There was a time, that a primary care clinic stood out as an essential element of a community. You had a butcher, a general grocer, a hardware store, a post office, a law office, and a doctor’s office. There was the bar, restaurant, theater, and the coffee shop. It was seemingly uncomplicated. A doctor spent years getting trained in a certain skill set, found a market that seemed to have a need, hung up a shingle, and simply practiced their craft.
What makes it so that today, a primary care doctor, family medicine or internist, cannot hang up a shingle and call a clinic their own? In my neighhborhood, there are 6 coffee shops that are within a 10 minute walk from my house. One would think that with one or two alone, the market is adequately saturated. Yet, there they are, each with their own take on what a coffee shop should be.
The case for the small clinic
Centralization creates single points of failure. My belief is that this applies to healthcare like it applies to the food chain, and other domains.
What is the need for a healthcare group to have all of their hundreds, or even thousands of physicians, ideologically aligned? In my view, community needs are as unique as individual personal needs. Doctors must exist in an environment where they can approach public health problems in unique ways. We used to be trained to familiarize ourselves with the individual, and to understand why perhaps their health concern doesn’t fit a certain pattern.
The failure of public health, and lung cancer is expensive
Smokers don’t care that if they get lung cancer, it is going to be very expensive to treat, much like people who drink 2 liters of Dr. Pepper a day, don’t mind that the rest should foot the bill for Ozempic to treat their Type 2 Diabetes. That is just the real world.
Doctors should not be soldier’s on the frontline of public health initiatives proposed at the scale of a nation or a state. It is more productive to work on the health needs of the individual or small community.
Spending 15 minutes to ask a patient if they have had a mammogram, colonoscopy, pap smear, fallen, feel depressed, live alone, or smoke, has proven to be abysmal to the patient experience. When a patient feels sick, we should talk about why they feel sick. We shouldn’t waste time getting hung up on “social determinants”.
Hanging up the shingle
Physicians need to be empowered to wrest away the power of large groups. Much like the coffee shop and the law firm, we have the power of the free market on our side. We must go back to seeing patients as individuals, with unique personalities, unique flaws. And, us physicians need to approach their needs, their illness, with our individual personalities and expertise. We need to be empowered to take a chance, and hang up a shingle.
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