient more.

They’re not paying traditional insurance, but the way that that insurance is deployed gives them a lot of those additional services included in the costs and their insurance. So what’s happening, you know, to try to get more younger physicians going into primary care, even specifically in our field, and geriatricians who specialize with the elderly. What is the education system, what are the schools doing? What’s going on from a marketing standpoint to try to get these young people to consider that as their profession because it’s moving and it seems to be moving in the opposite direction. Yeah, it’s been steadily moving in this direction for quite some time, and it’s a little sad.

The I think the medical schools and the residency programs recognize this as an issue, but they are they haven’t really been able to change that trajectory trajectory dramatically. So the first thing is, coming out of medical school, you decide on your specialty and you could choose a surgical and and it’s broad. Initially you choose a surgical, especially in general, or you choose something that’s a medical, especially internal medicine, family medicine, pediatrics, that kind of thing, and then you go to your residency where you learn the breadth of that at that specialty, and then you get another fork in the road. Many physicians, after spending all of those years through college and medical school and residency, want to get out in practice, but they’ll look at what is that practice going to be, Like, I’ve got loans that I need to pay back.

I want to start making some money and living a lifestyle because your first job, you’re you’re thirty years old as a physician at the earliest. And so that residency experience can help direct those medical specialists towards a subspecialty, so internal medicine. An internal medicine resident might decide to go into cardiology or pulmonology or sub especially like that where they’ve seen that there’s an opportunity to make more money and have a slightly different type of lifestyle. And it used to be that for staying in general internal medicine, you would do both the inpatient care as well as the outpatient care.

So when I was in practice many years ago, would see my patients in the office and if they end up in the hospital, I would take care of them there. And that longitudinal care I think had the best outcomes, but it was really again not super sustainable for a lifetime. And that hospitalist care is now separated, and so those internals that would have previously gone into that combination of care were bifurcated, and many of them were comfortable in the hospital where you have fixed hours and we’re doing that, and that also impacted how many were out primary care. So during the residency, the programs have been enforcing this experience in this longitudinal based care.

So everybody now has an outpatient clinic. If you’re an intramdicine resident family medicine resident, you will have your own panel of patients that you will follow over the course of a few years and get to really experience the reward of the impact that you can have getting to know someone and know that you’ve made a really big difference in their life. That’s helpful, but there probably needs to be more work in training on this sustainability model. What is out there that is an organization that you can join.

What kind of structures are there that you can join where you can continue to practice in that manner and have a sustainable lifestyle over the course of your career. Well, this has been very educational. Maybe just one final question, because unfortunately we’re out of time. I could talk to you for quite a bit more, but I’m sure you’ve got people waiting for you too.

So somebody that’s looking for a primary care physician, all right, Just any recommendations you can give as far as how do you select one, what type of questions to ask, what type of research should you do? Any thoughts there. So I’m a little biased, of course, and I think that having a good primary care physician is probably one of the most important decisions anyone will make. They are not just a guide through healthcare, but they’re you’re confident on. They need to be somebody that you’re very comfortable communicating with.

They need to understand you and help you navigate healthcare in a way that aligns with your priorities, your values. So where do you start Before you get to this practice style and arrangement, you need to find the practice. Oftentimes there’ll be a couple of limitations. One is where’s the practice located.

And then also if your health plan has a specific network, and that will start to narrow things down a little bit. And then if you can learn quite a bit from practice websites on what they value, what’s really important, and calling and asking questions will give you an idea of do they answer the phone, do you get put into a long chain of a telephone tree, or do you get to talk to a person. And then finally, you know, talking to friends or family people that are already getting their care at an office will give you insights into what their experience is like. And then once you have made that initial decision going in and that’s a great time to get your annual wellness visit, to get your initial physical.

You aren’t technically committed yet, you can always change your mind and that will give you an experience of do they listen, do they give you the time, do they address those social issues, do they communicate well? Is there focus on wellness and prevention? Are they aligned? And once you’ve assessed all that, then you’ll you’ll know you’ve got a good primary care provider who’s going to be there for the long term for you. Right, great don Adam Solomon check it out, UH care more help. Thank you so much for joining us that yourself, I really appreciate it. Thank you so much for having us ye.

And thank you everybody for joining us as well. Please be safe. We’ll talk to everybody next week. You’ve been listening to Boomers Today with Frank Sampson.

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