Are you pushing back against the patient portal? In Direct Primary Care, we say – Lean In!

I recently read a piece titled “Death by Patient Portal” by Dr. Michael Stillman. In the article, Dr. Stillman outlines how responding to his patient portal messages ultimately led him to burn-out and despair. He was completely overwhelmed by the messages, and it was taking a toll on his joy in practicing medicine.

This is a scenario I know all too well. While I worked in insurance-based, corporate medicine, the patient portal was also the death of me. The patient portal is a convenient way for patients to access their physician and get advice on medical topics. At face value, the patient portal should be one of the greatest tools we can leverage as we move into the future of medicine. Instead, it is a burden and a drag on physicians, who are still stuck in Insurance-based/corporate systems.

Ultimately, the problem is not the patient portal. The problem is that the structure of insurance-based primary care does not incentivize use of a patient portal. Under insurance-based care, clinicians are best reimbursed (meaning the best way to get paid by caring for patients) is an office visit. Most portal message responses are not paid for, so it becomes a mountain of uncompensated work that an already burdened primary care physician must handle – of course it would lean to burnout!

Now that we are facing an ever-growing shortage of primary care physicians, portal messages are only increasing. Even when patients try to “play by the rules” and make an appointment to handle their issues, they are met with impossible wait times of months to even a year before they are able to see their physician. The patients lack access. Patients then resort to finding other ways to reach their physician to get their needs met – this is where the portal serves them best. Rather than waiting months for an appointment – the patient can just message the physician and get a response within a reasonable time frame – hours or maybe a few days. What’s more, is that they can do this for free! Why wouldn’t they use the portal?

Instead of finding a way to leverage technology to improve patient access, insurance-based medicine fails patients and physicians alike. In Dr. Stillman’s case, he put up barriers to limit how patients can access him. The Mayo Clinic has responded by charging patients for their messages (I still wonder if the physicians see any of the money these institutions collect for the portal messages – Mayo Docs, report back please!!!)

This is where Direct Primary Care scores another point in patient value. Contact with your physician and portal messages are all included in your periodic membership fee! Instead of having to see patients all day in the office just to generate revenue (no matter how small the issue), and answering portal messages all night and weekend, DPC docs bake in the time to respond to your messages! In many DPC practices, our patients call, text and portal message us – and it no problem, because the care is pre-paid! In Direct Primary Care, we use in-office visits appropriately. If we need to examine you to diagnose your complaint, then, of course, you should come to the office. However, forcing you to come in to talk about a slightly abnormal lab value that does not require a change in care is simply asinine. This type of scenario is perfectly appropriate to handle by the portal, and we don’t mind doing it.

Bundling healthcare services has been shown to reduce costs and inspire innovation and healthcare. The periodic membership fee that direct primary care is built upon is an example of a bundled service. Rather than follow a fee-for-service model to nickel-and-dime our patients, we can right-size our fees to deliver optimal care with price transparency. It’s a win-win for doctors and patients alike.

So, when insurance-based care pushes against the value of the patient portal, in direct primary care, we say, lean in!