Imagine you are a primary care physician (PCP), fresh out of school. You've just put in 10+ years of training, and you're ready to officially start your career as a medical provider. Your dream is to provide a high level of care for people in your community, build strong relationships with co-workers, vendors, and patients, continue to build upon your knowledge base, and make great money so that you can support a family.

Sounds awesome, huh?  

Not so fast.

There's a good reason why the US Department of Health and Human Services projects a shortage of over 20,000 PCP's by the year 2020. Interestingly enough, however, there is currently no correlating reduction in the amount of students entering or finishing medical school to support that estimation. This tells us that the market for primary care is expanding, while the supply of providers is not. It seems as though fewer and fewer medical students are interested in primary care.

But why?

There are probably many possible explanations and lots of theories, but one thing is becoming more and more certain: The environment in which most PCPs are forced to work in today does not align with their vision for themselves as a medical provider. The current US healthcare system makes it hard for many PCPs to spend adequate time with patients, which often results in a stressed clinical environment with overworked providers that are usually forced to value patient volume over improved health outcomes.

The good news is that not all clinical practice models suffer from the pitfall of the current reimbursement system, and thousands PCPs nationwide are practicing medicine the way they always imagined that they would. Employer-sponsored medical clinics open new doors for primary care providers for several reasons:

1. Predictable Schedules

Today, the majority of primary care physicians are employed by organizations that rely heavily on patient volume in order to sustain a profitable business model. This isn't necessarily anyone's fault, but more a natural outcome of the current fee-for-service system. Regardless, providers in these organizations are usually asked to work longer hours and often weekends in order to meet patient quotas. Many times this requirement is removed if a provider is particularly strong at meeting their volume, coding, or referral goals. We'll get to those issues in a moment. 

In contrast, most on-site primary care providers spend much more quality time with their patients, often up to 30 minutes (compared to 5-7 minutes on mainstreet). The demand for volume is less intense, which usually has zero correlation with provider incentives. On-site providers go home when the employees go home, which allows the them to achieve a level of work-life balance that rarely exists in traditional clinic models.

2. Healthcare, not "Sickcare"

On-site clinics completely remove the barriers to care that exist in the current healthcare system and which cause many patients to wait until the seriousness of their issues outweigh the hassles of seeing a medical provider. Because on-site clinics are offered to employees at no cost and are located on-site or nearby, patients are more likely to utilize the preventive benefits of primary care. 

As mentioned earlier, because on-site providers don't have a waiting room full of patients, they're allotted more face time and can do more of what they were trained to do: practice preventive healthcare. This means less discussion about flu-symptoms and more discussion about cardiovascular risk markers and positive lifestyle change. 

In addition, many on-site primary care clinics are capable of dispensing medications at no cost to patients, which allows providers to further partner with patients in their efforts for improved health. By dispensing on-site, providers are able to coach patients, ensuring they understand details regarding dosage and the importance of medication compliance.  

3. Less Coding Pressure

On-site primary care providers are typically paid on salary, rather than on a per-claim (volume) basis. Additionally, on-site providers are often graded on health outcomes rather than on referral volumes. The result is less pressure to tack on unnecessary codes, referrals, and expensive diagnostics. This allows the provider to focus on what matters most to their patients: better healthcare. 

That being said, most on-site clinic providers utilize EMRs and traditional coding strategies to manage the health of their patients, as well as the financial expectations of their clients. See The Benefits of Onsite Clinics for more information on how coding helps create huge value within this delivery model. 

4. Incentives Tied to Outcomes

As mentioned before, one of the biggest differences between on-site clinics and fee-for-service practices is how medical providers are incentivized. Though many are in transition as a result of ACA, traditional fee-for-service practices bonus their providers on patient volume, coding averages, and referral type/volume. The negative impact of this approach, both financial and clinical, cannot be overstated.

In contrast, on-site clinic providers are encouraged to produce positive health outcomes by spending more time with each patient looking closely at not only the chief complaint, but lifestyle and medical history as well.

Moreover, in conjunction with on-site clinics, many companies incentivize their employees to participate in a health assessment, disease management programs, or wellness programs. This usually creates higher participation in programs that give on-site primary care clinic providers an opportunity to coach patients toward making meaningful lifestyle changes.

5. Improved Patient-Provider Relationship

Because they're usually given more time and the proper tools, on-site primary care providers are empowered to hyper focus on the specific needs of each individual patient. Naturally, when someone feels like their medical provider truly cares about their personal well-being, they begin to develop a level of trust with them. Trust between a patient and their provider is paramount if positive health outcomes are going to be realized.

This same level of relationship quality is becoming less frequent in the fee-for-service system. Studies show that nowadays, patients simply want to get in and out, and care much less about seeing the same medical provider each time. This behavior negatively impacts the opportunities for chronic disease intervention and proper patient management.