David Jones is a primary care provider in McLean, Va. He spends most of his days doing that you would expect, seeing patients for office visits and making referrals to specialists.
A few months ago, Jones did something you might not expect at all: He retained a research firm to poll Washington-area patients and find out what exactly they think about the primary care they receive.
Jones only opened his own practice last April, Principal Medical Group. He's still trying to understand what patients want, where their current health-care experience may be lacking.
Patients, it turned out, want a lot. "It ended up being pretty abysmal," Jones told me of the survey results, which he just got back.
Forty-three percent of those who did not have a regular wellness visit reported not doing so because there was no time in their doctor's schedule.
"I find it appalling that many doctors don't know their patients," Jones says. "At the same time, it's understandable. They have to run a business and sometimes that means seeing four patients in an hour. It's hard to get to know your patients in a setting like that."
In a decent number of cases, patients did not even bother going to their primary care providers: 31 percent said that their specialist could provide the same care. This lines up with a national study published this month, in the Archives of Internal Medicine, finding that 41 percent of primary care to be delivered by specialty doctors.
"Let's say you've had a heart attack, you're 50 and have no other medical issues," says Jones. "Often times that patient will deem the cardiologist their doctor, and see them for general things. The cardiologist doesn't want to alienate the patient, so they go along with it."
From a patient's perspective, he can see why heading to the cardiologist becomes the most appealing option. "If you've gone to your doctor a few times, and get a referral out, you get fed up," Jones says. "In a traditional payment structure, you don't always have time to ask more than a couple of questions. It's easier to refer out than make a diagnosis.
Jones continues, "Are they getting the care they need, and is it costing the system more? Absolutely."
For his part, Jones hopes that his clinic will give him more flexibility to see patients at greater length. He offers a concierge-style office: Patients pay a $2,000 membership fee to essentially have Jones on call around the clock.
Those membership fees give him a financial cushion, so he does not face as much pressure to churn through appointments. He aims to see about six to 10 patients each day and, if he can treat their problems at his clinic, take the time to do so.
"If I have someone with knee pain, 95 percent of the time they won't need surgery, they'll just need physical therapy," Jones says. "If you don't do the proper work up, you might just refer out to an orthopedic surgeon. Then he'll end up referring out to a physical therapist. What patients like about what I'm able to do, is I can do the work-up, and get them directly to a physical therapist."
Jones is happy with his practice; he likes the time it gives him to get to know his patients. At the same time, he realizes it isn't a full solution to the health-care system's woes. The membership fee can, for many, make his services out of reach. "For a select group of patients, this is what works," he says. "We can be all the things they want their primary care doctor to be."