Whose Time is More Valuable?

The article Why an Uber for health care is doomed to fail briefly made me consider tossing the Pre-R towel. But not for long.

“Uber for healthcare” is a catch phrase I hear more and more frequently now. It seems the author of the above article wanted to be the guy to disrupt medicine, as Uber and Lyft have for catching a ride in San Francisco and many other cities.

He started a house calls service in New York City in 2007, and much of what he describes resembles Pre-R. He was more tech oriented and he did more patient scheduling, but many of his motivators were the same. He wanted more time with his patients in the comfort of their homes, and tried to help keep costs for care down.

If you read to the end though, it seems he threw in his towel in part because he was not able to see as many patients, or make as much money as he would have liked. He was spending too much time traveling in cabs as well. Now he feels strongly that primary care doctors need to stay in one place to be as efficient as they can possibly be… to move the most meat. He has moved on to a new medical tech venture called “Sherpaa” which looks interesting too.

In other articles about house calls doctors, concierge doctors, or any other kind of caregiver traveling to patients, the topic of inefficiency seems to be the big gripe. Why would a doctor spend years in training to then spend so much time driving around town (or sitting in NYC cabs) rather than seeing patients? We have a primary caregiver shortage, so they seem to suggest it’s best to put PCPs in one place on the assembly line, and have patients flow on by, whether in person or through telemedicine.

At the core of this inefficiency argument, however, is an assumption that a doctor’s time is more valuable than a patient’s.

Frankly, I disagree. Even numerically, when I visit a patient, it’s just me (or me + Vanessa if the problem seems interesting like a laceration and we have baby care.) When a family sits in a waiting room to be seen, that’s a bunch of people sitting around burning their day, and sometimes catching colds from neighboring patients. They’re plumbers, teachers, policemen who do work every bit as valuable as mine. Cynical readers will think of homeless or patients on welfare, but I’d argue these folks need more time than anyone to claw their way from day to day. Time lost in a waiting room is time not spent getting life back in order.

Plus when I head to peoples’ homes I’m still able to field calls from other patients, many of whom are fine and have simple easily answered questions.

The problem is not that I’m inefficient when driving. The problem is that I’m not optimally monetizing the mother who calls me to ask the right dose of children’s ibuprofen while I’m driving. If she is shoved into a waiting room, or perhaps onto a telemedicine platform, then a system can kick in that turns a 30 second answer into 30 minutes of button clicking, coders, billers and cash, or possibly collections.

The article above threw me for a loop, but ultimately it made me even more committed to our Pre-R model. I can’t speak for healthcare delivery in New York City, but for myself in SLO, inefficiency is a non issue. Pre-R may not do any healthcare disrupting, but for me and V… we’re still in.

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