Telemedicine, walk-in clinics cloud role of family doctor

Lisa Love hasn't seen her doctor of 25 years since she discovered telemedicine.

Love tried virtual visits last summer for help with a skin irritation and returned for another minor problem. She doesn't feel a pressing need to seek care the old-fashioned way, especially since she also gets free health screenings at work.

No more waiting for the doctor's office to open. Convenience rules in health care now, where patients can use technology or growing options such as walk-in clinics and urgent care centers to get help whenever they need it.

A survey last year found about a quarter of U.S. adults don't have a regular doctor. Some like Love wonder how much they still need one.

"Telemedicine probably can't do everything ... but for most of the things I might ever have, I'm pretty sure they can take care of it," the Twin Falls, Idaho, resident said.

Health care experts say the changing, fragmented nature of care is precisely why people still need someone who looks out for their overall health, which is the traditional role of primary care physicians like family doctors and internists.

They know patients' medical histories, and they're trained to spot developing problems instead of just addressing symptoms prompting the patient's visit. They also can make sure medications don't conflict with regular prescriptions, and they can help make sense of the information patients dig up with a Google search.

But the nature of primary care is changing as patients branch off to drugstore clinics and urgent-care centers. Practices are slowly shifting to more of a team-based approach focusing on keeping patients healthy and reserving visits with a doctor for the more serious cases.

"The idea that the primary care physician is the one-size-fits-all solution ... that's going to change pretty dramatically," said Sam Glick, an executive with the research firm Oliver Wyman.

This evolution began years ago when drugstores started providing flu shots and opening clinics handling minor issues such as ear infections or pink eye. The two largest chains, CVS Health and Walgreens, now run about 1,500 clinics combined.

More recently, employers have started adding worksite clinics, and thousands of urgent care centers have opened around the country to treat emergencies that are not life-threatening. Then there's telemedicine, which patients can use to connect to a doctor in minutes without leaving their home or office.

Love said she's hooked on virtual visits. They only cost $42, or less than half the price of an office visit under her insurance plan.

"I like technology, and I like new things, and I like saving money," Love said. "It was worth it to me to try it."

About 25% of adults don't have a regular doctor, the not-for-profit Kaiser Family Foundation found last year. That jumps to 45% for those younger than 30.

On top of all the competition for patients, the field also is fighting a shortage of doctors as medical school students opt for higher-paying specialties.

Primary care practices have adjusted by adding physician assistants or nurse practitioners to handle annual physicals and other routine care.

They're also creating teams helping them take a broader look at patient health. Those teams might include mental health specialists who screen for depression and health coaches who can improve diet and exercise.

The idea is to keep patients healthy instead of waiting to treat them after they become sick.

"We want to do as much outside the walls of the clinic as we can," said Stanford University's Dr. Megan Mahoney, noting this push depends on insurers expanding what they will cover.

Doctors also are continuing to focus more on coordinating care for people with complex health needs.

Bryant Campbell's care team includes a primary care doctor, a pharmacist and specialists to help manage his chronic liver condition and rheumatoid arthritis. The Portland, Oregon, man said his team members talk frequently to avoid problems such as duplicate tests, and their approach gives him more confidence.

"I sometimes think as patients we feel isolated in our health care, and this team-based approach helps a patient be as involved as you need or want to be," he said.

Doctors say the expanded scope of their practices is changing how they interact with patients. Dr. Russell Phillips frequently responds to email or cellphone questions from his patients. He also refers them to clinics for minor issues such as urinary tract infections.

The Harvard Medical School professor said primary care is evolving into more of a flowing, virtual relationship where patients have more frequent but briefer contact with their doctor's office instead of just office visits maybe twice a year.

"Getting medical care is such a complex activity that people really need somebody who can advise, guide and coordinate for them," Phillips said. "People still really want a relationship with someone who can do that."