The recent news that US retail giant CVS Health will purchase insurance giant Aetna, in part to gain millions of new customers for its prescription drug and primary care businesses, is another ominous sign for patients. Consolidation often limits competition, and when that happens in market-based systems the result, says good research, is often that the cost of health care goes up.
Retail thinking is spreading quickly in health care. It promises greater convenience and speed for delivering basic health care services — but it isn’t what patients really want. Retail thinking views patients as consumers: faceless targets for buying services and products that aren’t always health-related. It’s the thinking behind technology-assisted health care services, like ZocDoc, Amwell, and One Medical, which quickly triage symptoms or serve up medical advice.
There is a physician workforce crisis in primary care, both in the United States and United Kingdom. In the UK, half or more general practice physician training positions have been difficult to fill in certain parts of the country. In the US, the American Association of Medical Colleges estimates that by 2025 there will be a shortfall of between 15,000 and 35,000 primary care physicians nationally.
We live in challenging times for physicians, who are required to do things that are wearing them out and making them feel bad about their jobs. Surveys showing large percentages of doctors burned out, dissatisfied with their work or regretting their career choice point to something deeply psychological that is happening to many doctors—something that should make all of us very concerned.
If there is a single profound thing that has occurred in health care over the past couple of decades, that has neither benefitted patients or the doctors who care for them, nor the health system as a whole, it is the fairly rapid deterioration of the physician-patient relationship as the centerpiece of effective, satisfying, and high quality health care delivery.