Specialists can learn from PCP counterparts
Become indispensable to patients, PCPs
By Elizabeth Gallup, MD, JD, MBA
Every specialist I know is sick and tired of hearing how primary care physicians are going to take over the world. The specialists see those types of predictions in their specialty newspapers and journals, and even in The Wall Street Journal. However, being sick of hearing about something does not insulate specialists from the fact that it may be true and that they can and should do something about it.
Specialists can learn from their primary care physician counterparts to recreate some of the reasons that have propelled them to the top of the hill as physicians. The big thing that primary care physicians have is their indispensability.
Why are they indispensable? Primary care physicians are indispensable because of their relationships with the patient. Patients see primary care physicians far more often than they see specialists. Patients have long-standing relationships with primary care physicians, while they usually see specialists on an episodic basis.
This makes a primary care physician panel of sufficiently large size and high quality a valuable tool for health plans to use in marketing themselves to employers, the real buyers of most health care. So the payers spend a great deal of time and effort courting primary care physicians to join their panels. Quite often, this courting results in a better contract rate for primary care physicians who organize and contract as a group. The payers, in large measure, do not like paying these primary care physicians a more appropriate reimbursement rate, but they have to. If they did not, chances are they would lose the PCPs, which might result in the payers losing a contract with an employer.
So if specialists desire a future as bright as the one primary care physicians seem to have, then the key question is, "How do I become indispensable?"
Thankfully, there are many ways for a specialist, no matter what the field is, to become indispensable. First, the specialist can develop an indispensable relationship with his or her patients. This is especially true for those specialists who care for patients with chronic diseases, such as cardiologists, oncologists, endocrinologists, pulmonologists, and rheumatologists. More and more payers are permitting their enrollees with chronic diseases to receive their primary care from specialists who specialize in chronic disease states.
Assist your patients in writing letters to their insurers and employers delineating why it is in everyone’s best interest that they receive continuing care from you without having to go to a primary care physician first. Your argument will be greatly assisted if it is supported with data demonstrating that you deliver high-quality and cost-effective care.
The second thing to do is to make yourself indispensable to your primary care colleagues. If it is the primary care physicians that have the clout, hang on to their coattails and use their clout.
I know of several instances where this has worked well for specialists. In one instance, a large hospital system decided it would coalesce all the pathology departments in seven different hospitals into one and fire half of the pathologists. The primary care physicians said that if that happened, they would take their patients to a competing hospital. The consolidation plan was scrapped.
In addition, primary care physician organizations often prefer to choose their own referral specialists and not have their referral network chosen by the payers. By making yourself indispensable to the primary care physicians, they often will stand up and fight for you. What they are really fighting for is better patient care. They know that when they use specialists with whom they have a long-standing relationship, and who have demonstrated high quality and cost-effective results, their patients will fare better than if they are forced to use only specialists of the payer’s choosing.
Another way to make yourself indispensable to primary care physicians is to figure out how to price yourself on a capitated basis or otherwise share risk with them. Primary care physicians, with their specialty colleagues, are trying to organize and acquire as much risk as possible from the payers. If you can work with them to acquire and manage that risk, you become indispensable. I know of instances where a group of primary care physicians changed their allegiance from one single-specialty group to another because the second group knew how to manage risk.
In short, explore any and all ways to make yourself indispensable. Like most things in medicine, to be indispensable requires that you be clinically excellent and have good communication skills. In this arena, it will also be of great importance to either have business skills or have access to an administrator who can assist you.
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