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We discuss the growing challenges within the U.S. health care system, from long wait times and fragmented care to the corporatization of medical services. Our guest, patient advocate Michele Luckenbaugh, shares insights on the lack of continuity in patient care, the rise of urgent care centers, and the strain on both patients and health care professionals. Together, we explore what’s needed to restore trust, prioritize patient care, and support overburdened health care staff.
Michele Luckenbaugh is a patient advocate.
She discusses the KevinMD article, “Why is our health care system going down the drain and no one seems to care?”
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Transcript
Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast. We welcome back Michele Luckenbaugh. She’s a patient advocate. Today’s KevinMD article is “Why Is Our Health Care System Going Down the Drain and No One Seems to Care?” Michele, welcome back to the show.
Michele Luckenbaugh: Thanks, Kevin. It’s great to be back with you again.
Kevin Pho: So tell us, before talking about the article itself, what led you to write this particular one in the first place?
Michele Luckenbaugh: Well, a lot of things kind of gelled together through family and friends, you know, they were informing me that, you know, when a health issue came up, then they would call into their primary care office and then they would be told that, well, I’m sorry, but you’re going to have to wait a month, two months to see your primary care doctor. And obviously, as we’re all aware, sometimes health situations can’t wait that long. We also know that, you know, when it comes to, say, booking an appointment for a specialist, those appointments at this point in time can wait six to eight months or longer. The primary care office informed my friend that, well, if the health situation was, you know, important to them, maybe to go to an urgent care center.
And that’s, you know, all fine and dandy. For one thing, usually at those locations, you are not seeing an M.D. or D.O. You are seeing potentially a nurse practitioner under the guidance maybe of an M.D. But the problem being is that issue at that time may be addressed, and then it’s dropped. Usually there’s, my understanding, a note sent back to the primary care physician informing them that a patient of theirs was seen and the issue addressed. Many times, because of the patient load that that primary care doctor has just keeping up with the day-to-day influx of scheduled patients, they never get back to that patient that made that visit to that urgent care center. And so it’s putting us in a position of disjointed patient care. And so that probably was the basis of it. The pandemic, as we know, caused a lot of tragic situations, deaths, certainly the stress on the health care community that was trying to save lives.
This led to, at the time, many physicians, many of the nursing staff, after the pandemic was over and we are now theoretically in the period of recovery, if they were anywhere close to being near retirement, they left, and that left huge staffing gaps. And as a result, these long delays for a patient to book an appointment are a reality that we have to face.
Now what also entered into it as far as the writing of the article is at the same time, I was seeing many of these corporate health systems undergoing very large and extensive building construction—constructing new multi-floor towers to house, you know, specialty situations such as for cardiology, for surgery, for orthopedics. But yet at the same time, as I said, the basic staffing of the primary care offices is lacking. There’s just not enough doctors at this point in time to fill these positions. And again, that, as I said, adds to the delay in which a patient can be seen at a primary care office. So I figured I had to pick up the pen and paper and write the article.
Kevin Pho: Now, from your perspective as a patient advocate, how do you feel when you call a primary care office or when you hear friends and family call their primary care offices and they say they don’t have anything available in the next few weeks and they have to be seen either in an urgent care or emergency department? From your perspective as a patient, what’s your reaction to that common scenario?
Michele Luckenbaugh: To be honest with you, I get pretty irritated. Now, luckily, at this point in time, that personally has not happened to me. But as I said, it has happened to family members. It has happened to friends of mine. And, you know, one individual suffered a pretty serious situation when he was out of state traveling. And when he came back, he had to have a series of, like, an MRI taken. And when he called in to have that scheduled, it was like a month, month and a half before that process could be done. And as you and I both know, Kevin, there’s a lot in terms of the health of an individual that could certainly go downhill in that time period. So again, it was a motivating force, all of these factors coming to a head. And I said, nope, I got to sit down and try to put these thoughts together.
Kevin Pho: Now, you mentioned the pandemic as one exacerbating factor for this, but what other reasons do you see from your perspective that are leading to this situation where there’s understaffing, where there’s a lack of primary care physicians, and the building of these corporate medical centers? Tell us the underlying reasons you think are leading to these trends.
Michele Luckenbaugh: Well, you know, I’m old enough to know and to date back to the times where, you know, primary care offices were privately owned and operated by the physician. They got to know you on a pretty personal basis. You got to know them. Now, with corporate America having their hand in health care, yes, there are some good points. They have the extra financial, monetary funds available to, you know, to kind of keep up with the latest advances in technology related to health care. But in my opinion, it’s taken somewhat of the personality, the personal care out of the field of health care.
Many, many times—and again, this is the feeling that I’ve not personally gone to urgent care—I know there’s a necessity for them, but you have not really an opportunity to establish an ongoing relationship with a particular physician, because pretty much every time you go into one of those centers, maybe it’s a different individual that you’re seeing. And depending upon how intensive or extensive their medical records, if any, they have of you, unless that patient is willing to provide the background, you know, what do they know about you? But yet at the same time, what’s visible to the communities surrounding these large corporate health systems is money is being spent certainly, but it’s these construction projects which will pull in more income.
I get the feeling, and it’s not just my feeling—I’ve kind of been told this by some of the friends that I have that are involved in health care—that they’re interested in making sure that they are supporting the specialty areas that tend to bring in the large amount of money for services provided, as I referred to earlier, you know, the surgical, orthopedic, cardiology. But again, the primary care field is kind of the little man on the totem pole, and it has been that way for a number of years. I don’t know if I mentioned it today, but I know that I’ve mentioned it previous times I’ve appeared here with you. I consider that to be the foundation stone of medicine.
That’s the first point of contact that a patient has. And when they walk into that door, into that exam room, the impression that they get is, you know, a make-or-break attitude. And these days, more often than not, that physician, if you’re lucky to get an appointment, is so hectic a schedule that he has to deal with, many times doesn’t really center on that interaction between the two of you. He’s inputting, looking up records on the computer, certainly trying to do his best or her best to accommodate the situation you’re in. So, you know, I’ve always had the feeling that many, many times these corporate boards make decisions that aren’t necessarily always in the best interest of the patient. They may be in the best interest of the bottom line of the company or the corporation that they’re running, but not establishing a long and trusting relationship in terms of health care.
Kevin Pho: What about your fellow patients? I talked to some patients and they’re almost resigned to the fact that there are just not enough primary care physicians. They’re used to the turnover. Every time they go to the clinic, they see a new clinician. Do you get a sense from other patients that they really want that single physician to take care of them?
Michele Luckenbaugh: I recall one time when I was going in to have an x-ray, and the tech was telling me just that situation where she said, I had previously gone in a month or two in regards to a health problem that she was having, took the time and effort, the two of them, to give the background of her set of problems that she was experiencing. And then the follow-up appointment that she had was an entirely different health provider that stood in front of her. And she said, you know, that was pretty, pretty annoying that she again had to go through basically and repeat the same information because this now was a new face that was standing before her.
So yeah, it is disheartening for a patient to not really be able to make any sort of a connection. And, you know, I was lucky here in the situation personally; I had my last physician for about 12 years until he recently retired. And the physician who I was then placed under the care of is one that I had gotten to know over those same years. So for me, I’m not running into any major difficulties personally, but it’s all around me. I have family members that every time they book an appointment, it seems they’re seeing a new face. And if they should require, say, two, three months down the line, as you said, there’s a new person in that position. And many times, as you said, it’s not necessarily an M.D. or a D.O.; it’s a nurse practitioner, which I’m not discounting. But as you and I both know, the amount of experience and training involved in those professions varies widely.
So, you know, when I’ve got what I consider to be a serious health condition, I certainly want to have the opportunity to see an M.D. And if you go, Kevin, and I have done that—looking over articles that have been written by physician writers posting back, say, 8 to 10 years—you didn’t really hear or read many disgruntled articles, many blatant complaints as to how their life in health care was going. There’s hardly a day that goes by now, I think you will agree, Kevin, that there’s not an article where a physician or a nurse is saying how rough it is to still continue on in health care. And, you know, in reading over some of the responses to some of the articles, there have been people who are either retired physicians or who are about to be, that come out and say, if you’re thinking about going into primary care, think about something else. So how do you beat that?
Kevin Pho: So what are some things patients can do to advocate for a stronger primary care system? You’re obviously doing your part—you’re writing articles on KevinMD, appearing on this podcast, and ringing the alarm bells—but is there anything patients as a whole can do to help advocate for a stronger primary care system?
Michele Luckenbaugh: I have, in addition to the articles that I’ve submitted to your site, Kevin, submitted similar articles to my local newspapers. I’ve contacted the TV stations in my area, and, you know, I’ve encouraged them. I said, why don’t you have a session where you invite a scattering of physicians from the local area and just discuss how their day-to-day life is being a physician, any issues that they’re experiencing. You know, I, I’m aware of the reticence of physicians to speak directly out, but I think the whole problem now has come to a head.
So I would urge patients to search online for patient advocacy programs. What I think we need—and I was going to make this as my closing message, but might as well point it out now—is there needs to be a combined effort from patients and physicians lobbying for the patient but lobbying for better working conditions for the physician. I have close friends who are involved in the medical field who are doctors, who have come home because, you know, at night when they should be spending time with their family, they’re finishing up patient notes so that they’re, you know, more or less ready to start the next day. And that shouldn’t be the case.
I’ve heard comments written to me in response to some of my articles, this last article, where the physician was complaining about Medicare reimbursements not adequately compensating them for the work they perform with their patients, actually asking my opinion on should the Medicare patient pay the balance of the bill in that case. I can see their point, but, you know, we must realize that Medicare patients, Medicare Advantage patients are those patients that many of them are living on a set amount of money per month—a Social Security check from one month to the next. So I think it’s unfair to necessarily call upon them to make up the balance.
But I do think that both sides, patient and physician—and that’s if we can get physician groups as an entirety to get together; I know that is a task in and of itself—a unified front certainly provides more impetus to having a solution to the problem. And just as other lobbyists do for other groups, such as the pharmaceutical groups, we need such a force to represent the patient and the physician and the nurse. Too much time has passed, in my opinion. I mean, in other words, we had hopes of people, the government, so on and so forth, coming to their senses when they saw things falling away from them, but that has not been the case. So the time is now to take some sort of positive steps before any glimmers of hope just completely, you know, disappear from the horizon.
And many, many physicians have told me in their responses to my article, they feel that that’s already here. And so potentially maybe we’re all going to face one day, you know, our health care is going to be walking up to the big box store and taking a number like you do at a deli counter, getting service by a provider, and us being simply treated as a customer and turning around and walking away from that. And I don’t, I don’t like to accept that as my future as a patient.
Kevin Pho: We’re talking to Michele Luckenbaugh. She’s a patient advocate. Today’s KevinMD article is “Why Is Our Health Care System Going Down a Drain and No One Seems to Care?” Michele, we’ll end with some take-home messages to the KevinMD audience.
Michele Luckenbaugh: Well, I’ve kind of alluded to the majority of it. I’m not going to necessarily put 100 percent of the blame on corporate America, but I’m certain it is responsible for it over the years. They have seemed not to really listen to the complaints coming from their patient base, from their physician base, from their staffing base. So we have no more time to waste, and I know this is a nasty word to bring up, and I don’t know 100 percent all the legalities of it, but I know certain sectors of health care are doing it, and that’s unionization. The voice of the physician and more times than not maybe has been heard, but certainly their requests have not been acted upon.
Unionization in health care isn’t a new idea, but it’s one that’s met with a lot of resistance and concerns, especially when it comes to the implications for patient care. In theory, if done right, it could mean that physicians have a stronger voice when it comes to working conditions, fair compensation, and overall job satisfaction. That, in turn, could potentially lead to better patient care because when a physician isn’t burned out, isn’t overworked, they can focus more on each patient, they have the time to follow up, and they can provide the level of care that initially drew them into the profession.
But on the flip side, unionization brings challenges. There’s the concern that it might introduce conflicts with administration, slow down processes, or bring about strikes, which would disrupt patient care. It would require very careful planning and a unified approach, which, as we know, isn’t easy in the health care field, where opinions and experiences vary so widely. However, I do think it’s time that we start having those conversations, not just among physicians but with patient advocacy groups as well, because if we don’t work together to find solutions, we’re going to continue to see this decline in primary care and patient trust in the system.
Don’t be afraid to ask questions and advocate for yourself and your loved ones. Whether it’s about the quality of care you’re receiving, the wait times, or the type of provider you’re seeing, speak up. Patients have more power than they realize. And if we come together with our health care providers to push for changes—whether through advocacy groups, community discussions, or even just by supporting physicians and nurses in their roles—we can start to shift the system to prioritize long-term patient care over short-term profits.
Thank you again, Kevin, for having me on the show. It’s always a pleasure to share these important conversations with your audience.
