Portland Direct Primary Care
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Beyond 7 minutes

I trained as a Family Doctor so that I would be ready to help patients with any challenge. The old school family doc used to take that skill set out into the community on house calls, sports sidelines, and town hall meetings. At some point the job description was boiled down into a job that started and ended with a 7 minute office visit. That setup is not good for patients, and it's not good for doctors. In this column I hope to start to push the boundary of where the doctor patient interaction takes place - onto the page, into the community, and beyond 7 minutes.

Better health, stronger work force

The big economic news story of the last month has been the shortage of workers. As people become vaccinated and start to resume normal activities businesses are becoming busier. Many of these businesses had to cut back worker hours, or in some cases even close during the pandemic. Now that restrictions are easing, commerce is becoming feasible again with one missing piece; workers. 

Although unemployment is relatively low, many employers are reporting that they are unable to fill job vacancies. There are different views on why this may be. Economists speculate that low wages could be a deterrent to people going back to work. Others think that unemployment benefits, which were increased early in the pandemic, may make it less likely for people to enter the labor market. Others cite continued health concerns with COVID exposure being exponentially higher in front line and service industry workers. The true story is likely some combination of all of the above. 

In medicine we first look for a diagnosis before we can recommend a treatment. If the diagnosis above is correct, what is the treatment? One opportunity could be to incentivise return to work by making employment more attractive. Historically benefits such as health insurance, retirement plans, and paid time off were used to attract workers. Unfortunately in the low margin sectors where workers are most likely to be scarce there is typically not a budget to offer a robust benefit package. For a business to offer even the most meager health insurance they must often dedicate 20% of their overhead for a service the workers may never use.

This is where low cost, high value health care options come in. Increasingly small businesses are turning towards local doctors who offer health care services for a fixed fee. In our area the New England Direct Primary Care Alliance (https://www.nedpca.org/) is one such organization. I joined the NEDPCA in 2018 when I opened my practice in South Portland. By contracting directly with a doctor or a group of doctors a company can offer health care access for a fraction of the cost of what it might take to offer an insurance plan. In addition to keeping spending local, this service also offers a benefit employees are more likely to use and therefore appreciate. It makes sense that worker retention not only saves businesses money but leads to better worker satisfaction. From a doctor perspective working together with other independent local doctors allows us increased bargaining power to negotiate great deals for our patients on things like labs, meds and imaging. 

As we progress through this  pandemic an investment in health care may be the solution we need to rebuild a happy healthy workforce and re-open businesses. Looking beyond traditional insurance may be a way smaller businesses can invest in their workers and attract employees without going over budget or wasting money.

Oren Gersten, MD