For whatever reason, being 35,000 feet in the air makes me reflective. During one flight, I had a flurry of thoughts, and the reason I decided to get into this whole mess of direct primary care spilled out of me. I want to share it here because if you don’t know why — or you can’t convey why — you’re doing something, what’s the point in doing it?
In line with my desire to have a career that served others, I had the opportunity to do my residency in family medicine at a federally qualified health center in Denver that also served as that metro area’s international refugee intake clinic. We saw people from all walks of life and tended to each and every person in the same way, under the same constraints and system that dominates health care.
As I advanced in my training, more and more patients were added to my schedule. At first, I was expected to see 12 patients in a day. Then it crept to 16, 18, 20 and peaked at 22 at the end of my training. A schedule like that meant I was starting a new patient visit every 20 minutes. If I wanted to place any orders, coordinate care, look up the best medical evidence, seek advice (I was, after all, in training), or simply document the visit, that face-to-face time with the patient was squeezed to 12 minutes or less. This time crunch was further complicated by the fact that more than half of our visits were translated — leaving half the amount of time to realistically care for and communicate with someone.